Pregnancy and Birth Control Options After Bariatric Surgeryby Robin Elise Weiss, Ph.D. Health Professional
Birth control can be a sensitive subject for anyone, and women who are considered overweight or obese may face special challenges. And when you’ve had bariatric (weight loss) surgery, there are even more things to consider.
The American College of Obstetricians and Gynecologists (ACOG) has stressed that your body mass index (BMI) should not be a barrier to appropriate health care. Yet, some women who are overweight and obese don’t receive the care they need due to a lack of understanding of best practices or resources — not to mention that bias can play a part in the medical care that these women receive.
Obesity rates have more than doubled since the mid-1980s. In 2017, 36.5 percent of women aged 20-39 were obese, according to the Centers for Disease Control and Prevention (CDC). Obesity contributes to an increase in many health risks for women — and at an increased cost. This means that many women seek care to help lose or manage their weight.
In some cases, women seeking to lose weight may choose to get weight loss surgery. About one-half of the women getting weight loss surgery are of reproductive age. The term “bariatric surgery” includes more than one type of procedure, but the procedures are all designed to help reduce a person’s weight. Which surgery a person gets depends on many factors, including their medical history and their doctor’s preference.
Types of Weight Loss Surgery
There are two common types of bariatric surgery. One involves restriction of the stomach, meaning that the stomach will only be able to hold a small amount of food. This type of surgery includes procedures like the gastric band or lap band surgery. The second type of bariatric surgery interferes with the body’s absorption of nutrients, meaning that your body will not process food in the same manner.
Do I Need Follow-up Care After Weight Loss Surgery?
After surgery, you should receive general follow-up care for your surgery and weight loss. Follow-up should include a team approach, meaning it involves your surgeon, a dietitian, and others who will help you maintain a healthy lifestyle. Part of maintaining that healthy lifestyle may include family planning and birth control.
Why Is Birth Control Important After Weight Loss Surgery?
After surgery, your body will need time to heal. Experts recommend you wait 12-18 months after weight loss surgery to get pregnant. Because your body is in a state of flux and rapid weight loss is occurring during your recovery, pregnancy can have increased risks. These risks include having babies who are born small for gestational age, who are born too soon, or who are more likely to be admitted to the neonatal intensive care unit (NICU).
However, a recent study showed that about 4 percent of women studied were actively trying to become pregnant right after their weight loss surgery, and 42 percent were having unprotected sex right after surgery.
To increase your changes of a healthy pregnancy, it’s smart to wait the recommended amount of time after surgery. You should also have preconceptional health visits and follow your doctor’s guidelines to get healthy before you get pregnant. Working with a dietitian and physician will help you lose weight and get your body to its optimal state of health.
What Are My Options for Birth Control After Weight Loss Surgery?
The good news is that there are many birth control options after weight loss surgery. Each option can be tailored to your personal goals and desires, including a potential pregnancy in the future.
You should discuss specific birth control methods that will work best with your body after surgery with your doctor. For example, many forms of weight loss surgery alter your body’s ability to absorb nutrients, which may hinder the effectiveness of certain birth control methods. For example, birth control pills may not be the best option; this is because birth control pills are absorbed through the digestive system.
Non-oral forms of birth control may be better for people who have undergone weight loss surgery, especially during the critical months right after surgery. One study favored the implant. The CDC recommends that those have had a malabsorption type of surgery steer clear of both combined hormonal birth control pills and progestin-only birth control pills, with no restrictions on other methods.
Despite this recommendation, about 11 percent of women are reportedly still using birth control pills after weight loss surgery.
Following up with a practitioner specializing in women’s health, like an obstetrician or midwife, can be helpful in reducing the pregnancy rates during the first 18 months after bariatric surgery. It can also help you plan for later pregnancy and ensure you are as healthy as possible.
The Bottom Line on Birth Control After Weight Loss Surgery
If you’ve had bariatric surgery or are planning it in the future, be sure to keep your reproductive health in mind. There are certain birth control options that may be limited after surgery, depending on the type of procedure you have. Whether you intend to prevent pregnancy for the short term or long term, there are options that are available to you that will work well even after your choice of surgery.