Reproductive health counseling, menstruation, contraception, and conception after sleeve gastrectomy: a...

Reproductive-aged women constitute a substantial proportion of patients undergoing weight loss procedures. Little is known regarding reproductive health outcomes among women after sleeve gastrectomy (SG).

We aim to explore reproductive health patterns and outcomes after SG.

University hospital.

A cross-sectional study performed among reproductive-aged women who underwent SG at a university hospital. Women were surveyed using a questionnaire developed as a collaborative, multidisciplinary effort of a maternal-fetal medicine expert, general gynecologist, and a bariatric surgeon.

Overall, 1030 women of childbearing age (median 34 years) underwent SG at our center during the study period. Of them, 928 women completed the questionnaire (response rate of 90%) with a median follow-up duration of 8.4 years. Menstrual irregularity rate (11.9% vs. 43.5%, P < .001) and duration of menstrual bleeding (median 5 vs. 6 days, P < .001) were significantly reduced after surgery as compared to preoperatively. Only 632 (68.1%) women received contraceptive advice perioperatively, with oral contraception being the most commonly used method following surgery (n = 322, 34.7%). Most women (n = 867, 93.4%) received a recommendation to delay conception after surgery, however, 65 (7.5%) women were sexually active in the first year postoperatively without using any mode of contraception. Overall, 301 (32.4%) women delivered after surgery, with pregnancy reported as unintended by 22 (7.3%) women, most of them (n = 14) using oral contraception.

Menstrual cycle pattern significantly improves after SG. Adequate reproductive-health counseling is important after SG in order to inform optimal contraceptive care and potentially prevent unintended pregnancies particularly in the early period after surgery.