Oral contraceptive bariatric surgery-

Women will enroll prior to planned gastric bypass surgery and complete one cycle of oral contraceptive use and evaluation. At that time, women will complete the second cycle of OC use and evaluation. Study participation is then complete. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.

Oral contraceptive bariatric surgery

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The Contraceptive Choice Project. National Center for Biotechnology InformationU. However, the absolute risk for VTE in women of reproductive age is small, and there is unlikely to be a significantly higher risk from one type of CHC compared with another [ 5354 ]. Whether obesity has an impact on contraceptive efficacy is the concern that this article attempts to address. Oral contraceptive bariatric surgery can also have negative effects on a pregnancy in the months following the surgery—but in the long term it supports healthier pregnancy. Nisbet AC. Glasier et al. To our knowledge, this is the largest study concerning contraceptive counseling for women who undergo bariatric surgery. Female Sterilization Female Oral contraceptive bariatric surgery is a permanent form of contraception typically Oral contraceptive bariatric surgery a surgical procedure to cut, block or remove the fallopian tubes that carry eggs from the ovaries to the womb. Method Perfect-use failure rate Oral contraceptive bariatric surgery failure rate Intrauterine contraception levonorgestrel 0. Efficacy of hormonal contraceptives among obese women Much of the concern for altered hormonal contraceptive efficacy in obese women stems from worries about how weight-related physiologic alterations affect the PK of estrogenic and progestogenic contraceptive hormones, and whether this translates into altered pharmacodynamics. We aimed to in a larger sample describe how women having bariatric surgery perceived the contraceptive counseling they were given before the procedure and to determine patterns of contraceptive Myspace kevin gay texas before and after the surgery in these women.

The Centers for Disease Control and Prevention estimate that

  • The information outlined below is simply a summary of some of the surgical literature and suggestions.
  • Our aim in this study was to describe patterns of contraceptive use before and after gastric bypass in Sweden, and to describe the contraceptive counseling given preoperatively to women undergoing gastric bypass.
  • Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women.
  • In the last 20 years, obesity has been on the rise in the U.

Don't miss out! Create your free JWatch. Robert L. Contraception May. Many clinicians in bariatric surgery programs do not understand the relative contraceptive efficacy of the available choices. Bariatric surgery is common in women of reproductive age.

In a study of contraceptive knowledge among clinicians in bariatric surgery programs, members of the American Society of Metabolic and Bariatric Surgery completed surveys. Among reproductive-aged women with significant medical issues, contraceptive counseling is often woefully inadequate.

Ensuring coordination among clinicians is an important step toward improving contraceptive care — and documenting the contraceptive plans of reproductive-aged patients both men and women in the medical record should be habitual. Jatlaoui TC et al. Family planning knowledge, attitudes and practices among bariatric healthcare providers. Contraception May; Get Your Copy. Contraception May Many clinicians in bariatric surgery programs do not understand the relative contraceptive efficacy of the available choices.

Comment Among reproductive-aged women with significant medical issues, contraceptive counseling is often woefully inadequate. Citation s : Jatlaoui TC et al. October 20, Internal Medicine. Internal Medicine Physician Opportunity in St.

Petersburg, Florida. Saint Petersburg, Florida. Internal Medicine Physician. Hospitalist, Oncology. Valhalla, New York. Anesthesiology, Consultant Physician. United Arab Emirates. Surgery, General. Orthopaedic Surgeon-Finger Lakes. Newark, New York. By continuing to use our site, you accept the use of these cookies.

Please review our privacy policy. Despite conflicting information regarding the efficacy of some hormonal contraceptives in obese women, it is important to remember that any contraceptive, even if less efficacious, is a better and safer choice than no method at all. The main outcome measures were patterns of use of contraception before and after bariatric surgery. What if I want to get pregnant after bariatric surgery? While all three had levels sufficient to prevent ovulation, the authors also raised concerns that the lower concentrations may indicate a need to replace the implant sooner than the licensed 3 years. After bariatric surgery, you are less likely to have: diabetes during pregnancy, high blood pressure during pregnancy, very large babies, and cesarean sections. It is also associated with decreased activity of the hepatic enzyme CYP3A4, the enzyme primarily responsible for metabolism of contraceptive steroids [ 7 ].

Oral contraceptive bariatric surgery

Oral contraceptive bariatric surgery. Bariatric surgery, birth control, and pregnancy

The authors state that this translates to an attributable risk of 2—4 additional pregnancies per women-years among overweight and obese COC users [ 30 ]. Data from 50, women in the USA, which were collected as part of a prospective, noninterventional cohort study, demonstrated higher oral contraceptive failure rates with higher BMI, when adjusted for age, parity and education level.

When the analysis was stratified by individual progestins, only one — chlormadi-none acetate — was found to be significantly associated with contraceptive failure in obese women.

While the data conflict, the cumulative conclusion seems to be that pregnancy rates among overweight and obese women using COC seem to be similar to or slightly higher than rates among normal-weight women. The large numbers of women included in some studies, and the biological plausibility for altered PK, do suggest the possibility that COC may potentially be less efficacious in obese women. It has been theorized that extended or continuous use of COC formulations may improve effectiveness compared with traditional monthly cycling in women of normal weight, by reducing or eliminating the hormone-free interval that has been identified as a time period of concern.

This has not been conclusively demonstrated. There was no significant difference in pregnancy rates across weight and BMI deciles [ 35 ]. However, this may currently be an understudied area of research. The contraceptive patch contains 6 mg norelgestromin and 0. Compared with a daily COC containing the same hormones, the AUC of EE and norelgestromin delivered by the patch are higher than when taken orally [ 37 ].

Increased body weight and body surface area were associated with decreases in the AUC of both EE and norelgestromin among patch users, but these were not thought to be clinically significant.

The contraceptive vaginal ring provides a non-oral, nondaily contraceptive method for women interested in short-term birth control. The ring contains a total of Efficacy studies of the vaginal ring included very few obese women [ 41 ]. A recent study comparing serum and physiologic markers of ovulation in 18 normal-weight and 19 obese women using the ring found lower EE concentrations in the obese participants, but no difference in ENG concentrations [ 42 ].

While this study was too small to assess pregnancy rates, there was no difference in ovarian follicle development or serum progesterone levels between the two groups, suggesting that contraceptive efficacy is maintained in obese women. Even if combined methods are slightly less efficacious in obese women than in normal-weight women, this is not equivalent to lack of efficacy.

The possibility of lower efficacy of some shorter-acting methods should lead to serious consideration of longer-acting methods. If a woman makes an informed choice to use a combined method, she should not be refused contraception based on body weight alone.

A levonorgestrel-based regimen involves either a single dose of 1. These dosing regimens are effective at reducing the risk of pregnancy up to 72 h after unprotected intercourse. Only two studies have investigated the effects of obesity on the efficacy of ECPs.

Glasier et al. An overestimation of contraceptive risk in obese women may lead to inadequate provision of effective contraceptive methods. In general, obese women may not receive preventive reproductive health screenings as often as normal-weight women [ 48 ].

For all women, including obese women, the risks of pregnancy generally outweigh the risk of potential harm from contraceptives. Hormonal contraception is a safe choice for obese women, in the absence of other contraindicating health conditions.

Both documents advise that there are no safety concerns with the use of any progestin-only contraceptive methods in obese women. This includes pills, injectables, implants and intrauterine contraception. However, the absolute risk for VTE in women of reproductive age is small, and there is unlikely to be a significantly higher risk from one type of CHC compared with another [ 53 , 54 ].

Thus, CHC are considered appropriate for obese women in the absence of other medical contraindications [ 45 , 50 ]. Data taken from [ 49 , 50 ]. No discussion of contraceptives and obesity would now be complete without consideration of bariatric weight-loss surgery. The majority of reproductive-age patients undergoing bariatric surgery are women [ 55 ], who are strongly advised to avoid pregnancy for up to 2 years after surgery [ 56 ].

The dramatic weight-loss that follows bariatric surgery leads to improvement in hypertension, diabetes and dyslipidemia, and can also lead to resumption of ovulation and normalization of menstrual irregularities [ 57 ].

There are very limited data on the use of contraceptives after bariatric surgery, but there are theoretical concerns that both malabsorptive and restrictive procedures could decrease the absorption of oral contraceptives [ 52 , 58 ]. The efficacy of nonoral methods is not believed to be affected by bariatric weight-loss surgery, except that any obesity-related effects that do exist will resolve as excess weight is lost [ 55 ].

Concerns for use of oral contraceptives after bariatric surgery are largely related to the type of surgery. There are three main categories of bariatric surgery: restrictive, malabsorptive and combined restrictive—malabsorptive. Purely malabsorptive procedures have fallen out of favor and are rarely performed. Restrictive procedures, which limit the size of the stomach and thus limit the amount of oral intake, include the popular gastric banding operations.

Since restrictive procedures do not interfere with the absorptive capacity of the gut, they are not believed to decrease efficacy of oral contraceptives. Restrictive—malabsorptive procedures, however, may be a different story. A common example of such a procedure is the Roux-en-Y gastric bypass. This procedure both surgically limits the size of the stomach restrictive component and bypasses a significant portion of the duodenum, intentionally creating a malabsorptive state.

This malabsorption may also decrease the ability of the gut to absorb hormones from oral contraceptives, which could in turn decrease their contraceptive efficacy. This concern is based on limited data from poorly designed studies [ 52 ]. However, the concern is sufficient that the US MEC, which otherwise focuses primarily on contraceptive safety, advises against the use of oral contraceptives in women after gastric bypass surgery [ 45 ]. For women who have undergone gastric bypass surgery, there is also concern that subsequent malabsorption could reduce the efficacy of ECPs [ 45 ].

Table 4 summarizes recommendations for contraceptive use in women who have had bar-iatric weight-loss surgery. Current research in this area is ongoing. Medical Eligibility Criteria for selected contraceptive methods in women who have undergone bariatric weight-loss surgery. Data taken from [ 49 ]. To date, providers of hormonal contraceptive methods employ a one-size-fits-all approach.

Similarly, clinical trials of new contraceptives have historically excluded obese women. However, all women are given the same dosages of contraceptive hormones regardless of weight. The significant variability in serum hormone concentrations among individuals begs the question of whether this one-size-fits-all approach is realistic, especially given the rising prevalence of obesity and the serious consequences of inadequate contraception.

The question is also relevant given that the dose of EE in oral contraceptives has steadily decreased over the last several decades. It is unclear whether these lower doses are exposing women to increased risk of contraceptive failure [ 59 ]. Evidence to date is reassuring that many contraceptive methods maintain their efficacy in obese women. Despite conflicting information regarding the efficacy of some hormonal contraceptives in obese women, it is important to remember that any contraceptive, even if less efficacious, is a better and safer choice than no method at all.

Overweight and obese women are at increased risk of pregnancy complications, including gestational diabetes, hypertensive complications and cesarean delivery [ 60 ].

Since it is unclear how much obesity may reduce the efficacy of short-acting contraceptives in particular, it seems overly alarmist to restrict the use of these methods in overweight and obese women.

These should be considered first-line methods for obese and overweight women and can be offered to all appropriate candidates. Obesity affects a continuously growing number of reproductive-aged women, and helping obese women manage their reproductive health is as important as with any chronic disease. Healthcare providers who understand how obesity may affect the efficacy of hormonal contraceptives will be better able to assist their patients in reproductive decision-making.

Providing effective contraception is also a crucial part of helping obese women undergo weight loss therapy. Obese women represent a population whose reproductive health is greatly affected by their weight, yet factors that influence contraceptive efficacy in this population are poorly understood. Research is beginning to focus on the best contraceptive methods for overweight and obese women.

Elucidating the relationship between obesity and contraceptive efficacy should continue to be a focus of future research, and evaluation of new contraceptive methods should proactively include obese women. Future directions should also include the integration of contraceptive provision into weight-loss programs.

This will enable women to improve their health before undertaking the demands of pregnancy, and will also reduce their risk of obesity-related complications of pregnancy. Obesity is a prevalent health problem and may affect the pharmacokinetics and efficacy of hormonal contraceptives. Limited data suggest that long-acting reversible contraceptives methods intrauterine devices and implants retain excellent contraceptive efficacy in obese women.

Oral contraceptives, the contraceptive patch and emergency contraceptive pills have been shown to have increased failure rates in obese women compared with normal-weight women. Disclosure: Charles P Vega has disclosed no relevant financial relationships.

Disclosure: Jennifer A Robinson has disclosed no relevant financial relationships. Disclosure: Anne E Burke has disclosed no relevant financial relationships. Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

National Center for Biotechnology Information , U. Womens Health Lond Engl. Author manuscript; available in PMC Jul 2. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Womens Health Lond Engl. See other articles in PMC that cite the published article. Abstract Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women.

Keywords: birth control, hormonal contraception, obesity, pharmacodynamics, pharmacokinetics. Table 1 Categories of obesity and weight. Open in a separate window.

PK implications: cause for concern? Distribution After absorption, a drug is dispersed throughout the body into various compartments depending on its chemical properties, such as size, charge, lipophilicity or affinity for plasma proteins.

Metabolism The effects of obesity on drug metabolism are unclear. Elimination Clearance refers to how quickly the body can eliminate the drug, usually via the kidneys or liver. Efficacy of hormonal contraceptives among obese women Much of the concern for altered hormonal contraceptive efficacy in obese women stems from worries about how weight-related physiologic alterations affect the PK of estrogenic and progestogenic contraceptive hormones, and whether this translates into altered pharmacodynamics.

Table 2 Perfect- and typical-use failure rates for selected methods of hormonal contraception. Method Perfect-use failure rate Typical-use failure rate Intrauterine contraception levonorgestrel 0.

Progestin-only contraceptives Progestin-only contraceptives include long-acting reversible contraceptives intrauterine devices [IUDs] and implants , injectables and progestin-only pills.

Intrauterine devices Owing to the contraceptive effect of IUDs occuring primarily via local actions on the uterus, there is no reason to think that IUDs would be less effective in obese women than in women of normal weight.

Contraceptive implants Etonogestrel implant Prescribing information for the etonogestrel ENG implant indicates that serum ENG levels decline with increasing body weight [ 14 ]. Injectable contraception Depot medroxyprogesterone acetate Depot medroxyprogesterone acetate DMPA is an injectable contraceptive that is widely used around the world.

Norethisterone enanthate Norethisterone enanthate is another injectable progesterone-only contraceptive method that is given every 8 weeks.

Progestin-only pills Progestin-only pills are seldom used by women in the USA [ 25 ]. Contraceptive patch The contraceptive patch contains 6 mg norelgestromin and 0. Contraceptive vaginal ring The contraceptive vaginal ring provides a non-oral, nondaily contraceptive method for women interested in short-term birth control.

Safety concerns An overestimation of contraceptive risk in obese women may lead to inadequate provision of effective contraceptive methods. Table 3 Medical Eligibility Criteria for selected contraceptive methods in obese women. Bariatric surgery No discussion of contraceptives and obesity would now be complete without consideration of bariatric weight-loss surgery.

Table 4 Medical Eligibility Criteria for selected contraceptive methods in women who have undergone bariatric weight-loss surgery. Discussion To date, providers of hormonal contraceptive methods employ a one-size-fits-all approach. Conclusion Obesity affects a continuously growing number of reproductive-aged women, and helping obese women manage their reproductive health is as important as with any chronic disease.

Future perspective Obese women represent a population whose reproductive health is greatly affected by their weight, yet factors that influence contraceptive efficacy in this population are poorly understood. Executive summary. Pharmacokinetic implications: cause for concern? Efficacy of hormonal contraceptives among obese women Limited data suggest that long-acting reversible contraceptives methods intrauterine devices and implants retain excellent contraceptive efficacy in obese women.

References 1. American College of Obstetricians and Gynecologists. Obstet Gynecol. Pharmacokinetic considerations in obesity. J Pharm Sci.

Basic and Clinical Pharmacology. Mishell DR. Am J Obstet Gynecol. Metabolism and pharmacokinetics of contraceptive steroids in obese women: a review. The pharmacokinetics of levonorgestrel and ethynylestradiol in women — studies with Ovran and Ovranette. Wilkinson GR. The Pharmacologic Basis of Therapeutics. Oral contraceptives and individual variability of circulating levels of ethinyl estradiol and progestins. Trussell J, Guthrie KA.

Choosing a contraceptive: efficacy, safety, and personal considerations. Pharmacokinetic and pharmacodynamics studies of levonorgestrel-releasing intrauterine device. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women. Pharmacokinetics of the etonogestrel contraceptive implant in obese women. Clinical trial with 3-keto-desogestrel subdermal implants. Graesslin O, Korver T.

Etonogestrel concentrations in morbidly obese women following Roux-en-Y gastric bypass surgery: three case reports. Hum Reprod. Nisbet AC. Intramuscular gluteal injections in the increasingly obese population: a retrospective study. Fotherby K, Koetsawang S. Metabolism of injectable formulations of contraceptive steroids in obese and thin women. Progestin-only pill use among women in the United States.

Nelson AL, Cwiak C. Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic—pituitary—ovarian activity. Pharmacokinetics of a combined oral contraceptive in obese and normal-weight women. Obesity and oral contraceptive failure: findings from the National Survey of Family Growth. Am J Epid. Body mass index, weight, and oral contraceptive failure risk.

Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev. Effectiveness of oral contraceptive pills in a large US cohort comparing progestogen and regimen. Oral contraceptive effectiveness according to body mass index, weight, age, and other factors. Contraceptive failures in overweight and obese combined hormonal contraceptive users. We trust that sexy brain of yours to post with good intentions. And we promise to respect your perspective, thoughts, insight, advice, humor, cheeky anecdotes, and tips.

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The Centers for Disease Control and Prevention estimate that To perform the study, University of Pittsburgh researchers examined post-surgery contraceptive practices and conception rates by gathering information from the Longitudinal Assessment, which includes adults seeking first-time bariatric surgery at 10 U.

Women ages with no history of menopause, hysterectomy, or estrogen and progesterone therapy were enrolled between and Participants completed preoperative and annual postsurgical assessments for up to seven years until January Primary outcomes included self-reported contraceptive practices, overall conception rate, and early less than 18 months postsurgical conception.

Within the first 18 months after bariatric surgery, the conception rate was 4. Contraceptive counseling both before and after bariatric surgery are critical pieces of the multidisciplinary needs of the bariatric patient, noted Anita Courcoulas , MD, MPH, FACS, director of minimally invasive bariatric and general surgery at Magee-Womens Hospital.

For women who have undergone restrictive bariatric surgery, the U. Reprints Share. Related Articles Check birth control after bariatric surgery. Keywords surgery. Contraception and conception after bariatric surgery. Obstet Gynecol ; National Center for Health Statistics. Hyattsville, MD; Surg Obes Relat Dis ;9:e Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient — update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery.

Surg Obes Relat Dis ; Impact of bariatric surgery on fetal growth restriction: Experience of a perinatal and bariatric surgery center. Am J Obstet Gynecol ; Medical Eligibility Criteria for Contraceptive Use, Burke A.

The effect of obesity on contraceptive efficacy: What we now know. Presented at the Contraceptive Technology Quest for Excellence conference. Atlanta; November Report Abusive Comment. Restricted Content You must have JavaScript enabled to enjoy a limited number of articles over the next days. Please click here to continue without javascript.. View PDF. Contraceptive Technology Update Vol. Begin Test. Shop Now: Search Products. All Fields Required. Sign Up. Help Search About Us.

Oral contraceptive bariatric surgery