Contraceptive Practices Before and After Bariatric Surgery: Survey Findings

Overview

A survey of 563 Swedish women who underwent bariatric surgery revealed that 67% used contraception preoperatively, with intrauterine devices being the most common method both before and after surgery. Despite recommendations to avoid pregnancy for 12–24 months postoperatively, nearly 25% reported receiving no advice on this, and about 10% continued oral contraceptive use more than one year after surgery.

Background

Obesity rates in Sweden have increased, with bariatric surgery, primarily gastric bypass, being a common treatment for morbid obesity. Women undergoing surgery are advised to avoid pregnancy for 12–24 months postoperatively due to risks such as premature birth and small for gestational age infants. The impact of bariatric surgery on oral contraceptive absorption is unclear, and contraceptive counseling practices vary. Understanding contraceptive use patterns before and after surgery is important for optimizing reproductive health outcomes.

Data Highlights

Key Findings

• 67% of women used contraception before bariatric surgery, with progestin-only pills being the most common oral contraceptive.
• Intrauterine contraception was the most frequently used method both before and after surgery, with a non-significant trend towards increased use of levonorgestrel intrauterine systems postoperatively.
• Use of oral contraceptives significantly declined after surgery, yet approximately 10% continued oral contraceptive use more than one year postoperatively.
• Nearly 25% of women reported not receiving advice to avoid pregnancy after surgery, and 14.8% did not recall if such advice was given.
• No difference in weight loss during the first postoperative year was observed relative to contraceptive method used.

Clinical Implications

Clinicians should ensure comprehensive contraceptive counseling for women undergoing bariatric surgery, emphasizing the importance of avoiding pregnancy for 12–24 months postoperatively. Given the continued use of oral contraceptives by some women beyond the recommended period and potential concerns about absorption after gastric bypass, alternative contraceptive methods such as intrauterine devices may be preferable. Regular follow-up to reinforce contraceptive advice is warranted.

Conclusion

This survey highlights gaps in contraceptive counseling and shifts in contraceptive use among women undergoing bariatric surgery. Improved education and tailored contraceptive strategies are needed to optimize reproductive health outcomes in this population.

References

1. Swedish Obesity Surgery Register (SOReg) Data and Related Studies
2. Victor et al. 1987 -- Plasma levels of progestogens post jejunoileal bypass
3. Kjaer et al. -- Pregnancy outcomes after bariatric surgery
4. Victor et al. -- Contraceptive failure risk in obese women
5. Survey Study on Contraceptive Practices Before and After Bariatric Surgery