At present, women are recommended to avoid pregnancy 12–18
months after bariatric surgery. 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.
In October 2012, a questionnaire was sent to 1000 Swedish
women who all had undergone gastric bypass during 2010. The women had been
included in the Scandinavian Obesity Surgery Register at time of surgery. The
main outcome measures were patterns of use of contraception before and after
bariatric surgery.
The response rate was 57 %. The most commonly used
contraceptive methods were intrauterine devices, 29 % preoperatively and
26 % postoperatively even though there was a postoperative switch from the
copper intrauterine device to the levonorgestrel intrauterine system. Thirty
percent did not use any contraceptive during the first 12 months after
surgery. Sixty percent of the responders were aware of the recommendations to
avoid pregnancy after surgery.
Many women who undergo bariatric surgery are not using any
contraceptive method despite the recommendation that they should avoid
pregnancy for at least 12 months. There is a great need to improve
contraceptive counseling for this growing group of women.
Table 2
Contraceptive methods used before and after surgery
| Contraceptivea | 12 months before, n = 563 | 1–2 years after, n = 563 | Sign.c | 1–2 years after, n = 563 |
|---|---|---|---|---|
| n (%) | n (%) | n (%) | ||
| Longer-acting reversible contraceptives | ||||
| Copper intrauterine device | 77 (13.7) | 61 (10.9) | NS | 40 (7.1) |
| Lng IUSb | 86 (15.3) | 104 (18.5) | NS | 108 (19.2) |
| Implant | 21 (3.7) | 23 (4.1) | NS | 14 (2.5) |
| Short-acting hormonal contraceptives | ||||
| Any oral contraceptive | 130 (23.1) | 87 (15.5) | p = 0.001 | 53 (9.4) |
| Combined oral contraceptives | 43 (7.6) | 29 (5.2) | NS | 22 (3.9) |
| Desogestrel progestin-only pill | 59 (10.5) | 46 (8.2) | NS | 28 (5.0) |
| Other progestin only pills | 28 (5.0) | 12 (2.1) | p = 0.01 | 3 (0.5) |
| Vaginal ring | 6 (1.1) | 13 (2.3) | NS | 7 (1.2) |
| Patch | 0 (0) | 5 (0.9) | 3 (0.5) | |
| Other contraceptives | ||||
| Depo-Provera® | 34 (6.0) | 32 (5.7) | NS | 29 (5.2) |
| Condoms/other | 110 (19.5) | 109 (19.4) | NS | 78 (13.7) |
| None | 182 (32.3) | 168 (29.9) | NS | 210 (37.2) |
aParticipants could choose more than one option if they had changed method during the given period of time
bLevonorgestrel intrauterine system
c12 months prior to surgery vs. 12 months postsurgery. Chi-square test
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden
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