Reproductive health counseling, menstruation, contraception, and conception after sleeve gastrectomy: a cross-sectional study

Background: 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). Objective: We aim to explore reproductive health patterns and outcomes after SG. Setting: University hospital. Methods: 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. Results: 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. Conclusions: 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.