Menstrual Concerns and Intrauterine Contraception Among Adolescent Bariatric Surgery Patients

Abstract

Objective: Adolescent obesity has dramatically increased in recent decades, and along with that so have other medical comorbidities, such as hypertension, diabetes, hyperlipidemia, nonalcoholic steatohepatitis, polycystic ovary syndrome (PCOS), and pseudotumor cerebri. Obesity and related comorbidites may be contraindications to hormonal contraception, making contraception counseling of morbidly obese adolescents more challenging. Obese adolescent females seeking bariatric surgery need effective contraception in the postoperative period. This study is designed to determine the acceptance rate of the levonorgestrel-releasing intrauterine device (IUD) and describe common menstrual problems in obese adolescent bariatric surgery patients. Methods: This is a historic cohort study of adolescent females who underwent bariatric surgery over a 2-year period at a tertiary referral center for pediatric obesity. Data were systematically abstracted. The percent of patients with menstrual problems and the acceptance rate for the levonorgestrel-releasing IUD were determined. Results: Twenty-five adolescents met inclusion criteria. The mean age was 17.4 years (standard deviation [SD] 2.6), and the mean body mass index (BMI) was 51.4 (SD 6.3) kg/m 2 . Eighty-four percent were white. Twentyeight percent had menorrhagia, 32% had oligomenorrhea, 40% had dysmenorrhea, and 36% had PCOS. Ninetytwo percent (23 of 25) underwent IUD placement. Conclusions: There was a high prevalence of menstrual problems among this sample of severely obese adolescent females. The majority accepted the IUD, indicating it is a viable option among this population.

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

“…A study measuring etonogestrel implant effectiveness following RYGB showed that hormone levels remained above the threshold required to achieve contraception in a study of three patients [127]. In a separate study, levonogestel-releasing intra-uterine devices were deemed an acceptable form of contraception in adolescents following bariatric surgery [128]. Hence, parenteral forms of hormonal contraception should be recommended first line [127].…”

Contraception for Adolescents

“…78,80 Levonorgestrel IUDs also provide an important option for adolescent bariatric surgery patients, for whom experts recommend a delay of pregnancy of at least 12 to 18 months after surgery but who often experience a rapid return to fertility after surgery. 81 Barriers to pediatricians inserting IUDs, such as lack of training, lack of office capacity, or not seeing enough patient volume to maintain skills, pose an access problem, which can be overcome by identifying specific providers in the community to whom these patients can be referred.…”

“…Presurgery data reveal a high prevalence of menstrual problems among adolescents with morbid obesity. 81 Postsurgery data demonstrate an improvement in fertility, and professional consensus statements recommend delaying pregnancy for at least 12 to 18 months after bariatric surgery. 244 Together, these suggest a need for highly effective contraceptives in such patients.…”

Contraception for Adolescents

“…37 There is increasing experience and success with the levonorgestrel IUD placed at the time of surgery. 154 …”