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Wednesday, May 31, 2006

Birth control pills may be effective after bypass

In talking with some post-op friends the other day, I realized that many of us had received conflicting information from our doctors regarding the use of birth control pills after gastric-bypass surgery.

As a Kaiser patient, I had been told that barrier methods and IUDs were the best options after surgery, and birth control pills were off-limits. Another woman was told nothing by her doctor about contraception and had continued taking the same oral contraceptives as before surgery. The third woman was told that our pouches lack the digestive acids to break down the pill so she chewed hers up every day to ensure absorption.

Contraception is a serious issue for post-op patients. In general, it is not safe to get pregnant within the first 18 months after gastric-bypass procedures. The high rate of weight loss, reduced caloric intake and frequent vitamin and electrolyte imbalances do not make for a body able to sustain a healthy pregnancy.

Those of us with pre-op infertility have to be even more careful. Most times, that infertility is caused by obesity-related hormonal imbalances. As the weight drops off, some women become super fertile at a time when pregnancy would be dangerous for both them and the fetuses they would carry.

Of course, birth control pills are not the only forms of contraception on the market, but they are among the most commonly covered by insurance companies. For instance, my new employer-provided insurance plan only covers oral contraception. That makes the Pill the cheapest form of contraception available to me, and it's important to know whether it’s a viable medical option.

After talking with these women, I decided to e-mail the medical director of my bariatric program to ask why we had been discouraged from taking the Pill. Her answer surprised me. It had nothing to do with malabsorption issues. She said the risk of blood clots after surgery was too high, and birth control pills would add to it. According to her, oral contraception is safe and reliable after the first month.

A quick Google search shows some Web sites still advocating against the Pill because of malabsorption concerns. When it comes down to it, contraception is not a decision that can be taken lightly by a post-op. After all, if a chosen method fails, the resulting pregnancy can be quite dangerous. I’m still on the fence about whether I’ll trust the Pill to protect myself from getting pregnant this year, but the decision is individual. The friends whom I mentioned in the beginning of this column will continue as they have before and expect the same level of success. Only time will tell.


michael said...

I think after you undergo operations like this, you should not take birth control pills. If you wish to do so, you should ask your doctor if it is safe to take oral contraceptive pill.

Tonya Kubo said...

Thanks for your comment, Michael. Unfortunately, a lot of doctors still don't know what's best. From what I've seen in the years since bariatric surgery, it is best for all post-ops to use a barrier method until the 2-year mark and then reevaluate.

Jeannie said...

What have you decided to go with? I have been on the Nuva Ring, but it's super expensive, so am considering the Pill. $4 a month vs. $75 is a huge savings, but I don't want to sacrifice quality of protection either.

Tonya Kubo said...

I used the Pill for close to a year after originally publishing this post but have since decided that barrier methods give me more peace of mind and fewer unpleasant side effects.