WHAT CONTRACEPTIVES MAY A WOMAN USE AFTER BARIATIC SURGERY?

I am a fourth-year pharmacy student on rotations and I have been asked whether oral contraceptive pills are a viable option for women after bariatric surgery (for extreme obesity).  My gut instinct is no, I am leaning towards NuvaRing, IUDs or Depo-Provera. But I have yet to find any literature supporting this.

 

Any advice you could give me (and my preceptor) would be greatly appreciated.

 

Thank you so much for your help!

 

A:        Here are the most recent United States Medical Eligibility Criteria from the CDC regarding women seeking contraception following bariatric surgery:  See what this number means below:

Women may use all contraceptive options including pills (1) following restrictive bariatric procedures that decrease the storage capacity of the stomach.

On the other hand, women who have had malabsorptive procedures that decrease absorption of nutrients and calories by shortening the small intestine should not be prescribed combined hormonal contraceptives (3) or progestin-only pills (3).  They may use Depo (1), implants (1) or Mirena IUDs (1)

 

WHO and the CDC categories for temporary methods:

  • WHO 1 –Can use the method.  No restrictions on use.
  • WHO 2 – Can use the method.  Advantages generally outweigh theoretical or proven risks.  If method is chosen, more than usual follow-up may be needed.
  • WHO 3 – Should not use the method unless clinician makes clinical judgment that the patient can safely use it.  Theoretical or proven risks usually outweigh the advantages of method.  Method of last choice, for which regular monitoring may be needed.

●    WHO 4 – Should not use the method.  Conditions represents on unacceptable health risk if method is used.

This is described in the latest edition of Managing Contraception 2010-2012 on page A-4 of the appendix.

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