Post-op Birth Control

Carolyn M.
Post-op birth control is very important if you are female, heterosexual, between the ages of 13 and 50, and have all your female parts intact.

It is very dangerous to get pregnant in the 18 months following your surgery. Not just because it can mess up your weight loss, and not just because it is hard to nourish an unborn baby when your intake is restricted and you are malabsorbing protein and vitamins, but because for at least the first few months, you will be in ketosis much of the time. Ketones can cause fetal brain damage. Don’t risk it. This is why post-op birth control is so important. You may not think you are fertile, and many obese women aren’t very fertile, but you can become fertile again very quickly as the weight comes off.

Many but not all surgeons will advise you to use reliable birth control post-op. Birth control pills alone aren’t considered reliable post-op, because they may be partly malabsorbed, and because as you lose fat, your estrogen levels fluctuate anyway. And if you didn’t know it already, the more overweight you are, the less reliable the Pill is to begin with. If you are on the pill, you will also need to use a barrier method, such as condoms, the sponge, a diaphragm, or vaginal film or foam (listed in order of reliability).

You could also use condoms plus the Sponge, or condoms with vaginal foam or film for post-op birth control.

If your family is complete, male or female sterilization procedures may be your best long-term option.

Temporary post-op birth control methods that you can use alone are the Depo-Provera shot, the Nuva Ring, or the Mirena or Paragard IUD.
A little bit about these post-op birth control choices:

1. The shot is extremely effective birth control, similar to having your tubes tied but less permanent. You may have irregular bleeding for the first 3-6 months or so, after that most people have little to no bleeding. Other side effects–if you are prone to depression, it can make depression worse. If you are prone to acne, it can make acne worse. In 25-30% of women, it stimulates the appetite. This is why it can be associated with weight gain. In about 2% of women it can cause hair loss. Because many of us have had problems with depression and appetite pre-op, and problems with hair loss post-op, this might not be the best choice. It takes up to a year to become fertile again after going off the shot.

2. The NuvaRing is a thin flexible plastic ring that you insert into your vagina, leave in for three to four weeks, and then remove. You can leave it out for up to 7 days to have a period, or insert the next ring immediately to skip periods (if you use it to skip periods, you will have breakthrough bleeding from time to time. You can remove the Ring for 3-5 days and then reinsert it to stop breakthrough bleeding. But to avoid losing contraceptive effectiveness, always leave each new Ring in for at least three weeks and reinsert the next Ring within 7 days).

With the NuvaRing, you have more local hormone effect, so it is very good at preventing pregnancy and controlling periods, but a lower blood level of hormones than with any other hormonal method, and thus fewer side effects. It is very comfortable to wear; you won’t even feel it when it is in place. Most women who try the NuvaRing end up loving it. You become fertile again right away after stopping the Ring. It’s not a preferred medication on most insurance plans, so you may pay higher co-pay (compare to the costs of using the Pill plus a barrier method).

3. The Paragard IUD is expensive to start out with, full cost is $450-750 to purchase and get it inserted. But it lasts 10 years, so it’s the cheapest method in the long run. It takes a procedure to put it in, which can be a little uncomfortable. After placement, you may have intermittent spotting and cramping for a couple of months. After that, your periods may continue to be a little heavier and crampier than your usual. It contains no hormones, so you will not have any hormone related side effects. You can usually use the Paragard IUD even if you haven’t had any children. Your fertility returns immediately after the IUD is removed.

4. The Mirena IUD contains a small amount of progesterone. It is also expensive to start with, but lasts 5 years. It can be used not only for birth control, but to decrease bleeding for women who have heavier or more frequent periods. By the time you have had it in for 2 years; you will have very scant periods, if any.

For the first year or so, you may have frequent and/or prolonged episodes of very light bleeding. This can be annoying but isn’t dangerous as the actual amount of blood loss is low.

Most of the progesterone effects are confined to the uterus, however, sensitive women may experience some of the side effects listed under Depo-Provera (depression, acne, hair loss, etc.) These effects, if experienced, tend to decrease with time. You can use the Mirena IUD only if you have already borne at least one child. It may take a few months after this IUD is removed for you to become fertile again.

Please make an appointment with your OB/GYN provider or visit your local Planned Parenthood or County Health Dept. to discuss which of these post-op birth control methods may be right for you.