birth control question

I have heard that by itself the pill is no longer a suitable form of birth control in preventing pregnancy. However I am asking if there is anyone out there that has used it as a SOLE means of birth control and didn't get pregnant. Thanks!

 I cannot do the mirena IUD. My insurance will not pay for it and between vits and food I am tapped out on cash to pay for it out of pocket. Also, just the thought process of how they get that thing in and out scares me and I do not have the pain tolerance level to take it (I still cry like a baby getting my blood drawn).

You are correct the bill can not be trusted as birthcontrol after WLS, due to huge hormonal changes we experience compounded by the malabsorption.

I am sure there are a few lucky folks who didnt get pregnanat and used it, but who willyou be? PRegnancy should be avoided for 18 mo much of the literature states, not only is there the risk to the baby most can kiss any wt loss goodby if they do get pregnant early on! (you lose the honeymooon sadly!)....

My iUD was the best thing I ever did 5 yrs ago almost, no periods at all, no cramping etc. The insertion was mildly uncomfortable truly not an issue and I do not like pain either.

If you are having RNY get used to lots of crying as we need labs for life and usually a good 10-12 ials at a pop!

Consider condoms and BCPs perhaps; some say the nuvaring may help or be ok (no research to back this but bypasses the gut) as does the patch MAY be ok, although wt limit for effect is 198 pounds, many after wls are above this for quite a while/forever still depending on starting BMI.

Talk with your surgeon and OBGYN.
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http://www.aboutmso.com/faq/faq.cfm

How does the gastric bypass affect the absorption of medications?
Most medications absorb normally. The exceptions to this are birth control pills, hormone replacement medication, and certain sustained release (slow release) medications.
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ALSO BE AWARE OF THE RISK OF OSTEOPOROSIS w/ DEPO shot (not to mention many gain 50#+ on this and have a tough time losing even when they stop the med!!!) so after RNY we are already at risk for metabolic bone disease due to calcium malabsorbtion and wt loss!
http://www.medscape.com/viewarticle/522069_print
DMPA May Cause More Weight Gain Than Do Oral Contraceptives CME
Jan. 23, 2006 -- Depot medroxyprogesterone acetate (DMPA) is associated with significant weight gain compared with an oral contraceptive **** or no contraceptive, according to the results of a prospective study reported in the January issue of the Archives of Pediatrics & Adolescent Medicine.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/printer.cfm?id=291
New Warning on Depo-Provera Contraceptive Injection
FDA Patient Safety News: Show #36, February 2005
The FDA recently announced that a new black-box warning is being added to the labeling for Depo-Provera Contraceptive Injection. The warning alerts prescribers that prolonged use may result in loss of bone density. Pfizer, the drug's manufacturer, has also issued a Dear Doctor letter with the same information, and the new information also appears in the patient information sheet.

The loss of bone density increases the longer the woman is on the drug and so the black box warning says that Depo Provera shouldn't be used as a long-term birth control method (for example, longer than two years) unless other methods aren't adequate. This bone density loss may not be completely reversible after discontinuation of the drug. This bone density loss may not be completely reversible after discontinuing the drug.

The "warnings" section of the label says that women with osteoporosis risk factors (e.g., metabolic bone disease, chronic alcohol or tobacco use, anorexia nervosa, a strong family history of osteoporosis, or chronic use of drugs that can reduce bone mass, such as anticonvulsants or corticosteroids) should consider other birth control methods. Another high risk group is adolescent women. The label warns that it's not known whether Depo-Provera might reduce their peak bone mass and increase the risk of osteoporotic fractures later in life.
Additional Information:
FDA MedWatch 2004 Safety Alert - Depo-Provera (medroxyprogesterone acetate injectable suspension)
http://www.fda.gov/medwatch/SAFETY/2004/safety04.htm#Depo

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5. : Med Clin North Am. 2007 May;91(3):515-28, xiii. Links
Improvement in infertility and pregnancy outcomes after weight loss surgery.
Patel JA, Colella JJ, Esaka E, Patel NA, Thomas RL.
Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA.
The majority of bariatric surgical procedures are performed in young women. There is a concern about safety and outcomes of pregnancies after weight loss surgery. Pregnancy after weight loss surgery is not only safe, but is associated with more favorable outcomes in comparison to obese populations who do not undergo weight loss surgery. An interval of 2 years is recommended from surgery to pregnancy. This delay helps avoid most of the potential nutritional complications. Optimal patient care is achieved in an experienced, multidisciplinary center. Early involvement of the bariatric surgeon in evaluating abdominal pain is critical because the underlying pathology may relate to the previous weight loss surgery. Although infertility is improved after weight loss surgery, reliable modes of contraception may be limited in this population.
PMID: 17509393 [PubMed - indexed for MEDLINE]
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4. : Crit Care Nurs Q. 2005 Jul-Sep;28(3):263-8. Links
Hormonal status, fertility, and pregnancy before and after bariatric surgery.
Raymond RH.
Department of Obstetrics and Gynecology, Allegheny General Hospital, Pittsburgh, PA, USA. [email protected]
At the present time, the exact etiology and developmental course of obesity in many individuals is still being debated. The majority of healthcare professionals are in agreement, however, that morbidly obese persons are at risk for a wide range of health problems, both before and after bariatric surgery. Obesity is, unfortunately, a condition in which the disease as well as the available treatments have the potential to cause serious alterations in health status. The average candidate for bariatric surgery has experienced decades of varying degrees of obesity as well as multiple failed dietary and medication regimens. As a result of almost continual physiologic instability, these individuals typically are subject to a wide range of hormonal imbalances. Since the majority of persons who are obese, and those seeking bariatric surgery, are women, it is important for healthcare providers to understand how these hormonal fluctuations can have a devastating impact on sexual and reproductive function. Although the research to date has been limited, studies have demonstrated changes in fertility, contraceptive response, and pregnancy outcomes in obese women, as well as obese women who undergo bariatric surgery. As morbid obesity continues to increase in incidence in the female population, greater numbers of women will seek bariatric surgery, and, as a consequence, experience some of the untoward effects shown to date. Addressing the concerns of these patients, both before and after surgery, will continue to be a complex and challenging task.
PMID: 16041226 [PubMed - indexed for MEDLINE]



Worth the Weight Pregnancy After Gastric Bypass Surgery
from Advance Newsmagazine for Nurse Practitioners
Vol. 13 ?Issue 11 ? Page 45
Worth the Weight
Pregnancy After Gastric Bypass Surgery
By Joy Burt, NP
http://nurse-practitioners.advanceweb.com/common/EditorialSearch/printerfriendly.aspx?AN=NP_05nov1_npp45.html&AD=11-01-2005

following is a snippet from that article....

Birth Control
Pregnancy is contraindicated for the first 18 to 24 months after GBP. During this time, the body is adjusting to its new gastric capacity and absorption processes. In fact, almost half of excess weight is lost in the first 12 to 18 months.12 In this rapid weight loss period, vomiting and food intolerances are common, and pregnancy during this time would be a strain on the body as well as a risk to the fetus.15 Therefore, it is essential to address birth control issues prior to surgery.12,15,16
Because absorption of food and medications is varied due to bypass of some of the intestine, women should not rely on oral contraceptives as a means of contraception. Prior to surgery, a woman should meet with her women's health provider for consultation about appropriate contraception.15 Due to the rapid weight loss after surgery, ovulation and fertility are likely to return quickly in women who were previously anovulatory. Regardless of prior fertility prevention needs, these women should begin contraceptive use prior to surgery -- the same as ovulatory women.15
Women who become pregnant unintentionally should be encouraged to openly express their feelings about the pregnancy. Some women who were previously unable to conceive may view the pregnancy as a gift. However, women who have recently gone through a total body transformation may be apprehensive about the possibility of gaining weight during pregnancy.


If you need literature to support BCPs not being effective I have quite a few articles!

Could you check with planned parenthood for more reasonalbe cost to IUD? OR prehaps you could appeal the IUD refusal as medically necessary given your WLS?

Just some thoughts....
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Here are a few groups for support if interested!

http://groups.yahoo.com/group/OSSG-pregnant/
http://health.groups.yahoo.com/group/OSSG-breastfeeding/
http://groups.yahoo.com/group/ossg-pregnancy-grads/
http://www.obesityhelp.com/forums/postop_pregnancy/

I switched to the Nuva Ring and haven't had any problems. I'm over 4 years post op and thank goodness no pregnancy.