From the Guidelines
Gastric surgery for weight loss is unlikely to directly lead to amenorrhea, but rather, it can improve fertility through restoration of ovulation in women with a history of oligomenorrhea or amenorrhea due to insulin resistance, as noted in a study published in the American Family Physician in 2013 1. To address potential menstrual irregularities after gastric surgery:
- Consult an endocrinologist or gynecologist for a thorough evaluation.
- Ensure adequate nutrition, particularly:
- Iron: approximately 65 mg daily, as recommended for patients after bariatric surgery 1
- Vitamin B12: 350 mcg daily, as suggested for patients after bariatric surgery 1
- Folate: 400 mcg daily, as recommended for patients after bariatric surgery 1
- Vitamin D: 400 to 800 IU daily, as suggested for patients after bariatric surgery 1
- Consider hormone replacement therapy if indicated, but there is limited evidence to support its use in this context.
- Maintain a healthy body mass index (BMI) between 18.5-24.9 kg/m².
- Regular exercise and stress management techniques may also be beneficial, but their specific impact on menstrual regularity after gastric surgery is not well-studied.
Rapid weight loss after gastric surgery can disrupt the hypothalamic-pituitary-ovarian axis, but the surgery itself is more likely to improve menstrual regularity in women with a history of insulin resistance and oligomenorrhea or amenorrhea, as supported by a study published in Obesity Reviews in 2019 1. Nutritional deficiencies, particularly iron, can exacerbate menstrual irregularities, and hormone replacement may be necessary to restore menstrual function and prevent long-term health consequences like osteoporosis. Achieving and maintaining a healthy weight through proper nutrition and exercise can help regulate hormonal balance and restore normal menstrual cycles. However, the most recent and highest quality study on this topic, published in Obesity Reviews in 2020 1, focuses on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery, and does not directly address the relationship between gastric surgery and amenorrhea.
From the Research
Gastric Surgery and Amenorrhea
- Gastric surgery, also known as bariatric surgery, can lead to significant weight loss and improvements in obesity-related comorbidities 2.
- However, weight loss, regardless of the method, can lead to amenorrhea (absence of menstruation) in some women 3, 4.
- A study on the effects of Roux-en-Y gastric bypass surgery on premenopausal women found that 85% of women with oligo-/amenorrhea gained regular menstrual cycles after surgery 5.
- Another study found that weight loss-related amenorrhea can have adverse effects on women's health, including reproduction, skeletal and cardiovascular systems, and mental health 4.
- The relationship between gastric surgery and amenorrhea is complex, and more research is needed to fully understand the effects of bariatric surgery on menstrual cycles.
Mechanisms and Complications
- Gastric surgery can induce physiologic and neuroendocrine changes that affect the weight regulatory centers in the brain 2.
- Weight loss-related amenorrhea is associated with anovulation and hypoestrogenism, which can have short- and long-term adverse effects on women's health 4.
- Bariatric surgery can also lead to nutritional and metabolic complications, including macronutrient and micronutrient deficiencies 6.
- Counseling, monitoring, and nutrient and mineral supplementation are essential for the treatment and prevention of nutritional and metabolic complications after bariatric surgery 6.