Bariatric surgery and adolescent gynecology.
OBJECTIVE
This review summarizes the impact of bariatric surgery on gynecologic complications in the context of the extremely obese adolescent and reviews contraceptive considerations before and after adolescent bariatric surgery.


RESULTS
Eighteen percent of children and adolescents have a body mass index greater than the 95th percentile, with 4% of adolescents being greater than the 99th percentile. Gynecologic morbidities identified in obese adolescents include anovulatory complications such as acute menorrhagia, polycystic ovary syndrome and endometrial hyperplasia, and cancer. When conventional dietary and behavioral therapy fail to result in weight loss, specific criteria have been identified to justify bariatric surgery in extremely obese adolescents. Bariatric surgery in adult women often results in resumption of ovulatory menses, resolution of clinical and laboratory evidence of hyperandrogenism, and return of fertility. Adolescents are at risk for unintended pregnancies, and there are special concerns regarding pregnancy in bariatric patients. Specific contraceptive methods have particular potential risks, benefits, and drawbacks for use in obese adolescents.


CONCLUSIONS
Clinicians who provide care for extremely obese adolescents must be aware of the potential for gynecologic morbidities including polycystic ovary syndrome, dysfunctional bleeding and endometrial hyperplasia, expected gynecologic and fertility outcomes of weight loss surgery for teens, as well as the implications on contraceptive options.
Miller
Rachel J
RJ
Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. rachel.miller@cchmc.org
Xanthakos
Stavra A
SA
Hillard
Paula J Adams
PJ
Inge
Thomas H
TH
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D003276:Contraceptives, Oral / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D015391:Gastroplasty; D005831:Genital Diseases, Female / Q000150:complications / Q000175:diagnosis*; D006176:Gynecology / Q000379:methods* / Q000639:trends; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis / Q000209:etiology
D003276:Contraceptives, Oral