title: Menstrual concerns and intrauterine contraception among adolescent bariatric surgery patients.
abstract: OBJECTIVE
  Adolescent obesity has dramatically increased in recent decades, and along with that so have other medical comorbidities, such as hypertension, diabetes, hyperlipidemia, nonalcoholic steatohepatitis, polycystic ovary syndrome (PCOS), and pseudotumor cerebri. Obesity and related comorbidites may be contraindications to hormonal contraception, making contraception counseling of morbidly obese adolescents more challenging. Obese adolescent females seeking bariatric surgery need effective contraception in the postoperative period. This study is designed to determine the acceptance rate of the levonorgestrel-releasing intrauterine device (IUD) and describe common menstrual problems in obese adolescent bariatric surgery patients.
  
  
  METHODS
  This is a historic cohort study of adolescent females who underwent bariatric surgery over a 2-year period at a tertiary referral center for pediatric obesity. Data were systematically abstracted. The percent of patients with menstrual problems and the acceptance rate for the levonorgestrel-releasing IUD were determined.
  
  
  RESULTS
  Twenty-five adolescents met inclusion criteria. The mean age was 17.4 years (standard deviation [SD] 2.6), and the mean body mass index (BMI) was 51.4 (SD 6.3) kg/m(2). Eighty-four percent were white. Twenty-eight percent had menorrhagia, 32% had oligomenorrhea, 40% had dysmenorrhea, and 36% had PCOS. Ninety-two percent (23 of 25) underwent IUD placement.
  
  
  CONCLUSIONS
  There was a high prevalence of menstrual problems among this sample of severely obese adolescent females. The majority accepted the IUD, indicating it is a viable option among this population.
authors.affiliation: Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA. jennifer.hillman@cchmc.org
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hillman
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Miller
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Inge
mesh_terms: D000293:Adolescent; D050110:Bariatric Surgery; D015331:Cohort Studies; D003267:Contraception / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D016912:Levonorgestrel / Q000627:therapeutic use*; D008599:Menstruation Disturbances / Q000453:epidemiology* / Q000209:etiology; D009765:Obesity / Q000150:complications / Q000523:psychology / Q000601:surgery; D009820:Ohio / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel