Menstruation & WLS: Answering All of Your Common Questions

Article By: Jessi Beaven, Dietetic Intern

Co-Author: Rachel Ignomirello, MS, RDN, CSOWM, LDN

Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.

With increasing rates of obesity in the United States, bariatric surgery is utilized as a tool for effective weight loss. Body weight and fat composition are heavily related to hormonal balance. Women with obesity often struggle with their sex hormones because adipose (fat) tissue produces excess estrogen. Women with obesity have higher amounts of inflammation and experience heavier menstrual cycles. This increases the risk for breast and uterine cancers because the uterus cannot efficiently repair itself and the endometrium does not properly shed. This damage has negative impacts on fertility outcomes.

1) Is there a link between higher BMIs and PCOS? Women with higher BMIs are also at greater risk for developing PCOS (polycystic ovarian syndrome) where more androgens (male sex hormones) are released. Women with PCOS have elevated testosterone and low estrogen levels. This hinders periods from being regular or even happening at all. Women with BMIs over 35 are more likely to stop any menstrual bleeding for up to 3 months at a time. This is called secondary amenorrhea.

2) What are anovulation and endometriosis? Anovulation is when the egg does not release from the ovary during the menstrual cycle. It is more common in women with obesity, and it can cause irregular or nonexistent periods. Endometriosis is a condition in which tissue similar to the lining of the uterus grows on other parts of the body. Those with endometriosis still qualify for bariatric surgery but must be followed closely by their providers since there is an increased risk for bleeding and therefore iron-deficiency anemia.

3) How does WLS affect menstrual cycles? Bariatric surgery affects a woman's menstrual cycle by helping them lose a significant amount of weight and better regulate hormones and bodily functions. Because of the weight loss, menstrual irregularities often disappear due to hormonal correction and ovulation normalization. This will increase fertility and the likelihood of pregnancy. Some bariatric patients may see an initial delay of their period for up to 2 months afterwards, but it may be tied to medications used to stop bleeds while in recovery from the surgery.

By losing 5% of body weight, obesity-related anovulation can be reversed. Fat mass loss decreases the amount of estrogen released from adipose tissue, which helps regain ideal hormone levels. Reduced inflammation follows this weight loss, helping the uterus make repairs and improve overall fertility outcomes. Periods will become lighter and more regular, which decreases the risk of developing iron-deficiency anemia.

Bariatric surgery improves period symptoms with better regulation of sex hormones (especially estrogen) and increases ovulation, improving fertility in women of childbearing age.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.