Analysis of the effectiveness of bariatric interventions in women with morbid obesity on the restoration of their menstrual and reproductive function

Abstract

Purpose - to evaluate the effectiveness of weight loss after bariatric surgery (BS) in women with morbid obesity (MO) on the recovery of menstruation and the realization of reproductive functions. Materials and methods. Changes in menstrual and reproductive functions were analyzed in 51 women with MO and accompanying metabolic syndrome (MS), aged 22 to 55 years, who underwent BV. Women with a higher body mass (BMI) underwent biliopancreatic bypass (BPS) in the Hess-Marceau modification (I clinical group - 21 women), patients with a lower body mass index (BMI) - longitudinal gastric resection (LGR) - II clinical group (30 patients). The duration of observation in the postoperative period ranged from 3 to 7 years. The BMI of women ranged from 29.2 kg/m2 to 62.1 kg/m2 and averaged 44.0±1.0 kg/m2. The experience of obesity varied from 5 to 21 years. Results. Menstrual cycle disorders (MC) were observed in 100% of cases. 16 out of 24 (66.7%) women under the age of 40 had reproductive plans (RP) in the postoperative period. In 18 (75.0%) of them, we were talking about chronic anovulatory cycles. Endometrial and myometrial pathology was noted in 14 (27.5%) women. Analysis of the dynamics of MO indicators during the first 3 years after BS showed general trends towards a probable (p<0.001) decrease in BM and BMI indicators in patients of all clinical groups already after 3 months from the start of treatment. Regular MC in women under 40 years of age was restored within 1.5 years against the background of a decrease in MT without medical intervention. Spontaneous pregnancy occurred in 7 (43.8%) women with RP 3 years after BS and in 5 (31.3%) - with the help of assisted reproductive technologies. Conclusions. An intense decrease in body weight and, accordingly, BMI, is observed within 12 months after operative treatment using the combined BPS method and in the period of 3-6 months in patients after PRS. Achieving statistical comparability of BMI indicators in both groups (p>0.05) occurs already after 6 months. Stabilization of average BMI indicators in subsequent years occurs in the range (95% CI) of 25.7 - 32.1 kg/m2, regardless of the method of surgical intervention. Weight loss improved reproductive potential in women with MS by 42%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.