A study exploring the impact of laparoscopic sleeve gastrectomy (LSG) on menstrual cycles and fertility in Saudi women, has found that a substantial proportion of women experienced menstrual changes after the procedure, with regular cycles being the most common (n=102, 26.3%). Specifically, 70.5% of participants reported changes in their menstrual cycle post-surgery. Overall, quality of life post-surgery was rated highly by participants (70.8% (n=274) giving ratings of four or five out of five.
The investigators noted that more than 30% of adults (male and female) in Saudi Arabia are reported to be living with obesity and 32% of women in Saudi Arabia considered to be overweight. The high proportion of obesity among women in the country is a significant problem as it impairs their ability to have offspring.
Because of their higher levels of oestrogen, women with obesity are more likely to experience abnormalities and irregularities during their menstrual cycles, as well as frequently experience menstrual disorders, such as irregular periods and dysmenorrhea. These anomalies could lead to conception problems. In addition, it has been reported that hormone imbalances linked to obesity worsen irregular menstruation and have a deleterious effect on reproductive health, including polycystic ovarian syndrome (PCOS).
However, LSG has been shown in numerous studies to be effective and successful in improving reproductive function in women living with extreme obesity and has been shown that it also improves menstrual cyclicity in anovulatory cycle.
Therefore, the researchers designed a study to assess how LSG affects the menstrual cycle, with particular attention to hormonal dynamics and consequences for fertility. Using an electronic online survey, this cross-sectional study was conducted among women in Saudi Arabia post-LSG between December 2023 and May 2024 and included women from all regions of Saudi Arabia who had undergone the procedure.
Our study's inclusion criteria include any woman in Saudi Arabia aged between 18 and 55 years, as well as any woman who underwent SG surgery. On the other hand, the exclusion criteria consist of an uncompleted questionnaire, and any women have not accepted to participate.
The first part of the questionnaire covered the sociodemographic information of the study participants such as age, marital status and region. The second part about details of the LSG operation involved asking about sleeve surgery history and weight loss after the surgery. The third part of the questionnaire is about the medical history and menstrual history mentioned in its chronic diseases, also if she used contraception. In menstrual history, they asked about any changes in the menstrual cycle and complications related to the menstrual cycle, such as pain or severe bleeding before the operation, and any changes noticed after the operation.
In the final part of the survey, they assessed the quality of life by using the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF) score system. The WHOQOL-BREF is a 26-item instrument that measures quality of life across four domains: physical health, psychological health, social relationships, and environmental health (each item is scored from one to five).
Outcomes
In total, the study included 803 women of which 387 were included and the remaining were excluded based on exclusion criteria. A significant proportion of participants were aged between 26 and 35 years (n=147, 38.0%) and those aged 36-45 years constituted 30.7% (n=119). The majority of participants were married (n=230, 59.4%), while 40.6% were single (n=157). Regional distribution showed that most participants were from the south (n=139, 35.9%), followed by the central region (n=74, 19.1%), east (n=70, 18.1%), west (n=66, 17.1%), and north (n=38, 9.8%). Additionally, 69.8% (n=270) reported not suffering from any chronic disease, whereas 30.2% (n=117) reported having chronic conditions.
Anaemia was the most common comorbidity (30.8%, n=36) of the participants, followed by diabetes (19.7%, n=23), hypertension (10.3%, n=12) and rheumatoid arthritis (6.8%, n=8). Additionally, a significant portion (32.5%, n=38) had two or more comorbid conditions.
Most participants had the surgery over a year ago (n=227, 58.7%), with fewer having it six months to one year (n=68, 17.6%), three-six months (n=53, 13.7%), or less than three months prior (n=39, 10.1%). A significant majority experienced notable weight loss post-surgery (n=336, 86.8%).
Contraceptive use was low, with only 16.0% (n=62) used contraceptives. Before surgery, 62.5% (n=242) had regular menstrual cycles, whereas 37.5% (n=145) had irregular cycles. About half had experienced menstrual changes prior to surgery (n=195, 50.4%) and 31.3% (n=121) reported menstrual problems. Post surgery, 70.5% (n=273) noticed changes in their menstrual cycle, while 29.5% (n=114) did not.
The researchers reported that a significant proportion of women experienced a regular menstrual cycle post-surgery (n=102, 26.3%), followed by irregularity in the menstrual cycle (n=96, 24.7%), while increased menstrual pain was reported by 18.3% (n=71) of participants. Additionally, 17.1% (n=66) noticed a decrease in menstrual cycle length. On the other hand, 10.3% (n=40) observed an increase in cycle length. Heavy menstrual bleeding affected 8% (n=31) of the women and 4.9% (n=19) became pregnant. However, 31.8% (n=123) did not notice any changes in their menstrual cycle following the surgery.
For satisfaction with the ability to carry out daily activities, 18.6% (n=72) disagreed, 24% (n=93) were neutral and 57.4% (n=222) agreed, and satisfaction with available health services indicated that 16.5% (n=64) disagreed, 20.7% (n=80) were neutral and 62.8% (n=243) agreed.
A logistic regression analysis showed age was a significant negative association (p=0.028), indicating that younger age groups are less likely to experience menstrual changes. Marital status (p=0.329) and time since surgery p=0.841) were not significant predictors. Having a chronic disease (p=0.242), using contraceptives (p=0.583), significant weight loss (p=0.249) and a regular menstrual cycle before surgery (p=0.195) were not significant predictors. However, having changes in the menstrual cycle before surgery was a significant predictor (p=0.002), increasing the likelihood of post-surgery changes. Having menstrual problems before surgery (p=0.376) was not significant.
A majority of patients rated their quality of life highly, with 48.8% (n=189) giving it a five and 22% (n=85) giving it a four. A moderate quality of life rating of three was also reported by 22% (n=85). Lower ratings were less common, with 4.4% (n=17) rating their quality of life as two and 2.8% (n=11) rating it as one.
“Our research adds to the expanding corpus of literature on the impact of sleeve gastrectomy on menstrual health and quality of life among Saudi women. The findings underscore the need for comprehensive pre-operative counselling, personalised management strategies, and ongoing support to address menstrual changes and optimize overall health outcomes post-surgery,” the study concluded. “By understanding these dynamics, healthcare providers can better tailor interventions to meet the unique needs of bariatric surgery patients, improving their general state of health and living standards.”
The findings were featured in the paper, ' Menstrual Changes in Women Who Undergo Sleeve Gastrectomy in Saudi Arabia', published in Cureus. To access this paper, please click here
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