Obesity and its concomitant comorbidities have a myriad of detrimental effects on health, fertility, and quality of life. Bariatric surgery is an effective treatment for inducing weight loss and reduction of obesity-related comorbidities including subfertility. The aim of this study was to explore the expectations and experiences of women with a desire to have children as a motivation for undergoing bariatric surgery. An inductive qualitative design was used. Fourteen women were interviewed, and transcriptions were analysed with thematic analysis. Two themes emerged: (i) Motherhood and Femininity and (ii) A Normal Life. Participants found no other solution than to seek bariatric surgery to be able to become pregnant and carry a child to term. Coping physically with pregnancy and being an active mother were important factors. Overall, postoperative expectations were met, and the women experienced the effects of normalised sex hormone levels, were more physically mobile, and were released from the previous social hindrances that obesity caused them. This study has clinical implications for providing support and information to women with subfertility considering bariatric surgery and to better understand their experiences of life after bariatric surgery.

Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss.    

This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss.  

Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery.  

Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data.  

Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration of levels after surgery. Ten women were included, and analysis of the horizons created the fusions of “Recognition of Unhealthy Body Weight”, “Dealing with Other People’s Opinions and Society’s Norms”, “Life has Changed in a Positive Way” and “Accepting Inner Self and Bodily Changes”.  

Finally, to elaborate on previous studies' findings and better understand the current knowledge base, a systematic review and interpretative meta-synthesis of published literature involving qualitative methods concerning women’s experiences of womanliness related to changes after undergoing bariatric surgery was conducted in study IV. Ten relevant studies were included, and a meta-synthesis, according to Gadamer’s hermeneutics, created the fusions of “Womanliness,” “A Healthy and Functioning Body,” and “Mind and Body Connection.”  

This thesis provides a clearer understanding of the experiences of living with obesity that motivate premenopausal women to seek bariatric surgery. The importance of postoperative benefits such as restored function, health and womanliness are illustrated as well as clarifying difficulties involving adaptations to life after surgery. These findings may inform potential bariatric surgery candidates and healthcare professionals of the experiences of women living with obesity, as well as expectations,  postoperative experiences and challenges. These findings promote patient-centred guidance prior to surgery and during postoperative follow-up. 

Objective

Few studies have been carried out concerning the influence of bariatric surgery on female sexuality and hormones, particularly utilizing hormone-based questionnaires. The effect of bariatric surgery on sex hormone levels, sexual function and health-related quality of life (HRQL) in women was analyzed in this study. Participants were included in a single-center study at a regional hospital in Sweden, with a duration of one-year follow-up.

Methods

One hundred non-smoking women, undergoing laparoscopic Roux-en-Y gastric bypass, were included in the study. Blood assay for sex-hormone binding globulin (SHBG), testosterone, estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was analyzed. Participants completed the Female Sexual Function Index (FSFI), Women’s Health Questionnaire (WHQ) and Psychological General Well-being Inventory (PGWB) parallel to lab testing.

Results

At one-year follow-up, several significant results were found concerning hormones and questionnaires. Testosterone decreased and SHBG increased, N = 68/100. Desire, arousal, orgasm, satisfaction and total score domains for the FSFI increased after one year, N = 53/100. WHQ domains concerning depressed mood, somatic symptoms, memory, anxiety, sexual behavior and attractiveness improved after one year, N = 47/100. All domains in the PGWB (N = 52), including anxiety, depressed mood, positive well-being, self-control, general health, vitality and total score improved at follow-up. Spearman’s Rho coefficient analysis found correlation between testosterone/WHQ-sexual problems (0.3), SHBG/WHQ-general health (0.3) and SHBG/FSFI-arousal (−0.3).

Conclusions

Bariatric surgery normalizes levels of sex-hormones in women, and results in improved sexual function, health-related quality of life and psychological well-being.