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Pre-Op - Help choosing surgery type for long term success with menopause working against me?



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Newbie here!
I am in menopause and have been for at least 5 years. I have a BMI of 42 with approximately 100 lbs to lose, which is about 78% of my excess weight. The reason why I gained this much weight is because I was in perimenopause since the age of 32 and my weight kept creeping up year after year. No diet or exercise regimen has worked and I see surgery as the only way I can lose without gaining it back and then some.
I am working with a bariatric surgeon in a bariatric center of excellence in my area. She is very good at what she does, and has done 300 surgeries a year for the last 4 years, and does bariatric surgeries exclusively. After examining me and hearing my concerns she has given me the choices of Gastric bypass "Roux en Y" or Gastric sleeve and said it is up to me which I would rather do, and I'm researching this now. I do not have any GERD/acid reflux.
Before I even walked into her office, I wanted the gastric sleeve because of the lower risks and not losing any nutrient absorption in my small intestine. BUT... the more research I do seems to point to menopausal women losing a much more statistically significant amount of weight with Roux en Y Gastric Bypass. I am also nervous about gaining back the weight after the initial 1 year of weight loss after surgery... surgery doesn't affect "those" hormones and I don't want to lose my 100 lbs just to have it keep creeping up and up again.
Given your experiences, which surgery would you go with in my shoes? If you ruled out all of the health risks and only took into account the ability to get down to a good goal weight and stay there, is one procedure much better than the other or are they about even?
Thanks in advance for your insight.

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people on average supposedly lose more weight with the bypass, but it's really not by a significant amount. We're talking a few pounds. And that's just an average anyway - some sleevers end up losing more than bypassers, so YMMV. Your level of commitment to your plan has a lot more to do with your ultimate success than which surgery you go with. There are people on here who've been wildly successful with both - and other people who have failed on both. It comes down to how committed you are. If you follow the rules, you'll be successful.

you do have to put in a lot of work to get the weight off and keep it off. The way I like to describe the surgery is that it gives you a strong "tail wind", which really helps you get to where you want to go. For once in my life, my efforts actually worked. I lost all of my excess weight and I'm not obese anymore. But - it was still effort - and it's also still an effort to maintain my loss. Five years out, I still have to monitor myself - weigh myself often, log everything I eat. If I stop paying attention for more than a few days, my weight starts heading north.

as far as risks, yes, there are slightly more risks with the bypass, but both are extremely low risk surgeries. Many of us never had any complications, and of those who do, most are minor and "fixable". Major complications with these surgeries are pretty rare.

Malabsorption of nutrients with the bypass is rare as long as you keep on top of your Vitamins. The one exception seems to be Iron. Some people don't absorb iron from tablets very well and have to get occasional infusions. But that's not very common - most of us absorb iron from tablets just fine. As far as other Vitamin deficiencies - again, very rare. Most people who experience those aren't keeping to top of their supplements.

as long as you don't have GERD, it really comes down to personal preference. I went with the bypass because I had GERD prior to surgery, so it was a no-brainer. If that weren't the case, I probably still would have gone with the bypass because at the time I had surgery (five years ago), the sleeve was still kind of new, so I was a little leery about going with it. That was the time people were having tons of problems with lapbands and many people were having them removed, and I was afraid of the sleeve becoming "lapband 2". However, it's been around long enough now that it's proved itself, so I wouldn't have that fear anymore.

btw - I was 55 when I had surgery and post-menopausal.

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Thank you catwoman7. This helps a lot. I'm 50. How long did it take you to get down to your current weight? That is my "too good to be true" weight, I'm shooting for 160 best case scenario.

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5 hours ago, minimamaz00m said:

Thank you catwoman7. This helps a lot. I'm 50. How long did it take you to get down to your current weight? That is my "too good to be true" weight, I'm shooting for 160 best case scenario.

I reached my lowest weight (138) at 18-20 months post-surgery. I gained c. 12 lbs in year 3, which is very common (most people seem to have a 10-20 lb "bounce back" during year 2 or 3). I've been pretty stable since then, though.

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I had my sleeve post-menopause at age 55. I lost 100 lbs and kept it off. Developed GERD and converted to bypass 2 weeks ago. I don't think being post-menopausal had anything to do with my success, I think it was the right surgery for me at the time and I had a great surgeon. If I had it to do all over again I'd still have a sleeve first. catwoman is right when she says the surgery helps but it's not going to work if you don't do your part. chocolate and ice cream slide down a sleeve very easily. I saw the scale start to creep up when I relaxed my vigilance but fortunately resolved the problem before it became more than 5 lbs, which were not too difficult to lose.

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Check the stats on patients with the sleeve that regain their weight. I went that route first and regained. This year I had a modified DS (SADI-S) done. I've had amazing results. Stats on keeping the weight off with this surgery are very good.

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I put on weight when I was peri menopausal too (about 15kg over 3yrs) & then I swear, overnight, I put on another 15 when I became menopausal at about 50 (so didn’t want to be that big at fifty!) Couldn’t shift it at all. My battle with weight started when I hit puberty - gain, lose, repeat. Blasted hormones!!

I had my sleeve surgery 14 months ago when I was almost 54 & I’ve surpassed my goal. I haven’t been this weight since I began puberty - so full circle. Yes, I worry about regain especially the not uncommon 5+kg in yrs 1&2. I intend to work at this every day & try not to slide into habits that will cause me to gain.

Our weightloss journeys are all different & what works for one may not work for another. The key is to find what best works for you & how you want to live & enjoy your life be it which surgery you chose, how much weight you want to lose lose, how active you want to be, etc.

As an aside all my menopausal symptoms disappeared during my weight loss thanks to all that eostrogen flooding my body from the vanishing fat. I actually dropped my HRT at about 12 months thinking I was over it but... no. They all came back so I’m back on HRT. Have to admit the hot flushes weren’t as severe as when I was overweight probably because I was always hot then.

Good luck.

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Fellow Pre-mature menopauser here. Last period was age 42. I'm 47 now. I was not obese at age 42. Those who did not suffer the consequences of losing those particular hormones early don't really understand how it contributes to the gain. I am 5' 5" and was 217 on my surgery day. I opted for Bypass largely because of the way early menopause changed my body and my inability to lose even when following healthy diets like Weight Watchers. It's been slow. I'm post op day 35 and have lost 18 pounds. But I'm trucking right along and happy with my surgery choice. I believe my surgeon would say if you don't have GERD the choice is not significant. I was concerned about dumping and malabsorption. So my doc did a short bypass, 100 cm instead of the usual 150-200cm. Could also be why the loss is slower. But I fully believe my body does not want to feast on the fat that early menopause grew. Anyway, just wanted to say "Hi" and I get it. And while either surgery is a fine choice I chose Bypass to combat the early meno. Best of luck! Keep us updated!

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@MaybeMeow Thank you for your insight! My last diet I tried was the Fast Metabolism Diet. While other people were losing 20 lbs in a month, I lost 3 lbs in 4 months of following the program religiously. So, my body likes to hold on to that fat too... I was about 160 lbs before early menopause happened, so I've gotten an extra 100 lbs from it. 😒

Please keep us updated on your progress. I don't have to decide on a surgery type for about a month, maybe 2. As another early menopauser I'd really like to learn from your experience.

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