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Do Menstrual Problems Increase After Tubal Ligation?



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Am Fam Physician. 2001 Jul 1;64(1):153-157.

Tubal ligation is the most common method of contraception used in the United States. It is considered safe and highly effective. However, since the early 1950s, the existence of a “posttubal ligation syndrome” has been debated. The hallmark of this syndrome is an increased risk of menstrual abnormalities. Moreover, results from one study indicated that women who have this surgery were four to five times more likely to have a subsequent hysterectomy; results from a second study showed that 41 percent of the women who underwent hysterectomy had a previous tubal sterilization. To make further determinations about this issue, Peterson and colleagues reported data from the U.S. Collaborative Review of Sterilization, a large prospective study evaluating the long-term safety and effectiveness of tubal ligation.

The U.S. Collaborative Review was started in 1978 and included women between 18 and 44 years of age who were undergoing tubal sterilization at one of several institutions throughout the country. A second group of women whose partners had undergone vasectomy was added to the study later. All women were followed by annual telephone interviews for five to 14 years and were asked to describe their three most recent menstrual periods. Six features of periods that were addressed were duration of bleeding, length of cycle, bleeding or spotting between cycles, cycle irregularity, amount of menstrual pain and amount of bleeding. The findings from the tubal sterilization group were compared with findings from the group whose partners had undergone vasectomy. The primary outcomes of interest were changes in various features of the menstrual cycle.

There were 9,514 women in the tubal ligation group and 573 women in the group whose partners had a vasectomy; the median age of the women in the two groups was 31 ± 6 years and 32 ± 5 years, respectively. The primary difference between the two groups was that women in the tubal ligation group were more likely to have used oral contraceptives or an intrauterine device before their surgery. Adjusting for age, race and baseline menstrual characteristics, women in the surgery group were more likely to report persistent decreases in the amount of bleeding and days of bleeding, and in menstrual pain. These women were also more likely to report a persistent increase in cycle irregularity. However, when analysis of the data was limited to women who had their most recent natural cycles immediately before surgery, the differences noted above were no longer statistically significant. The authors also noted no differences in the various aspects of the menstrual periods in relation to one of the six methods used for sterilization.

The authors conclude on the basis of this data that tubal sterilization does not result in a post-tubal ligation syndrome. Women who undergo this procedure are actually more likely to experience a decrease in the amount and duration of bleeding. The authors state that past observations of an association between tubal sterilization and menstrual abnormalities are coincidental and attributable to the fact that both events occur commonly. A second reason for the observed variability in menstruation may be that women often stop taking oral contraceptives at the time they undergo sterilization. Finally, the authors note that indications for hysterectomy should be the same in women who have undergone tubal sterilization as in those who have not.

Peterson HB, et al. The risk of menstrual abnormalities after tubal sterilization. N Engl J Med. December 7, 2000;343:1681–7.



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