The Risk of Menstrual Abnormalities After Tubal Sterilization
Tubal sterilization is the method of family planning most commonly used. The existence of the post-tubal-ligation syndrome of menstrual abnormalities has been the subject of debate for decades.
Abstract Background
Tubal sterilization is the method of family planning most commonly used. The existence of the post-tubal-ligation syndrome of menstrual abnormalities has been the subject of debate for decades.
Methods
In a cross-sectional study, 112 women with the history of Pomeroy type of tubal ligation achieved by minilaparatomy as the case group and 288 women with no previous tubal ligation as the control group were assessed for menstrual abnormalities.
Results
Menstrual abnormalities were not significantly different between the case and control groups (p = 0.824). The abnormal uterine bleeding frequency differences in two different age groups (30–39 and 40–45 years old) were statistically significant (p = 0.0176).
Conclusion
Tubal sterilization does not cause menstrual irregularities.
Background
Tubal sterilization is the most commonly used method of family planning. In 1990 the corresponding percentage of married women in reproductive age who used sterilization was 22% in developing countries and the corresponding percentage in developed countries was 11%. These women represented 44% and 18% of all contraceptive users in developing and developed countries, respectively. Questions regarding the existence of a post tubal ligation syndrome of menstrual abnormalities continue. Questions arose initially when Williams and colleagues reported in 1951 that sterilized women had a higher than expected occurrence of menorrhagia and metrorrhagia [1]. After that the existence of a post-tubal-ligation syndrome of menstrual abnormalities has been debated for decades [2]. Many authors have investigated the sequelae of female sterilization [2-9]. Increased premenstrual distress, heavier and more prolonged menstrual bleeding, and increased dysmenorrhea have been reported [3]. However, failure to control for use of oral contraceptives, age, obesity, parity, interval since sterilization, or type of sterilization may have effects on the results of these studies [1,3]. Because of the importance of this debate, we compared the occurrence of menstrual abnormalities in women with and without a prior history of tubal ligation.
Methods
This cross sectional case control study has been carried out on 500 women at Al-zahra hospital during 1999 to 2001 to assess the effect of tubal sterilization on the menstrual cycle. 260 women with abnormal uterine bleeding referred for diagnostic curettage, and 240 healthy women under the coverage of the hospital family planning center were selected randomly, and all were assessed for tubal ligation.
All women aged 30 to 46 were selected from a low-income urban population, with body weight between 50 to 90 kg. In the abnormal uterine bleeding group, those who had intrauterine device (IUD), leiomyoma on sonography, uterine size of greater than 9 cm or suffered from medical disorders were excluded from the study. Of 260 patients with menstrual irregularities, 30 subjects were excluded from the study. From the remaining 230 subjects, assessed for tubal sterilization, 87 patients had tubal ligation. Of 240 healthy women assessed for tubal ligation, 95 had previous tubal ligation. Totally 182 subjects with previous tubal ligation (case) and 288 subjects with no history of previous tubal ligation (control) were compared for abnormal uterine bleeding. Those subjects in the case group who had menstrual abnormalities, IUD, medical disorders or were on hormonal contraception, during the first year prior to the sterilization were excluded from the study. Those who were at least 30 and at most 40 years of age by the time of tubal ligation and had Pomeroy type of interval tubal ligation via minilaparatomy were included the study. Finally, considering the exclusion and inclusion criterias, 112 subjects remained in the case group and 288 with no tubal ligation in the control group were evaluated for menstrual abnormalities. Information on demographic, obstetrics, medical and menstrual bleeding pattern of all subjects were obtained. Women were asked about the duration and amount of bleeding, and length of cycle (number of days from the beginning of one menstrual period to the beginning of the next one). A menstrual interval of 21 to 35 days was considered normal. A menstrual interval shorter than 21 days was defined as polymenorrhea. Duration of flow of 7 days or less was considered normal. A patient's self-described history of normal or heavy blood loss was indicative of the amount of flow. Regularly timed heavy bleeding and duration of flow greater than 7 days were considered menorrhagia and hypermenorrhea respectively. Excessive and prolonged bleeding that occurred irregularly was defined as menometrorrhagia.
Data was analyzed by the SPSS statistical software (version, 12) and compared with the chi-square test. P values of 0.05 or less were considered as statistically significant.
Results