OBJECTIVE:

To review the literature on menstrual and hormonal changes in women who under go tubal sterilization.

DESIGN:

A systematic review through MEDLINE and a literature search identified more than 200 articles in the English literature from which the most relevant were selected for this review.

RESULT(S):

Many authors have investigated the sequelae of female sterilization. Increased premenstrual distress, heavier and more prolonged menstrual bleeding, and increased dysmenorrhea have been reported. However, failure to control for age, parity, obesity, previous contraceptive use, interval since sterilization, or type of sterilization may have affected study results. Most studies that have controlled for these important variables have not reported significant changes, except in women who undergo sterilization between 20 and 29 years of age.

CONCLUSION(S):

Tubal sterilization is not associated with an increased risk of menstrual dysfunction, dysmenorrhea, or increased premenstrual distress in women who undergo the procedure after age 30 years. There may be some increased risk for younger women, although they do not appear to undergo significant hormonal changes.

PIP:

Evidence for a post-tubal sterilization syndrome was sought in a literature review of over 200 English-language articles. This syndrome has been described, variously, as encompassing symptoms such as abnormal bleeding and/or pain, changes in sexual behavior and emotional health, exacerbation of premenstrual symptoms, and menstrual symptoms necessitating hysterectomy or tubal reanastomosis. It has been postulated that the destruction of the fallopian tube and, in some cases, portions of the mesosalpinx, alters the blood supply to the ovary, with consequent impairment of follicular growth and corpus luteum function. Evaluation of the research literature is hindered by the failure to control for age, parity, obesity, previous contraceptive use, interval since sterilization, or type of sterilization. Despite the vast discrepancies in the research findings, it does appear that women 20-29 years of age with pre-existing histories of menstrual dysfunction are at increased risk of some post-tubal sterilization symptoms. After this age, however, there is no consistent evidence that tubal sterilization is associated with an increased risk of menstrual dysfunction, dysmenorrhea, or increased premenstrual distress.