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Lancet. 1985 Apr 13;1(8433):847-9.

Oestrogen deficiency after tubal ligation.


4 of 7 women who had undergone tubal ligation within the past seven years were found to have oestrogen excretion concentrations at ovulation below the tenth percentile. A disturbance in the oestrogen/progesterone ratio as a consequence of localised hypertension at the ovary, when the utero-ovarian arterial loop is occluded at tubal ligation, is proposed as a possible cause of oestrogen deficiency syndrome, dysfunctional uterine bleeding, and menorrhagia after tubal ligation. Similar pathophysiology may occur after hysterectomy with ovarian conservation.


In an effort to determine whether a disturbed estrogen/progesterone ration is a likely explanation for increased incidence of menorrhagia, abnormal uterine bleeding, and major surgery after tubal ligation, concentrations of estrogen and progesterone at ovulation were measured in 7 women who had used the Billings ovulation method to identify ovulation and who had subsequently undergone tubal ligation. To qualify for inclusion the women had to be able to identify fertile mucus and the peak sympton and be prepared to collect urine in 24-hour specimen lots on the 3 days surrounding ovulation. Total estrogen levels on the day of ovualtion were below the 10th percentile in 4 of the 7, while 5 of 6 post-ovulatory pregnanediol concentrations were within the normal range for ovulation. 1 woman who had experienced gradually longer and heavier menses over 3 years following unipolar tubal ligation by cautery had a return to normal from the 1st cycle after taking piperazine estrone .3mg from day 4 to day 25 of each cycle. The menstrual duration and flow had remained normal for 6 months on estrogen supplementation. A possible cause of the estrogen deficiency syndrome might be a disturbance in the estrogen/progesterone ratio resulting from localized hypertension at the ovary when the utero-ovarian arterial loop is occluded at tubal ligation. Production of both estrogen and progesterone by the ovary is dependent on blood supply; imbalence in the estrogen/progesterone ratio presupposes that progesterone production is less markedly affected than estrogen production. Between 3.3 and 8 times more oxygen is required to produce 1 mol of estrogen than to produce 1 mol of progesterone. A similar situation may occur after hysterectomy if 1 or both ovaries have been conserved. The hypothesis is consistent with evidence from several published reports.

[Indexed for MEDLINE]

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