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Contraception. 1988 Nov;38(5):541-50.

Post-tubal sterilization problems correlated with ovarian steroidogenesis.

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Computer Centre, Monash University, Clayton, Australia.


Mid-luteal phase total urinary oestrogen excretion was found to be significantly reduced in women who had previously undergone tubal sterilization at least two years before assay; pregnanediol levels at or below 2.0 mg/24 hrs were significantly more frequent for the study group. These findings indicate that reduced ovarian function is associated with that procedure. The major problems declared as having been experienced subsequent to tubal sterilization were classified into three categories; some women declared problems in more than one category: (1) Abnormal uterine bleeding and/or menorrhagia, (2) Physical problems, (3) Psychological and/or psychiatric problems. Category 1 was associated with a significant fall in total oestrogen excretion, and category 2 with a significant fall in both total oestrogen and pregnanediol excretion. Analysis of category 3 will be published elsewhere. A negative correlation between total oestrogens and cholesterol was observed.


Mid-luteal phase total urinary estrogen excretion and pregnanediol levels were monitored in 112 self-selected, regularly menstruating women who had been sterilized 2 or more years before, and compared to 55 controls. The controls had neither used contraception or ovulation identification methods within 3 months, nor had they had gynecologic surgery. The mean total estrogen excretion of the study subjects was significantly lower than that of the controls, 29.6 vs 36.0 mcg/24 hours (p0.0001). When the data were presented as histograms, 25% of the study group had estrogen means below the 10 percentile value for controls. The histograms were skewed to the right for both groups. Results for pregnanediol analyzed in the same way did not differ significantly, although 23.4% did have pregnanediol excretion below the 10 percentile level controls. The study subjects were categorized into 3 groups: those with abnormal uterine bleeding, physical problems, and psychological problems. Some other observations included the negative correlation between estrogen and pregnanediol excretion and serum cholesterol levels; as association of low estrogen with abnormal menstrual bleeding; and an association of low estrogen and pregnanediol with physical problems. The authors suggested a theory of localized hypertension and tissue damage to explain poor ovarian function in these sterilized women. Female hormone production has been linked with some of the problems found in these groups, such as weight gain, osteochrondritis,gastritis, irritable bowel syndrome, dysmenorrhagia and breast adenosis.

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