TUBAL-STERILIZATION AND LONG-TERM RISK OF HYSTERECTOMY - FINDINGS FROM THE UNITED-STATES COLLABORATIVE REVIEW OF STERILIZATION

Objective: To estimate the long-term probability of hysterectomy after sterilization according to demographic and clinical characteristics b efore the procedure. Methods: We used a prospective, multi-center coho rt study of 10,698 women undergoing tubal sterilization to examine the cumulative probability of hysterectomy up to 14 years after steriliza tion. Independent risk factors for subsequent hysterectomy were examin ed using the life-table approach and the Cox proportional hazards mode l. Results: The cumulative probability of undergoing hysterectomy 14 y ears after sterilization was 17%. The highest long-term cumulative pro babilities of hysterectomy occurred among women who, at the time of st erilization, reported a history of endometriosis (35%) or were older t han 30 years and reported prolonged bleeding during menses (46%). Mult ivariate modeling demonstrated an independently increased risk of hyst erectomy among women who, at the time of tubal sterilization, reported a history of heavy menstrual flow (relative risk [RR] 1.4; 95% confid ence interval [CI] 1.1, 1.7), severe menstrual pain (RR 1.3; 95% CI 1. 1, 1.6), bleeding of more than 7 days during menstrual cycles (RR 1.8; 95% CI 1.1, 2.8), pelvic inflammatory disease (RR 1.3; 95% CI 1.04, 1 .7), ovarian cysts (RR 1.6; 95% CI 1.2, 2.0), endometriosis (RR 2.5; 9 5% CI 1.7, 3.9), or uterine leiomyomata (RR 2.7; 95% CI 2.0, 3.7). Con clusions: Although women with gynecologic disorders before tubal steri lization were at greater risk of hysterectomy during the 14 years afte r sterilization than were women without these disorders, the majority of sterilized women in both categories did not undergo subsequent hyst erectomy. (C) 1997 by The American College of Obstetricians and Gyneco logists.