LONG-TERM EFFECT OF TUBAL-STERILIZATION ON MENSTRUAL INDEXES AND PELVIC PAIN

Objective: To evaluate the long-term effect of tubal sterilization on menstrual indices and pelvic pain. Methods: Five hundred women undergo ing sterilization were interviewed before sterilization, 6-10 months a fter surgery, and 3-4.5 years later. Four hundred sixty-six nonsterili zed comparison women were interviewed in parallel. The study populatio n consisted of low-income, ethnically and regionally diverse women fro m three participating institutions. Results: When women who were takin g oral contraceptives were excluded, no long-term difference was found between sterilized and nonsterilized women in terms of menstrual cycl es, bleeding between periods, prolonged or heavy flow, dysmenorrhea, o r noncyclic pelvic pain. Hysterectomy was uncommon (3.2%), but statist ically more prevalent among sterilized women (4.55%) than nonsterilize d women (2.17%) (P = .019). Conclusions: Tubal sterilization has no lo ng-term effect on menstrual indices or pelvic pain. An increase in sev ere dysmenorrhea, which emerged as a disturbing but nonsignificant tre nd at 6-10 months, did not progress over the next 3-4.5 years. Reasons for an increased rate of hysterectomy are not clear, but may be relat ed to a lower threshold for choosing hysterectomy as a treatment optio n once a woman has been sterilized.