The risk of menstrual abnormalities after tubal sterilization

Background: The existence of a post-tubal-ligation syndrome of menstrual ab normalities has been debated for decades. We used data from the U.S. Collab orative Review of Sterilization to determine whether the likelihood of pers istent menstrual abnormalities was greater among women who had undergone tu bal sterilization than among women who had not. Methods: A total of 9514 women who underwent tubal sterilization and 573 wo men whose partners underwent vasectomy were followed in a multicenter, pros pective cohort study for up to five years by means of annual telephone inte rviews. All women were asked the same questions about six characteristics o f their menstrual cycles in the presterilization and follow-up interviews. Multiple logistic-regression analysis was used to assess the risk of persis tent menstrual changes. Results: The women who had undergone sterilization were no more likely than those who had not undergone the procedure to report persistent changes in intermenstrual bleeding or the length of the menstrual cycle. They were mor e likely to have decreases in the number of days of bleeding (odds ratio, 2 .4; 95 percent confidence interval, 1.1 to 5.2), the amount of bleeding (od ds ratio, 1.5; 95 percent confidence interval, 1.1 to 2.0), and menstrual p ain (odds ratio, 1.3; 95 percent confidence interval, 1.0 to 1.8) and to ha ve an increase in cycle irregularity (odds ratio, 1.6; 95 percent confidenc e interval, 1.1 to 2.3). Among women who had had very heavy bleeding at bas e line, women who had undergone sterilization were more likely than women w ho had not undergone the procedure to report decreased bleeding (45 percent vs. 33 percent, P=0.03). Conclusions: Women who have undergone tubal sterilization are no more likel y than other women to have menstrual abnormalities. (N Engl J Med 2000;343: 1681-7.) (C) 2000, Massachusetts Medical Society.