Unintended Pregnancy Prevention:
Female
Sterilization |
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More women in the United States have undergone tubal sterilization as a
method of contraception, than any other single method available. Tubal
sterilization is a highly effective and safe procedure; however, the
possible existence of a “post-tubal ligation syndrome” of menstrual
abnormalities has been debated for years. Therefore, researchers conducted a
study using data from the U.S. Collaborative Review of Sterilization to
determine if menstrual abnormalities were greater among women who had
undergone tubal sterilization than among women who had not. This fact sheet
is a brief summary of the study that was published in the December 7, 2000,
issue of the New England Journal of Medicine.
Questions and Answers About the U.S. Collaborative
Review of Sterilization Study of Tubal Sterilization and Menstruation
Background: An article presenting
results of the Collaborative Review of Sterilization (CREST) study was
published in the December 7, 2000, issue of the New England Journal of
Medicine (volume 343, pages 1681–1687). For nearly a half century,
there has been some concern that tubal sterilization may result in
menstrual abnormalities, such as an increase in menstrual pain and
bleeding. Results of this study show that tubal
sterilization is not associated with menstrual problems.
Why is the study important?
Tubal sterilization is the
most common method of contraception used in the United States. More
than 10 million women in the United States, and more than 100 million
worldwide, have had the procedure. The concern that women who have
had tubal sterilization may suffer from menstrual abnormalities
following the procedure led many to classify such abnormalities as
“post-tubal ligation syndrome.” Because such a large number of
women could be affected, it was very important to determine whether
adverse menstrual problems may result from tubal sterilization. This
study provides evidence against any "syndrome" of menstrual
abnormalities following tubal sterilization. In the study, women who
had tubal sterilization were no more likely than women who had not
had the procedure to experience menstrual abnormalities.
What types of questions
about menstruation did the researchers ask women in this
study?
Women in the study were
asked several questions about their most recent menstrual periods,
including the number of days of menstrual bleeding they had during
their periods, the number of days from the beginning of one
menstrual period to the beginning of the next, how regular their
periods were, the amount of bleeding they experienced during their
periods (such as whether their periods were heavy or light), the
extent to which they had pain during menstruation, and whether they
had bleeding or spotting between periods.
Did the study only
include women who had undergone tubal sterilization?
No. Changes in
characteristics of menstruation occur throughout a woman's life,
from menarche to menopause. In order to determine whether menstrual
changes that occurred among women who had undergone tubal
sterilization were associated with the sterilization itself rather
than resulting from aging or some other factor, the researchers
needed to also interview a “comparison group” of women who had
not had tubal sterilization. Women whose partners had a vasectomy
were enrolled to serve as the comparison group. This was a
particularly good group for comparison purposes because these women
would be unlikely to use other methods of contraception, such as
birth control pills, which are known to affect menstrual cycles. In
addition, both tubal sterilization and vasectomy are permanent
methods of contraception; therefore, pregnancies would not be
expected in either group and information about several years of
menstrual cycles could be collected.
Were the women
interviewed more than once about their menstrual cycles?
Yes. The women who had
undergone tubal sterilization as well as the partners of men
undergoing vasectomy were interviewed every year for at least five
years. The researchers suspected that any true “syndrome” of
menstrual abnormalities would be persistent. Certainly, menstrual
changes that would be particularly bothersome to women would be
those that were persistent and occurred over several cycles. Each
woman was first interviewed just prior to her tubal sterilization or
close to the time of her partner's vasectomy. Women were then
interviewed each year for five years and asked the same questions
about their most recent menstrual cycles. By collecting the
information this way, the investigators were able to determine how
the women's menstrual cycles changed following the procedure,
whether any changes were persistent, and whether changes differed
between the women who had undergone tubal sterilization and women
whose partners had undergone vasectomy.
Would the specific type
of procedure used for the tubal sterilization make a difference? Are
some procedures more likely than others to result in menstrual
abnormalities?
This was a concern of the
researchers. To address this, they also analyzed the data by looking
at the specific surgical methods used for tubal sterilization. None
of the methods were associated with a syndrome of menstrual
abnormalities.
What should a woman do
if she has menstrual problems following a tubal sterilization?
Any woman who
experiences menstrual problems that concern her should seek the
advice of her doctor, whether or not she has had a tubal
sterilization.
What about
hysterectomies?
Hysterectomies are
sometimes recommended to treat menstrual abnormalities, and belief
in a “post-tubal syndrome” has led some gynecologists to
recommend hysterectomy as treatment for the “syndrome.” Previous
analyses of CREST data found that women who had a tubal
sterilization were more likely to later have a hysterectomy than
women who had not had a tubal sterilization. However, a variety of
treatment options are available for menstrual abnormalities,
depending on the nature and severity of the problem as well as the
patient's preference for treatment. In general, indications for
hysterectomy should be the same regardless of whether a woman has
had a tubal sterilization. The only obvious difference between
sterilized and non-sterilized women with respect to hysterectomy is
the fact that women who have chosen tubal sterilization have already
selected a permanent and surgical method of contraception.
What else is important
to know about tubal sterilization?
Tubal sterilization is a
safe and effective method of contraception. Tubal sterilization is a
permanent form of contraception, and should therefore only be
considered by those who no longer wish to bear children. Couples who
are considering a permanent form of contraception may wish to also
consider other permanent options, including vasectomy, or highly
effective but not permanent options, such as an interuterine device
(IUD).
Surgical sterilization in the United States:
prevalence and characteristics, 1965–1995
View PDF 289KB
This report presents national data on the prevalence of surgical
sterilization from 1965 to 1995 among women aged 15–44 years of
age. Data are shown by type of sterilizing operation and demographic
characteristics of the women. For the 1994 survey data, reasons for
the three most common sterilizing operations (tubal ligation,
vasectomy, and hysterectomy) are shown, as well as
the desire for reversal among those with potentially reversible
operations. Source: Vital and Health Statistics Series
23/No.20
Risk of Ectopic Pregnancy After Tubal
Sterilization Fact Sheet
Among 10,685 women studied, the risk of ectopic pregnancy within 10 years
after sterilization was about 7 per 1,000 procedures.
Source: March 13, 1997 issue (336:762-767) of
The New
England Journal of Medicine.*
American College of
Obstetrics and Gynecology*
National Library of Medicine
Conduct a search for more information about female sterilization and other health
topics.
Search PubMed for articles on Female Sterilization
This search is being conducted on PubMed an NLM/NIH service.
Search PubMed for articles on Etopic Pregnancy
This search is being conducted on PubMed an NLM/NIH service.
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Page last reviewed: 3/26/08
Page last modified: 4/4/07
Content source:
Division of Reproductive Health,
National Center for Chronic
Disease Prevention and Health Promotion |