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Does tubal sterilization influence the subsequent risk of menorrhagia or dysmenorrhea?
Bernard L Harlow1, Stacey A Missmer, Daniel W Cramer
1Department of Obstetrics and Gynecology, the Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. bharlow@rics.bwh.harvard.edu
Objective:
To evaluate the relation between tubal ligation, change in menstrual cycle characteristics, and early follicular phase hormones.
Design:
Cross-sectional analysis of women 36-44 years of age.
Setting:
The greater Boston area.
Patient(S):
Nine hundred seventy-six premenopausal women with intact uteri.
Intervention(S):
A comparison of women with and without a history of tubal ligation.
Main Outcome Measure(S):
Menstrual and reproductive histories were self-reported. Early follicular phase blood samples were obtained to assess FSH, LH, and E(2). We compared menstrual cycle changes from the first 5 years after menarche with completion of the baseline questionnaire in women with and without a prior history of tubal ligation.
Result(S):
Cycle length, cycle regularity, menses length, flow volume, dysmenorrhea, and hormone levels were similar in women with and without a history of tubal ligation. However, among parous women with a history of cesarean section, those with a tubal ligation >5 years ago experienced a marginal increase in volume of menstrual flow compared with women with no tubal ligation history.
Conclusion(S):
We found no significant change in menstrual cycle characteristics or hormone levels in women with or without a history of tubal ligation. However, tubal ligation may have a modest effect on the change in menstrual flow volume over time among parous women with a history of cesarean section.
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Hormonal Regulation of the Menstrual Cycle
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH release.
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Oogenesis