Tubal ligation and early menopause: a case-control study

Abstract

Submit Manuscript | http://medcraveonline.com Abbreviations: BMI, body mass index; FSH, follicle stimulating hormone; HDF, hôtel-dieu de france BackgroundThe effect of the use of tubal sterilization as a birth control method on ovarian function, ovarian reserve and menopausal age is questionable. In fact, bilateral salpingectomy or tubal ligation 1 and conservative abdominal hysterectomy 2 were sometimes related to decrease ovarian function and premature menopause. The decrease of hormonal secretion will cause endocrine disorders manifested by decreased libido, vaginal dryness, mood swings and vasomotor symptoms. The alteration of the ovarian function by sterilization has been hypothesized to be responsible for menstrual abnormalities and hormonal disturbances that characterize the so-called posttubal ligation syndrome.3,4 The logic behind this theory is that the vascularization of the ovaries by either ovarian artery or the uteroovarian anastomoses as well as the fallopian tube destruction reduce the utero-ovarian arterial blood flow in the mesosalpinx, which leads to ovarian tissue damage. 4 In 1987, Riedel HH et al. 5 found that the levels of estrogen and progesterone decrease after fallopian tube sterilization and hysterectomy.5 Nonetheless, Kusche M et al. 6 in 1994 contradicted this finding by stating that no endocrinological parameters in the perimenopause were found, neither did cycle anomalies and ovarian deficiency symptoms in terms of climacteric complaints occur earlier, nor did early onset of menopause occur more often in the operated group. In this context, the objective of the present study was to compare age at menopause between the women having already undergone tubal ligation and the control group having intact fallopian tubes. Also, we review literature about the long-term safety of tubal ligation. Methods Study settings and populationFor the purpose of this case-control study, we retrospectively reviewed the medical records of all women (cases) who had previously undergone bilateral tubal ligation between 1970 and 2010 at the department of Obstetrics and Gynecology, Hôtel-Dieu de France (HDF) University Hospital, Beirut, Lebanon.More than 200 patients were contacted of whom many were found to have changed their phone numbers. Eligible cases had to be menopaused; menopause was defined as having amenorrhea for more than 12 months with or without symptoms related to hormonal depletion. Exclusion criteria were patients who were operated for bilateral ovariectomy or salpingectomy or hysterectomy before their physiological menopause, and patients who got chemotherapy, radiation therapy or any hormonal therapy that could influence their reproductive function and alter their normal evolution towards menopause.The 50 cases were then compared to 50 randomly chosen menopaused women (controls) from the department of Obstetrics and Gynecology at HDF, who did not get any tubal ligation or gynecological surgeries (intact tubes, ovaries and uterus) but meeting the same eligibility criteria as the cases....

Association of oral contraceptives and tubal ligation with risk of early natural menopause

“…It is well established that TL is a preventive factor for ovarian cancer with one proposed mechanism for the protection being a disruption to the ovarian vascular blood supply resulting in diminished levels of sex steroid hormones produced by the ovaries (Hakverdi et al, 1994;Rice et al, 2012). As such, it has been hypothesized that the procedure may have negative implications for ovarian function and reserve, and lead to earlier menopause, yet few studies have examined the long-term association between TL and early menopause (Pokoradi et al, 2011;Nichols et al, 2013;Abi Tayeh et al, 2018;Ainsworth et al, 2019).…”