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Post- Tubal Syndrome
Title:Is there any evidence for post-tubal sterilization syndrome?
Author: G. Gentile
Address:Brooklyn NY and Bethesda MD
Source: Fertility and Sterility 69: 179-186 (February) 1998
The phrase "post-tubal ligation syndrome" has been used to describe a variety of symptoms that have been said to occur after tubal sterilization. These symptoms range from mild menstrual disturbances to severe pelvic pain and heavy bleeding significant enough to result in further gynecologic surgery. This study reviewed the literature using MEDLINE, selecting 50 studies from 1951-1993 to assess menstrual and hormonal changes in women who undergo tubal sterilization. Many authors had reported increased menstrual distress, heavy and prolonged bleeding, and dysmenorrhea. The studies analyzed were divided into 6 categories: outcome of hysterectomy after tubal sterilization; change in menstrual symptoms after tubal sterilization not controlled for prior contraceptive use; change in menstrual symptoms after tubal sterilization controlled for prior contraceptive use; non-hormonal objective measures of menstrual changes; hormonal measures in women with menstrual changes after tubal sterilization; hormonal measures in women with no menstrual changes after tubal sterilization. The primary design flaw unearthed in these studies appeared to be failure to control for age, parity, obesity, previous contraceptive use, interval of symptom onset, since sterilization and type of tubal sterilization. The authors state "the only consistency in the articles reviewed is their inconsistency." The of the 15 studies that did control for variables, there were no significant changes , except in women between the ages 20-29. It was concluded that tubal sterilization is not associated with an increased risk of menstrual dysfunction, dysmenorrhea, or increased premenstrual distress in women who have experienced tubal sterilization after 30 years of age. There may be an increased risk for those 29 although no significant hormonal change is noted in these women.
Comment: In 'What's Up Doc' 3/23/98 a "Causal Relationship" between tubal sterilization and hysterectomy was reported. The careful review above is convincing and should be added to the general knowledge base of practicing physicians. Somehow though, there seems to be an occasional patient in whom it is difficult to dismiss post sterilization changes.
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