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  • Title: Menstrual function after tubal sterilization.
    Author: Wilcox LS, Martinez-Schnell B, Peterson HB, Ware JH, Hughes JM.
    Journal: Am J Epidemiol; 1992 Jun 15; 135(12):1368-81. PubMed ID: 1510083.
    Abstract:
    More than 10 million women in the United States have undergone tubal sterilization. There has been concern that this procedure may increase the risk of later menstrual dysfunction. The Collaborative Review of Sterilization (CREST) is a large, multicenter, prospective study of tubal sterilization in the United States. This report describes CREST participants who were interviewed immediately before sterilization and again in annual poststerilization interviews for up to 5 years between 1978 and 1988. The authors analyzed reported changes in six menstrual cycle characteristics for 5,070 women undergoing interval sterilizations. Longitudinal, multivariate regression was used to adjust for baseline menstrual function and other potential confounders. Five years after sterilization, 35% of the CREST participants reported high levels of menstrual pain, 49% reported heavy or very heavy menstrual flow, and 10% reported spotting between periods. In contrast to the fifth year, the first year of follow-up was similar to presterilization menstrual function; in the first year, 27% of participants reported high menstrual pain, 41% reported heavy menstrual flow, and 7% reported spotting. These findings may be affected by aging of the cohort and other study limitations, but they suggest that if tubal sterilization leads to changes in menstrual function, such changes may take some time to develop. Over 100 Million women worldwide have undergone tubal sterilization. The Collaborative Review of Sterilization (CREST) study at 12 medical centers in the US between 1978-83 examined 5070 women at 4 periodic intervals up to 5 years after the procedure. The purpose was to ascertain whether there were any changes in 6 menstrual cycle characteristics. Several different sterilization methods were examined: unipolar coagulation, bipolar coagulation, silastic band application, spring clips application, partial salpingectomy, and thermocoagulation. Other baseline characteristics which might affect changes in menstrual function over time were examined, i.e., race, body mass index, education, age, gravidity, history of pelvic pathology and pelvic surgery, method contraception immediately preceding sterilization, and incidental pelvic pathology during the sterilization. The presurgery interview included information on baseline menstrual function. The findings from multivariate analysis with unadjusted data showed changes at 5 years but not 2, including increases in menstrual pain, amount of bleeding, and intermenstrual spotting in an amount 1.3-1.8 times greater than those reporting in year 2. There were significant decreases in days/cycle and days of bleeding/cycle for the most women reporting changes. Sterilization method analysis revealed differences between methods for days/cycle, amount of bleeding, menstrual pain, irregularity, and spotting. 33% of women with the spring clip procedure reported increases in menstrual pain. The adjusted model, showed statistically significant differences in cycle length in the 5th year vs. the 1st year, as well as increases in menstrual pain, amount of bleeding, and spotting. Women with the longest cycle lengths in the adjusted analysis used the unipolar coagulation method, and the shortest cycle lengths, the spring clip. Those with the spring clip were also more likely to have menstrual pain and greater bleeding. Black women reported less irregularity and spotting and fewer days of bleeding. Older age at sterilization was related to less pain and greater regularity. The changes in bleeding pattern and menstrual pain are of greatest concern and the most frequently reported in other studies of effects of sterilization. Tissue destruction was found not to be related. Caution is urged in the interpretation of findings. Future research should focus on follow up after 5 years and comparisons with nonsterilized women.
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