{"paper_id":"1ac0e8ee-6969-4035-9dea-9aaf7797817c","body_text":"Submit Manuscript | http://medcraveonline.com\nAbbreviations: BMI, body mass index; FSH, follicle \nstimulating hormone; HDF, hôtel-dieu de france\nBackground\nThe effect of the use of tubal sterilization as a birth control \nmethod on ovarian function, ovarian reserve and menopausal age is \nquestionable. In fact, bilateral salpingectomy or tubal ligation 1 and \nconservative abdominal hysterectomy 2 were sometimes related to \ndecrease ovarian function and premature menopause. The decrease \nof hormonal secretion will cause endocrine disorders manifested \nby decreased libido, vaginal dryness, mood swings and vasomotor \nsymptoms. The alteration of the ovarian function by sterilization \nhas been hypothesized to be responsible for menstrual abnormalities \nand hormonal disturbances that characterize the so-called post-\ntubal ligation syndrome. 3,4 The logic behind this theory is that the \nvascularization of the ovaries by either ovarian artery or the utero-\novarian anastomoses as well as the fallopian tube destruction reduce \nthe utero-ovarian arterial blood flow in the mesosalpinx, which leads \nto ovarian tissue damage. 4 In 1987, Riedel HH et al .5 found that the \nlevels of estrogen and progesterone decrease after fallopian tube \nsterilization and hysterectomy. 5 Nonetheless, Kusche M et al. 6 in \n1994 contradicted this finding by stating that no endocrinological \nparameters in the perimenopause were found, neither did cycle \nanomalies and ovarian deficiency symptoms in terms of climacteric \ncomplaints occur earlier, nor did early onset of menopause occur more \noften in the operated group.6\nIn this context, the objective of the present study was to compare \nage at menopause between the women having already undergone tubal \nligation and the control group having intact fallopian tubes. Also, we \nreview literature about the long-term safety of tubal ligation.\nMethods\nStudy settings and population\nFor the purpose of this case-control study, we retrospectively \nreviewed the medical records of all women (cases) who had previously \nundergone bilateral tubal ligation between 1970 and 2010 at the \ndepartment of Obstetrics and Gynecology, Hôtel-Dieu de France \n(HDF) University Hospital, Beirut, Lebanon.\nMore than 200 patients were contacted of whom many were \nfound to have changed their phone numbers. Eligible cases had to \nbe menopaused; menopause was defined as having amenorrhea for \nmore than 12 months with or without symptoms related to hormonal \ndepletion. Exclusion criteria were patients who were operated for \nbilateral ovariectomy or salpingectomy or hysterectomy before \ntheir physiological menopause, and patients who got chemotherapy, \nradiation therapy or any hormonal therapy that could influence \ntheir reproductive function and alter their normal evolution towards \nmenopause.\nThe 50 cases were then compared to 50 randomly chosen \nmenopaused women (controls) from the department of Obstetrics \nand Gynecology at HDF, who did not get any tubal ligation or \ngynecological surgeries (intact tubes, ovaries and uterus) but meeting \nthe same eligibility criteria as the cases.\nData collected\nSocio-demographic and biological data were collected from the \npatients’ medical records, such as year of birth, age at the time of \noperation, obstetrical history (gravida and para), age at menopause, \nweight and height. Body Mass Index (BMI) was calculated.\nObstet Gynecol Int J. 2018;9(2):100‒103. 101\n©2018 Tayeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestrited use, distribution, and build upon your work non-commercially.\nT ubal ligation and early menopause: a case-control \nstudy\nVolume 9 Issue 2 - 2018\nGeorges Abi Tayeh,1,2  T oufic Naba,1,2 Ogarite \nHabib,1,2 Elie Attieh,1,2 Fersan Mansour,1,2 \nAssaad Kesrouani,1,2 Samer Maalouf1,2 \n1Department of Obstetrics and Gynecology, Hôtel-Dieu de \nFrance University Hospital, Lebanon\n2Faculty of Medicine, Saint Joseph University, Lebanon\nCorrespondence: Dr. Georges Abi Tayeh, Department of \nObstetrics and Gynecology, Hôtel-Dieu de France University \nHospital, Boulevard Alfred Naccache, Beirut, Lebanon, P .O. Box: \n16-6926, T el 961 1 427 400, Fax 961 1 426 400, \nEmail \nReceived: September 28, 2017 | Published: March 19, 2018\nAbstract\nBackground: This study aimed to assess whether bilateral tubal ligation is associated with \npremature menopause by reviewing the menopausal age of patients with tubal ligation and \ncomparing it to patients with intact adnexa.\nMethods: This retrospective study collected data in 2015 from all bilateral tubal ligation \ncases performed at Hôtel-Dieu de France University Hospital, Lebanon. Data including age \nof menopause were analyzed and compared to an equal number of menopaused women \nwho did not undergo any tubal ligation or gynecological surgeries and randomly chosen \n(controls).\nResults: 50 cases of menopaused patients with a history of tubal ligation were analyzed and \ncompared to 50 controls. The mean menopausal age in the operated group was 48.86 years \nversus 49.56 years in the control group ( P=0.342). No significant difference was found \nbetween both groups for all the study variables.\nConclusion: The association of tubal ligation and premature menopause is still questionable \nalthough some studies suggest a relationship between tubal ligation and decreased ovarian \nfunction.\nKeywords: menopause, ovarian function, sterilization, tubal ligation\nObstetrics & Gynecology International Journal\nClinical Paper\n Open Access\n\n\nTubal ligation and early menopause: a case-control study\n102\nCopyright:\n©2018 Tayeh et al.\nCitation: Tayeh GA, Naba T, Habib O, et al. T ubal ligation and early menopause: a case-control study. Obstet Gynecol Int J. 2018;9(2):101‒103. \nDOI: 10.15406/ogij.2018.09.00314\nStatistical analysis\nCases and controls were compared using the Student’s t-test with \na two-sided significance level of 5%. Data were analyzed using IBM \nSPSS version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for \nWindows, Version 20.0. Armonk, NY: IBM Corp.).\nEthical considerations\nThe study was approved by the ethics committee of HDF and data \nwere collected after patients gave their written informed consent. \nAnonymity and confidentiality of all participants were guaranteed \nduring data collection and analysis.\nResults\n50 tubal ligation cases were included in this study and compared \nwith 50 menopaused patients with intact pelvic organs. The \ncharacteristics of these 100 patients are detailed in (Table 1).\nT able 1 Characteristics of the study population (N=100)\n Minimum Maximum Mean Standard \ndeviation\nAge (years) 47 77 58.16 6.9\nGravida 0 14 5 2.52\nPara 0 10 4.1 2.12\nAge at menopause (years) 35 57 49.21 3.66\nWeight (Kg) 45 115 71.71 12.67\nHeight (m) 1.47 1.75 1.64 0.05\nBMI (Kg/m2) 15.94 40.75 26.64 4.22\nNo significant difference was found between the cases and the \ncontrols for any of the study variables (Table 2).\nT able 2 Mean value of the characteristics of the two compared groups\n Case group \n(n=50)\nControl group \n(n=50) T otal (N=100) P-value*\nAge (years) 58.2 58.12 58.16 0.954\nGravida 5.24 4.8 5 0.364\nPara 4.36 3.82 4.1 0.204\nAge at \nmenopause \n(years)\n48.86 49.56 49.21 0.342\nWeight (Kg) 73.36 70.1 71.7 0.194\nHeight (m) 1.64 1.63 1.64 0.471\nBMI (Kg/m2) 27.14 26.15 26.64 0.242\n*T wo-sided significance level set at 5%.\nDiscussion\nTubal ligation may reduce the ovarian blood flow leading thus to \nthe decrease of the total follicular pool, ovarian function and in an \nearly state of hormonal deficiency. Several publications suggest that \ntubal ligation induces alteration of the endocrine profile of operated \nwomen. Goynumer G et al. 7 found a significant difference between \nthe postoperative 10th-month Day-3 total ovarian volumes and antral \nfollicle counts in the tubal sterilization groups. 7 Ozyer S et al. 8 went \nfurther and compared an elective tubal ligation by mini-laparotomy \nand tubal ligation done during a C-section. They found that intra-\noperative cesarean section tubal sterilization seems to have less effect \non the ovarian reserve when compared with planned tubal sterilization \nby mini-laparotomy (higher levels of anti-mullerian hormone, lower \nlevels of inhibin B and increased number of antral follicles and mean \novarian volumes).8 In 2004, Kelekci S et al. 9 reported an increase of \nfollicle stimulating hormone (FSH) levels with no decrease in ovarian \nreserve or ovarian stromal blood supply. 9 The same findings were \ndescribed in their two studies in 2005.10,11\nIn parallel, other publications made opposite conclusions. As \nsuch, Dede FS et al. 12 stated that the rate of ovulation was slightly \nimproved after the procedure, and ovarian reserve was not negatively \naffected.12 Carmona et al. 13 found no significant changes of FSH, \nluteinizing hormone, 17beta-estradiol and inhibin levels, despite that \na 45% increase in FSH concentration from baseline to the 60-month \ncontrol was detected in tubal sterilization versus 30% in the control \ngroups of women.13 Cevrioglu AS et al.14 also found no difference in \nuterine or ovarian artery blood flow rates or ovarian hormone secretion \nin comparison with baseline values.14\nFinally when comparing age of menopause, Nichols HB et \nal.15 found no significant association between tubal ligation and \nmenopausal age, 15 which is compatible with our findings. In our \nresults, there is a lack of data regarding smoking status and presence \nof endometrioma knowing that these two factors are important for \nthe occurring age of menopause. Pokoradi AJ et al.16 found that tubal \nsterilization was associated with younger age at menopause16 which is \nconsistent with findings of Visvanathan et al.17\nConclusion\nTo conclude, the present study found no difference in menopausal \nage between women who underwent or not tubal ligation. Based on \nthe review of literature, no conclusive statements can be made in \nthis regard due to contradictory results between publications. Larger \nrandomized case-control studies should be performed to enable \nmaking stronger conclusions about the long-term effect of tubal \nligation as a method for birth control.\nAcknowledgements\nWe would like to thank all women who participated in the study.\nDeclarations\nEthics approval and consent to participate\nWritten informed consent was obtained from the patients for the \npurpose of this study. A copy of the consent is available for review by \nthe Editor-in-Chief of this journal.\nConsent for publication\nNot applicable.\nAvailability of data and materials\nThe patients’ data are available upon request and after approval of \nthe authors to preserve the patients’ anonymity.\nFunding\nNone.\nAuthors’ contributions\nGAT and EA are responsible of the medical and therapeutic \nmanagement of the patients.\nOH, FM, AK and SM collected the data and performed the data \nentry.\nOH analyzed the data.\n\nTubal ligation and early menopause: a case-control study\n103\nCopyright:\n©2018 Tayeh et al.\nCitation: Tayeh GA, Naba T, Habib O, et al. T ubal ligation and early menopause: a case-control study. Obstet Gynecol Int J. 2018;9(2):101‒103. \nDOI: 10.15406/ogij.2018.09.00314\nDr GAT, OH and SM wrote the manuscript.\nAll authors approved the manuscript and GAT gave his final \napproval of the paper to be published.\nConflicts of interest\nThe authors declare that they have no conflict of interest in \npublishing the article.\nReferences\n1. Cattanach J. Oestrogen deficiency after tubal \nligation. Lancet. 1985;1(8433):847–9.\n2. Ahn EH. Effect of hysterectomy on conserved ovarian function. Yonsei \nMed J. 2002;43(1):53–8.\n3. Gentile GP, Kaufmann SC, Helbig DW. Is there any evidence for a post-\ntubal sterilization syndrome? Fertil Steril. 1998;69:179–86.\n4. Cattanach JF, Milne BJ. Post-tubal sterilization problems correlated with \novarian steroidogenesis. Contraception. 1988;38:541–50.\n5. Riedel HH, Lehmann-Willenbrock E, Semm K. Development of \nclinical pictures of ovarian deficiency following hysterectomy \nand destructive fallopian tube sterilization procedures. Zentralbl \nGynakol. 1987;109(12):755–70.\n6. Kusche M, Reusch-Kusche K, Neuhaus W, et al. The effect \nof tubal sterilization on ovarian function. Geburtshilfe \nFrauenheilkd. 1994;54(8):444–9.\n7. Goynumer G, Kayabasoglu F, Aydogdu S, et al. The effect \nof tubal sterilization through electrocoagulation on the ovarian \nreserve. Contraception. 2009;80(1):90–4.\n8. Ozyer S, Moraloğlu O, Gülerman C, et al. Tubal sterilization during \ncesarean section or as an elective procedure? Effect on the ovarian \nreserve. Contraception. 2012;86(5):488–93.\n9. Kelekci S, Yorgancioglu Z, Yilmaz B, et al. Effect of tubal ligation on \novarian reserve and the ovarian stromal blood supply. Aust N Z J Obstet \nGynaecol. 2004;44(5):449–51.\n10. Kelekci S, Yilmaz B, Yakut Y , et al. Hormonal and ovarian stromal \nblood supply changes after laparoscopic tubal sterilization: a prospective \ncontrolled study. Contraception. 2006;73(3):279–83.\n11. Kelekci S, Yilmaz B, Yasar L, et al. Ovarian reserve and ovarian stromal \nblood supply after tubal ligation by the Pomeroy technique: comparison \nwith controls. Gynecol Endocrinol. 2005;20(5):279–83.\n12. Dede FS, Dilbaz B, Akyuz O, et al. Changes in menstrual pattern and ovarian \nfunction following bipolar electrocauterization of the fallopian tubes for \nvoluntary surgical contraception. Contraception. 2006;73(1):88–91.\n13. Carmona F, Cristóbal P, Casamitjana R, et al. Effect of tubal \nsterilization on ovarian follicular reserve and function. Am J Obstet \nGynecol. 2003;189(2):447–52.\n14. Cevrioglu AS, Degirmenci B, Acar M, et al. Examination of changes \ncaused by tubal sterilization in ovarian hormone secretion and uterine \nand ovarian artery blood flow rates. Contraception. 2004;70(6):467–73.\n15. Nichols HB, Baird DD, DeRoo LA, et al. Tubal ligation in \nrelation to menopausal symptoms and breast cancer risk. Br J \nCancer. 2013;109(5):1291–5.\n16. Pokoradi AJ, Iversen L, Hannaford PC. Factors associated with age of \nonset and type of menopause in a cohort of UK women. Am J Obstet \nGynecol. 2011;205(1):34.e1-13.\n17. Visvanathan N, Wyshak G. Tubal ligation, menstrual changes, \nand menopausal symptoms. J Womens Health Gend Based Med . \n2000;9(5):521–7.","source_license":"CC0","license_restricted":false}