[Adverse effects of tubal sterilization in the female].

Depressive symptomatology requiring readmission to the psychiatric ward of a hospital appeared in a 27-year patient 2 years after she had submitted to tubal sterilization. Histological tests confirmed chronic mastopathy (chronic nonspecific lymphocytic xanthogranulomatic mastitides), and bilateral subcutaneous mastectomy was performed. 3 years after sterilization diffuse back pain appeared requiring renewed hospitalization in the orthopedic and neurological wards. Osteoporosis was the cause of the pain. 4 years after sterilization uterine bleeding disorders appeared lasting up to the present time. She had suffered angina pectoris after exertion in the last 2 years. Electrocardiogram showed diffuse alterations in repolarization that could not be influenced by pharmacological tests and with the exertion test maximum load could not be reached because of diffuse back pain and physical frailty. The use of nitrates improved the toleration of physical load considerably. Low level of high density lipoprotein (HDL) cholesterol and low values of HDl cholesterol and low density lipoprotein (LDL) cholesterol fraction were confirmed in the patient. The insufficiency of estrogens after tubal ligation can lead to premature climacteric in many cases 2-4 years later. This manifests itself in pain in the waist area, atrophy of external genitals, and uterine bleeding dysfunction often necessitating hysterectomy. Laparotomy a few years after tubal sterilization showed that capillaries far from the site of the interruption of oviducts were involuted or atrophied. Uterine bleeding was twice as frequent after thermocoagulation than after classical ligation. Curative-preventive health care principles require the warning of patients about the consequences of tubal sterilization in order to avoid regretting such a decision.