One of the largest investigations ever into the after effects of tubal sterilisation has concluded that menstrual irregularities are not a substantial risk of the operation.

Nevertheless, the conclusion of the researchers from the US Centers for Disease Control and Prevention is at variance with previous accounts of a ‘post tubal ligation syndrome’, including heavy bleeding and inter menstrual bleeding.

The researchers attribute the concept of such a syndrome to the fact that both tubal sterilisation and menstrual irregularities are common, and may simply occur coincidentally. In addition, they note that menstrual abnormalities often accompany stopping oral contraceptives.

The researchers consider their data, based on a five year study of 9514 women (median age 31) who underwent tubal sterilisation, the final word on the subject.

However, their reassuring conclusion hides some noteworthy findings. Some women who had brief, light, regular and painless periods before the operation tended to have long, heavy, irregular and painful periods over time whereas those with heavy bleeding tended to improve.

Also, women with average flow presterilisation were very likely to have heavier flows in the next five years. Such changes in flow are still largely unexplained, and women may derive benefit from being forewarned about them (N Engl J Med, 2000; 343: 1681-7,1724-6).

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