Menstrual Abnormalities and Pain after Five Tubal Sterilization Methods: A Randomized Controlled Trial

Background and Objective: Tubal sterilization is the most popular method of permanent female contraception, yet there is considerable debate concerning the influence of this procedure on the women’s health and menstrual pattern. Methods: We randomized 1358 women to one of the five methods of tubal sterilization; unipolar electrocauterization, bipolar electrocauterization, minilaparatomy, Pomeroy method, Falope ring, and Hulka clips to evaluate the effect of each method on menstrual pattern. Each woman was interviewed before sterilization and followed for 3 years. 850 women who did not undergo sterilization served as control group and were interviewed and followed. 248 women of study group and 503 cases of the control group did not fulfill the study criteria and were excluded. Results: Menstrual indices were significantly different between the control group and those women who were sterilized by unipolar, ring, and Pomery methods. The amount of bleeding, was increased by 28.3% in unipolar group (p=0.001), 19.9% in ring group (p=0.001), and by 23.9% in Pomeroy group (p=0.0001). Significant menstrual pain lasted for a maximum of 18 months was noted in unipolar coagulation group (p=0.0001). Conclusion: Sterilization methods which destroy the vascular communications along and immediately subjacent to the tube and that also disturb the countercurrent exchange of biologically active factors between the uterus and ovaries, are more likely to cause menstrual abnormalities.