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December 12, 1990, Vol 264, No. 22 >
ARTICLE | December 12, 1990

Tubal Sterilization and the Long-term Risk of Hysterectomy FREE

Andy Stergachis, PhD; Kirkwood K. Shy, MD, MPH; Louis C. Grothaus, MS; Edward H. Wagner, MD, MPH; Julia A. Hecht, PhD, MPH; Garnet Anderson, PhD; Esther H. Normand, RRA; Janet Raboud, MS
[+] Author Affiliations

Reprint requests to Program in Pharmacoepidemiology and Drug Policy, School of Pharmacy, SC-69, University of Washington, Seattle, WA 98195 (Dr Stergachis).


JAMA. 1990;264(22):2893-2898. doi:10.1001/jama.1990.03450220059023
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References

To assess the effect of tubal sterilization on the risk of hysterectomy, we studied 7414 women aged 20 to 49 years who had had a tubal sterilization at a health maintenance organization between January 1, 1968, and December 31,1983. Compared with a population-based cohort of nonsterilized women, women sterilized while 20 to 29 years old were 3.4 times more likely to have had a subsequent hysterectomy (95% confidence interval, 2.4 to 4.7). Adjustment for the effects of potential confounders with a subset of 276 women did not appreciably alter this association. For multivariate comparisons with 5323 wives of vasectomized men, there was no significant elevation in the risk of hysterectomy following sterilization among women sterilized while 20 to 29 years old. Tubal sterilization was not associated with hysterectomy for married women who underwent tubal sterilization at age 30 or older. These results do not support a biological basis for the relationship between tubal sterilization and hysterectomy.

(JAMA. 1990;264:2893-2898)

REFERENCES

1 +
Population Information Program.  Minilaparotomy and laparoscopy: safe, effective, and widely used . Pop Rep. 1985;;13:C125-C167.
2 +
Centers for Disease Control.  Tubal sterilization among women of reproductive age, United States, update for 1979-1980 . MMWR . 1983;;32 ( (suppl) ):9S-14S.
3 +
Neil JR, Hammond GT, Noble AD, Rushton L, Letchworth AT.  Late complications of sterilization by laparoscopy and tubal ligation . Lancet . 1975;;2:699-700.
4 +
Muldoon MJ.  Gynecological illness after sterilization . BMJ . 1972;;1:84-85.
5 +
Kendrick JS, Rubin GL, Lee NC, Schulz KF, Peterson HB, Nolan TF.  Hysterectomy performed within one year after tubal sterilization . Fertil Steril. 1985;;44:606-610.
6 +
DeStefano F, Pearlman JA, Peterson HB, Diamond EL.  Long-term risk of menstrual disturbances after tubal sterilization . Am J Obstet Gynecol. 1985;;152:835-841.
7 +
Rulin MC, Davidson AR, Philliber SG, Graves WL, Cushman LF.  Changes in menstrual symptoms among sterilized and comparison women: a prospective study . Obstet Gynecol. 1989;;74:149-154.
8 +
Huggins GR, Sondheimer SJ.  Complications of female sterilization: immediate and delayed . Fertil Steril. 1984;;41:337-355.
9 +
El-Minawi MF, Mashhor N, Reda MS.  Pelvic venous changes after tubal sterilization . J Reprod Med. 1983;;28:641-648.
10 +
Donnez J, Wauters M, Thomas K.  Luteal function after tubal sterilization . Obstet Gynecol. 1981;;57:65-68.
11 +
Verco CJ, Gannon BJ, Jones WR.  Rabbit oviduct microvascular architecture after tubal ligation . Fertil Steril. 1983;;40:127-130.
12 +
DeStefano F, Huezo CM, Peterson HB, Rubin GL, Layde PM, Ory HW.  Menstrual changes after tubal sterilization . Obstet Gynecol. 1983;;62:673-681.
13 +
Riedel H-H, Ahrens H, Semm K.  Late complications of sterilization according to method . J Reprod Med. 1981;;26:353-358.
14 +
Rivera R, Gaitan JR, Ruiz R, et al.  Menstrual patterns and progesterone circulating levels following different procedures of tubal occlusion . Contraception . 1989;;40:157-168.
15 +
Stock RJ.  Evaluation of sequelae of tubal ligation . Fertil Steril. 1978;;29:169-174.
16 +
Pokras R, Hufnagel VG.  Hysterectomy in the United States, 1965-1984 . Am J Public Health. 1988;;78:852-853.
17 +
Templeton AA, Cole S.  Hysterectomy following sterilization . Br J Obstet Gynaecol. 1982;;89:845-848.
18 +
Cooper PJ.  Risk of hysterectomy after sterilization . Lancet . 1983;;1:59.
19 +
Poma PA.  Tubal sterilization and later hospitalizations . J Reprod Med. 1980;;25:272-278.
20 +
Cohen MM.  Long-term risk of hysterectomy after tubal sterilization . Am J Epidemiol. 1987;; 125:410-419.
21 +
Vessey M, Huggins G, Lawless M, et al.  Tubal sterilization: findings in a large prospective study . Br J Obstet Gynaecol. 1983;;90:203-209.
22 +
Pearson DC, Grothaus LC, Thompson RS, Wagner EH.  Smokers and drinkers in a health maintenance organization population: lifestyles and health status . Prev Med. 1987;;16:783-795.
23 +
Walker AM.  Efficient assessment of confounder effects in matched follow-up studies . Appl Stat. 1982;;31:293-297.
24 +
Bergstralh EJ, Offord KP, Kosanke JL, et al.  Personyrs: a SAS procedure for person-year analyses . In: SUGI Proceedings . Cary, NC: SAS Institute; 1986;:868-873.
25 +
Cox DR.  Regression models and life tables (with discussion) . J R Stat Soc B. 1972;;34:187-220.
26 +
Koepsell TD, Weiss NS, Thompson DJ, Martin DP.  Prevalence of prior hysterectomy in the Seattle-Tacoma area . Am J Public Health. 1980;;70:40-47.
27 +
Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP.  A controlled trial of the effect of a prepaid group practice on use of services . N Engl J Med. 1984;;310:1505-1510.
28 +
Rulin MC, Turner JH, Dunworth R.  Post-tubal sterilization syndrome: a misnomer . Am J Obstet Gynecol. 1985;;151:13-19.
29 +
Fortney JA.  Long-term risk of hysterectomy after tubal sterilization . Am J Epidemiol. 1988;;127:200.
30 +
Cohen MM.  The author replies . Am J Epidemiol. 1988;;127:200.
31 +
Bunker JP, Brown BW Jr.  The physician-patient as an informed consumer of surgical operations . N Engl J Med. 1977;;290:1051-1055.
32 +
Bunker JP.  Elective hysterectomy: pro and con . N Engl J Med. 1976;;295:264-268.

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1 +
Population Information Program.  Minilaparotomy and laparoscopy: safe, effective, and widely used . Pop Rep. 1985;;13:C125-C167.
2 +
Centers for Disease Control.  Tubal sterilization among women of reproductive age, United States, update for 1979-1980 . MMWR . 1983;;32 ( (suppl) ):9S-14S.
3 +
Neil JR, Hammond GT, Noble AD, Rushton L, Letchworth AT.  Late complications of sterilization by laparoscopy and tubal ligation . Lancet . 1975;;2:699-700.
4 +
Muldoon MJ.  Gynecological illness after sterilization . BMJ . 1972;;1:84-85.
5 +
Kendrick JS, Rubin GL, Lee NC, Schulz KF, Peterson HB, Nolan TF.  Hysterectomy performed within one year after tubal sterilization . Fertil Steril. 1985;;44:606-610.
6 +
DeStefano F, Pearlman JA, Peterson HB, Diamond EL.  Long-term risk of menstrual disturbances after tubal sterilization . Am J Obstet Gynecol. 1985;;152:835-841.
7 +
Rulin MC, Davidson AR, Philliber SG, Graves WL, Cushman LF.  Changes in menstrual symptoms among sterilized and comparison women: a prospective study . Obstet Gynecol. 1989;;74:149-154.
8 +
Huggins GR, Sondheimer SJ.  Complications of female sterilization: immediate and delayed . Fertil Steril. 1984;;41:337-355.
9 +
El-Minawi MF, Mashhor N, Reda MS.  Pelvic venous changes after tubal sterilization . J Reprod Med. 1983;;28:641-648.
10 +
Donnez J, Wauters M, Thomas K.  Luteal function after tubal sterilization . Obstet Gynecol. 1981;;57:65-68.
11 +
Verco CJ, Gannon BJ, Jones WR.  Rabbit oviduct microvascular architecture after tubal ligation . Fertil Steril. 1983;;40:127-130.
12 +
DeStefano F, Huezo CM, Peterson HB, Rubin GL, Layde PM, Ory HW.  Menstrual changes after tubal sterilization . Obstet Gynecol. 1983;;62:673-681.
13 +
Riedel H-H, Ahrens H, Semm K.  Late complications of sterilization according to method . J Reprod Med. 1981;;26:353-358.
14 +
Rivera R, Gaitan JR, Ruiz R, et al.  Menstrual patterns and progesterone circulating levels following different procedures of tubal occlusion . Contraception . 1989;;40:157-168.
15 +
Stock RJ.  Evaluation of sequelae of tubal ligation . Fertil Steril. 1978;;29:169-174.
16 +
Pokras R, Hufnagel VG.  Hysterectomy in the United States, 1965-1984 . Am J Public Health. 1988;;78:852-853.
17 +
Templeton AA, Cole S.  Hysterectomy following sterilization . Br J Obstet Gynaecol. 1982;;89:845-848.
18 +
Cooper PJ.  Risk of hysterectomy after sterilization . Lancet . 1983;;1:59.
19 +
Poma PA.  Tubal sterilization and later hospitalizations . J Reprod Med. 1980;;25:272-278.
20 +
Cohen MM.  Long-term risk of hysterectomy after tubal sterilization . Am J Epidemiol. 1987;; 125:410-419.
21 +
Vessey M, Huggins G, Lawless M, et al.  Tubal sterilization: findings in a large prospective study . Br J Obstet Gynaecol. 1983;;90:203-209.
22 +
Pearson DC, Grothaus LC, Thompson RS, Wagner EH.  Smokers and drinkers in a health maintenance organization population: lifestyles and health status . Prev Med. 1987;;16:783-795.
23 +
Walker AM.  Efficient assessment of confounder effects in matched follow-up studies . Appl Stat. 1982;;31:293-297.
24 +
Bergstralh EJ, Offord KP, Kosanke JL, et al.  Personyrs: a SAS procedure for person-year analyses . In: SUGI Proceedings . Cary, NC: SAS Institute; 1986;:868-873.
25 +
Cox DR.  Regression models and life tables (with discussion) . J R Stat Soc B. 1972;;34:187-220.
26 +
Koepsell TD, Weiss NS, Thompson DJ, Martin DP.  Prevalence of prior hysterectomy in the Seattle-Tacoma area . Am J Public Health. 1980;;70:40-47.
27 +
Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP.  A controlled trial of the effect of a prepaid group practice on use of services . N Engl J Med. 1984;;310:1505-1510.
28 +
Rulin MC, Turner JH, Dunworth R.  Post-tubal sterilization syndrome: a misnomer . Am J Obstet Gynecol. 1985;;151:13-19.
29 +
Fortney JA.  Long-term risk of hysterectomy after tubal sterilization . Am J Epidemiol. 1988;;127:200.
30 +
Cohen MM.  The author replies . Am J Epidemiol. 1988;;127:200.
31 +
Bunker JP, Brown BW Jr.  The physician-patient as an informed consumer of surgical operations . N Engl J Med. 1977;;290:1051-1055.
32 +
Bunker JP.  Elective hysterectomy: pro and con . N Engl J Med. 1976;;295:264-268.

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