Menstrual Pattern following Tubal Ligation: A Historical Cohort Study

Background

Tubal ligation (TL) is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders.

Materials and Methods

A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group) and on 140 women using condom as the main contraceptive method (Non-TL group). They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC) was also used to measure the menstrual blood loss.

Results

Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002). Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006), hypermenorrhea (12.1 vs. 2.1%, P=0.002), menorrhagia (62.9 vs. 22.1%, P<0.0001) and menometrorrhagia (15.7 vs. 3.6%, P=0.001) than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001). According to logistic regression, age odds ratio [(OR=1.08, con- fidence interval (CI):1.07-1.17, P=0.03)], TL (OR=5.95, CI:3.45-10.26, P<0.0001) and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001) were significantly associated with menorrhagia.

Conclusion

We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

Comparison of menstrual disorders between groups

Parameters	Non-TL	TL	Sig
Menstrual irregularities*	14 (10)	34 (24.3)	0.002a
Oligomenorrhea*	12 (8.6)	21 (15)	0.12a
Polymenorrhea*	2 (1.4)	13 (9.3)	0.006a
Hypermenorrhea*	3 (2.1)	17 (12.1)	0. 002a
Metrorrhagia*	9 (6.4)	12 (8.6)	0.64a
Menorrhagia*	31 (22.1)	88 (62.9)	<0.0001a
Menometrorrhagia*	5 (3.6)	22 (15.7)	0.001a
PBLAC score**	87.91 ± 51.06	137.72 ± 90.91	<0.0001b

*; n (%), **; Values are mean ± SD, a; Chi-square test, b; T test, TL; Tubal ligation, and PBLAC; Pictorial blood loss assessment chart.

Full article at:   http://goo.gl/m3gdFa

By:  Shahideh Jahanian Sadatmahalleh, M.Sc,¹ Saeideh Ziaei, M.D,^1,* Anoshirvan Kazemnejad, Ph.D,² and Eesa Mohamadi, Ph.D³

¹Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

²Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

1 Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University,  Tehran, Iran

² Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³ Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

* Corresponding Address:P.O. Box: 1415-111, Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,

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Women with Minor Menstrual Irregularities Have Increased Risk of Preeclampsia & Low Birth Weight in Spontaneous Pregnancies

Very few studies describe the obstetric and neonatal outcome of spontaneous pregnancies in women with irregular menstrual cycles. However menstrual cycle irregularities are common and may be associated with increased risk, and women who develop pregnancy complications more frequently recollect irregular menstrual cycles before the time of conception in case-control studies.

This retrospective cohort study compares obstetric and neonatal outcomes in spontaneous singleton pregnancies in 3440 primiparous Danish women stratified according to menstrual cycle regularity. All pregnancies had a, delivery after 22 weeks of gestation and a nuchal translucency examination at Copenhagen University Hospital Hvidovre January 1. 2009 - December 31. 2010. Menstrual cycle irregularity was defined as more than 7 days deviation between self-reported and ultrasound examination based gestational age. Outcome measures were gestational diabetes, hypertension, preeclampsia, preterm premature rupture of membranes, preterm birth, prolonged pregnancy, birth weight, umbilical artery pH<7.1, APGAR<7 after 5 minutes, admission to neonatal intensive care unit and stillbirth. Women with more than 7 days deviation between self-reported and ultrasound examination based gestational age were compared to women with 7 days or less deviation.

Irregular menstrual cycle before conception increases the risk of preeclampsia (7.9% vs. 5.2%, p < 0.05) and low birth weight (6.0% vs. 3.6%, p < 0.05) in spontaneous pregnancies, but reduces the risk of prolonged pregnancy (1.4% vs. 4.7%, p < 0.001).

Irregular menstrual cycle before conception is associated with increased risk of adverse obstetric and neonatal outcome. This article is protected by copyright. All rights reserved.

Purchase full article at: http://goo.gl/0IadLM

By: Bonnesen B1, Oddgeirsdóttir HL1, Naver KV1, Jørgensen FS1, Nilas L1.

1Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

  

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