Changes in menstrual pattern, dysmenorrhea and ovarian function following Pomeroy’s ligation of the tubes for voluntary surgical contraception

O. Akyuz, B. Dilbaz, F. Suat Dede, E. Caliskan, V. Kurtaran, S. Dilbaz

SSK Ankara Maternity and Women’s Health Teaching Hospital, Turkey

Objective: To analyze the changes in menstrual pattern, ovarian reserve and presence of dysmenorrhea and ovulation using Pomeroy’s tubal ligation technique via minilaparotomy.

Design and Methods: Thirty consecutive women with regular menses applying for voluntary tubal ligation who had no gynecological pathology, history of dysmenorrhea and use of intrauterine device or oral contraceptive in the last 3 months were recruited in this prospective study. After getting an informed consent, the patients had tubal ligation using Pomeroy’s technique via minilaparotomy under general anesthesia and were discharged the same day uneventfully. One cycle before the procedure, blood samples were collected on day-3 for determination of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) and on day-21 for progesterone levels. All the operations were carried out in early follicular phase (day 2–5) with evaluation of FSH, LH and E2. Day-21 progesterone levels were also measured in the same cycle following tubal ligation. The same hormonal evaluation was carried out on the 3rd cycle following the procedure. All patients were followed for 3 months and changes in menstrual pattern, presence or absence of dysmenorrhea and ovulation were noted. The significance of difference between preoperative and postoperative values was analyzed by using analysis of variance and paired t test.

Results: After the procedure, menstrual pattern change occurred in one patients (3,3%), whilst 2 patients had mild dysmenorrhea (6,6%). The incidence of ovulation was 43% preoperatively, rising to 48% in the same cycle after surgery and maintaining almost a constant level at 50% 3 months after tubal ligation. There was no statistically significant difference in the serum FSH, LH and E2 levels in preoperative and postoperative assessments (p>0.05).

Conclusions: Tubal ligation has been blamed for causing luteal phase defect as a result of effected ovarian circulation. In our study, the rate of ovulation was even improved after the procedure and ovarian reserve was not negatively affected. Pomeroy’s ligation of the tubes did not alter the ovarian reserve and function in the early follow-up period of 3 months.