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.
