Tubal Sterilization (TS) is the widely prevalent contraception method that seems to dominate nearly 76% of the existent contraceptive occurrence. Currently employed TS practices comprise of minilaparotomy, laparoscopic sterilization and PPS or Post Partum Sterilization – procedure carried out within six weeks of child birth.

The TS procedure could be carried out either during the interval time period or as post delivery or post abortion procedure. Recent studies have revealed two viewpoints – an increased risk or no risk on the links between menstrual bleeding patterns and TS.

Menstruation irregularities could be decreased/infrequent, repeated/ long-lasting or the absence of menstrual cycle bleeding. Frequent or extended bleeding could endanger the physical health condition of women due to excessive blood loss. Decreased/sporadic or no menstrual bleeding mostly gets a proclivity to be classified as ‘mere irritant’ side effect however the clinical importance of this must not be undermined. It encroaches on the sexual, cultural and religious practises of a woman and has a negative bearing on the health and overall quality of life.

Researches that raised concerns have revealed a rise in the number of women having undergone TS procedure being hospitalised for menstrual related problems and a likely biological effect could not be ruled out. Unnatural bleeding patterns and pelvic discomfort and pain were the major problems encountered following sterilization.

Increased cases of hysterectomy were performed among sterilised women either for unnatural bleeding problem or pelvic pain. Unnatural bleeding pattern could be either excessive, extended bleeding, spotting and augmented pain during menses.

The early CDC findings, British record linkage study further corroborated these associations. A large case controlled study undertaken in Scotland have shown more than expected cases of hysterectomy noted amongst sterilised women with the risk being four times higher. Women that adopted sterilization as a post-delivery procedure have less chance of hysterectomy than others. Other associated problems that could be major contributors for menstrual-associated problems are the younger age of women that opted for sterilization; increasing years after sterilization, shorter time gap between the last delivery and sterilization and the status of last contraception. The concern with the study group was a major impediment in several studies on sterilization and its impact.

A second CDC report and a mass study carried out by CREST( US collaborative Review of Sterilisation) with a control set reported that sterilised women were no more prone than other women to have menstrual irregularities.

A US study undertaken showed no persistent variations in menstrual bleeding pattern or length of cycle among sterilized women, instead they were more likely to have lesser bleeding and erratic cycles.

Certain studies also show that monilial lower genital tract infection elevated the risk element to three times for decreased/sporadic bleeding pattern and the possibility of normal menses is decreased by 50%. On adopting appropriate menstrual hygienic practices, the likelihood for frequent or extended bleeding pattern was observed to be reduced by sixty percent.

Dysmenorrhea was seen to be more likely when sterilization was undertaken as a minilaparotomy procedure than when compared to laparoscopy and post-delivery sterilization. The tissue damage during the course of the operation and ensuing adhesion could also be the possible contributors. There was also a probability of reduction in dysmenorrhea when sterilization was undertaken concurrently with caesarean section.

Counselling prior to sterilization must be highlighted as sterilization is not the reason behind either menstrual problems or dysmenorrhea. Timely diagnosis and treatment of any infection and improving menstrual hygiene practices is essential for lowering menstrual morbidity.

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