Hormones are peddled by many practitioners as well as by the Goddess of estrogen herself, Suzanne Somers, as the fountain of youth. However, if hormones were actually proven to be that wonderful/amazing/effective/risk-free via evidence based medicine, well, uh, everyone would be dishing them out like candy. While there definitely are specific instances where hormone replacement therapy can be beneficial, they are not a panacea for every symptom and like every medication the risk-benefit ratio must be balanced for each individual.
From time to time I see links and tweets from hormone “experts” and one recently caught my eye: the claim that a tubal ligation causes premature lowering of hormones. The corollary being, “If you have had a tubal ligation and feel depressed/tired/have low libido/are gaining weight/not sleeping well then do I have a cure for you!”
I have a pretty good memory and in all my years of gynaecology (22 if you count residency) I don’t think I’ve ever heard convincing evidence that a tubal ligation causes early menopause. I knew at one point people wondered if cutting/burning the Fallopian tube (which includes cutting/burning the blood vessels that run with it) might affect blood flow to the ovary, possibly affecting the development of follicles (the eggs), the source of estrogen and progesterone. However, this proposed mechanism just didn’t seem biologically plausible as blood vessels from the ovary (and the uterus) supply the Fallopian tubes, not the other way around. While the uterine artery does connect with the ovarian artery and therefore might contribute some blood flow to the ovary, the ovary gets most of its blood from the ovarian arteries, which come off the aorta (or the renal artery). Regardless, neither the ovarian nor the uterine arteries are in the surgical field for a tubal ligation.
For good measure, I took a quick hop, skip, and a jump over to PubMed. In no time at all I had three good articles on hormone levels and tubal ligation. The studies evaluated cycle length and regularity as well as hormone levels. One study, part of the Penn Study of Ovarian Aging (Nelson DB et al, Contraception 2005;71), a well-done prospective study was especially interesting as half the women had their tubal ligation 15 years or more before enrollment. This study also evaluated menopausal symptoms in addition to hormone levels over a four year period of time.
The verdict: bilateral tubal ligation has no effect on the following sex hormone levels: estrogen, progesterone, FSH, LH, testosterone, DHEAS, and Inhibin. In addition, a bilateral tubal ligation has no effect on timing or severity of menopausal symptoms.
So add, “Your tubal ligation is affecting your hormone levels” to the caravan of hormonal snake oil along with salivary hormone testing and the hCG diet. I’ve already reviewed the hCG diet (24 studies say hCG adds nothing to your weight loss efforts), but I’ll save the nonsense that is salivary hormone testing for another post.
Nelson DB et al. Tubal ligation does not affect hormonal changes during the early menopausal transition. Contraception 2005;71.
Dede FS et al. Changes in menstrual pattern and ovarian function following bipolar electrocauterization of the fallopian tubes for voluntary surgical contraception. Contraception 2006;73.
Harlow BL et al. Does tubal sterilization influence the subsequent risk of menorrhagia or dysmenorrhea? Fertility and Sterility 2002;77.
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