A prospective cohort study of menstrual symptoms and morbidity over 15 years following laparoscopic Filshie clip sterilisation

Abstract

Objective To observe the incidence of menstrual symptoms and relevant surgery after sterilisation. Study design 1101 women sterilised with Filshie clips between 1983 and 2002 were assessed prospectively comparing menstrual symptomatology documented immediately before surgery and 5–14 years later by questionnaire. Main outcome measures Prevalence of menstrual dysfunction and subsequent surgery related to pre-operative menstrual symptoms and contraception. Results After excluding 232 (24%) of the 968 eligible women sent questionnaires whose address had changed, 573 of the remaining 735 women (78%) completed the questionnaire, 223 5–6 years after sterilisation, 175 after 7–9 years and 175 after 10–15 years; the respondents were demographically representative of the total population. Heavy periods increased from 9% before to 35% ( P < 0.0001) after sterilisation, painful periods from 2% to 21% ( P < 0.0001) and 6% had undergone hysterectomy or endometrial ablation. These findings were not influenced by the pre-sterilisation method of contraception but were inversely related to advancing age ( P < 0.0002). The lowest rates of menstrual symptoms were reported 10–15 years after sterilisation. Conclusion Menstrual symptoms increased following Filshie clip sterilisation irrespective of pre-sterilisation symptoms and contraception. Whatever the causative mechanism, the progestogen-loaded intrauterine system (IUS), with similar efficacy but with improved menstrual symptoms, should be considered before sterilisation.