Tubal ligation does not impact age of natural menopause

Abstract

This study aimed to determine the effect of tubal ligation (TL) on age at natural menopause, as a marker of long-term ovarian function. We utilized three pre-existing population-based cohorts for this cross-sectional study. Data from each cohort was analyzed separately. The cohorts included a referent cohort of women from the Rochester Epidemiology Project (REP, Cohort 1), and participants in the Mayo Clinic Biobank (Cohort 2) or the Mayo Mammography Health Study (Cohort 3). The cohorts for this project were restricted to women who never smoked and had reached natural menopause, without prior hysterectomy or oophorectomy. All cohorts included women from Olmsted County, MN and Cohorts 2 and 3 also included women from six surrounding counties. The following variables were self-reported on a questionnaire by participants in Cohorts 2 and 3: race, age of menarche, age of menopause, history of hysterectomy or oophorectomy, number of pregnancies and live births, tobacco use, and ever use of hormonal contraception. These variables were manually abstracted in Cohort 1, along with the type of TL and age at TL. For Cohorts 2 and 3, history of TL was obtained from a separate institutional form administered to all patients prior to an outpatient clinic visit at the Mayo Clinic and supplemented with procedure information from the resources of the REP. The primary outcome, age at natural menopause, was compared between the two groups (those with and those without a history of TL before natural menopause) using a two-sample t-test. 555 women from Cohort 1, 1,816 women from Cohort 2, and 1,540 women from Cohort 3 met inclusion criteria. Baseline characteristics did not differ between cohorts. The rate of TL was the same in all cohorts: 26.0%, 25.5%, and 25.0%, respectively. Women who underwent TL were more likely to have had at least one pregnancy and to have used hormonal contraception compared to women who did not have a TL. In Cohort 1, the women with prior TL reached menopause an average of 0.6 years later (mean (SD) 50.7 (3.7) vs. 50.1 (3.5) years, p=0.08), whereas in Cohort 2 the women with prior TL reached menopause an average of 0.3 years earlier (49.6 (4.7) vs. 49.9 (4.5) years, p=0.20). The average age of menopause was the same in Cohort 3 (50.0 (4.4) vs. 50.0 (4.2) years, p= 0.80). The type of TL (Cohort 1 only) had no effect on the age of menopause. TL did not impact the age at which women underwent natural menopause in any of the 3 large cohorts included in this study, which suggests that TL does not impart negative long-term effects on ovarian function. Salpingectomy for permanent contraception and opportunistic salpingectomy at the time of benign hysterectomy have emerged as potential cancer risk reduction strategies in women at average risk for ovarian cancer. The impact of these procedures on ovarian function requires further study.