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Tubal Ligation and Age at Natural Menopause

Ainsworth, Alessandra J. MD; Baumgarten, Sarah C. MD, PhD; Bakkum-Gamez, Jamie N. MD; Vachon, Celine M. PhD; Weaver, Amy L. MS; Laughlin-Tommaso, Shannon K. MD, MPH

doi: 10.1097/AOG.0000000000003266
Contents: Menopause: Original Research

OBJECTIVE: To determine the effect of tubal ligation on age at natural menopause, as a marker of long-term ovarian function.

METHODS: Three preexisting population-based cohorts were included in this cross-sectional study. Data from each cohort was analyzed separately. The cohorts were restricted to women who never smoked and had reached natural menopause, without prior hysterectomy or oophorectomy. The following variables were collected: race, age at menarche, age at menopause, history of hysterectomy or oophorectomy, gravidity and parity, tobacco use, and ever use of hormonal contraception. The type of tubal ligation and age at tubal ligation were manually abstracted in cohort 1. For cohorts 2 and 3, history of tubal ligation was obtained from an institutional form, completed by patient report. The primary outcome, age at natural menopause, was compared between the two groups (those with and without a history of tubal ligation).

RESULTS: Inclusion criteria was met by 555 women from cohort 1, 1,816 women from cohort 2, and 1,534 women from cohort 3. Baseline characteristics did not differ between cohorts. The percentage with tubal ligation was the same in all cohorts: 26.0%, 25.5%, and 25.0%, respectively. Women with a tubal ligation were more likely to have had at least one pregnancy and to have used hormonal contraception compared with women without a tubal ligation. There was no significant difference in age at natural menopause in women who underwent tubal ligation (50.1, 49.9, 50.0 years, respectively) compared with those who did not (50.7, 49.6, 50.0 years, respectively). The type of tubal ligation (cohort 1 only) had no effect on age at menopause.

CONCLUSIONS: Tubal ligation did not affect age at natural menopause in the three large cohorts included in this study.

There is no association of tubal ligation with age at natural menopause.

Department of Obstetrics and Gynecology, and the Divisions of Epidemiology and Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.

Corresponding author: Shannon K. Laughlin-Tommaso, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; email:

This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676 and grant from the National Cancer Institute (R01 CA97396). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Informed consent was obtained from all subjects.

Financial Disclosure Dr. Laughlin-Tommaso received money paid to her from Allergan Pharmaceuticals, UpToDate, and Bayer Pharmaceuticals. She was previously on DSMB for the ULTRA trial (Halt Medical). The other authors did not report any potential conflicts of interest.

Presented at the annual meeting of the American Society of Reproductive Medicine, October 6–10, 2018, Denver, Colorado.

Each author has confirmed compliance with the journal's requirements for authorship.

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© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.