Hormonal and menstrual changes after laparoscopic sterilization by Falope-rings or Filshie-clips

Abstract

Objective: To evaluate the influence of laparoscopic sterilization by Falope-rings (Cabot Medical Corp., Langhorne, PA) or Filshie-clips (Femcare, Nottingham, United Kingdom) on menstrual pattern and ovulatory function.

Design: A prospective, nonrandomized study of women sterilized by Falope-rings (n = 6) or Filshie-clips (n = 5). Menstrual charts were kept. Serum follicle-stimulating hormone (FSH), estradiol (E2) and progesterone (P) were measured by means of radioimmunoassay in one cycle before and 3, 6, and 12 months after the sterilization. Blood samples were drawn on day -6, -2, 0, +6, +10 of the menstrual cycle, ovulation corresponding to day 0. The women sterilized by Filshie-clips had abdominal ultrasonography of the ovaries measuring the leading follicle on day -6, -2, 0, +6 of the menstrual cycle.

Patients: Twelve women, 25 to 38 years old, with regular menstrual cycles and no use of oral contraceptives or intrauterine contraceptive device at least 6 months before sterilization. One woman was excluded.

Results: After the sterilization, all women reported unchanged menstrual pattern. The follicular rise in E2 unchanged, and FSH levels fell accordingly. Progesterone levels were ovulatory, but the midluteal P peak 3 months poststerilization was significantly decreased. Serial abdominal ultrasonography in women sterilized by Filshie-clips confirmed ovulation in all cycles except in one woman, who had an unruptured follicle in one cycle before and in the sixth cycle after sterilization.

Conclusion: Laparoscopic sterilization by Falope-rings or Filshie-clips does not seem to interfere with menstrual pattern or ovulatory function.

PIP: Physicians evaluated the effect of laparoscopic female sterilization by Falope-ring and the Filshie-clip technique on the menstrual pattern, the ovarian endocrine function, and the ovulatory function on 6 women at the Rigshospitalet in Copenhagen, Denmark and on 5 women at Gentofte County Hospital in Denmark. They followed these women from 1-2 months before sterilization and at 3,6, and 12 months after sterilization. The physicians took blood samples on day -6, -2, 0 (menstrual cycle), 6, 10 of the menstrual cycle to measure follicle stimulating hormone (FSH), estradiol, and progesterone. Ultrasonography measured the leading follicle of women sterilized by Filshie-clips on day -6, -2, 0, 6, 10 of the menstrual cycle. None of the 11 25-38 year old women used oral contraceptives or an IUD before the surgery. All experienced regular menstrual cycles. The sterilization did not cause any changes in menstruation. Moreover peak estradiol levels rose during the follicular phase and peak FSH levels decreased as normal. Overall peak progesterone levels stayed within normal limits of the ovulatory cycle, but it fell considerably 3 months after sterilization (p.05) and somewhat significantly 12 months after sterilization. Ultrasonography revealed that only 1 women sterilized by Filshie-clips experienced an unruptured follicle in the cycle before and the 6th cycle after sterilization. All other women sterilized by Filshie-clips experienced normal valuation. Based on these results, the researchers concluded that laparoscopic female sterilization by Falope-rings and the Filshie-clips do not affect the menstrual pattern or ovulatory function.