title: Menstrual Pattern following Tubal Ligation: A Historical Cohort Study.
abstract: BACKGROUND
  Tubal ligation (TL) is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders.
  
  
  METHODS
  A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group) and on 140 women using condom as the main contraceptive method (Non-TL group). They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC) was also used to measure the menstrual blood loss.
  
  
  RESULTS
  Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002). Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006), hypermenorrhea (12.1 vs. 2.1%, P=0.002), menorrhagia (62.9 vs. 22.1%, P<0.0001) and menometrorrhagia (15.7 vs. 3.6%, P=0.001) than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001). According to logistic regression, age odds ratio [(OR=1.08, con- fidence interval (CI):1.07-1.17, P=0.03)], TL (OR=5.95, CI:3.45-10.26, P<0.0001) and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001) were significantly associated with menorrhagia.
  
  
  CONCLUSIONS
  We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.
authors.affiliation: Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Shahideh Jahanian
authors.initials: SJ
authors.lastname: Sadatmahalleh
authors.affiliation: Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Saeideh
authors.initials: S
authors.lastname: Ziaei
authors.affiliation: Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Anoshirvan
authors.initials: A
authors.lastname: Kazemnejad
authors.affiliation: Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Eesa
authors.initials: E
authors.lastname: Mohamadi
keywords: Historical Cohort Study; Menstrual Disorders; Pictorial Blood Loss Assessment Chart; Tubal Ligation