Tubal ligation and the risk of vertebral fractures

Tubal Ligation and Age at Natural Menopause

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.

Prooxidant-antioxidant balance and malondialdehyde over time in adult rats after tubal sterilization and vasectomy

OBJECTIVE

Sterilization (tubal sterilization and vasectomy) is a widely applied contraceptive method worldwide. Although most studies have described sterilization as a safe method, there are reports of tubal ligation (TL) and vasectomy complications. The aim of this study was to evaluate the effects of TL and vasectomy on the serum oxidative stress, specifically prooxidant-antioxidant balance (PAB) and malondialdehyde (MDA) levels, over time.

METHODS

Male and female rats were classified into vasectomy, sham-vasectomy, TL, and sham-TL groups, respectively. The PAB and MDA levels were measured on days 15 and 45 and months 3 and 6 after the intervention. For female rats, blood sampling was performed during the diestrous phase and estradiol and progesterone were also measured.

RESULTS

Serum PAB and MDA increased after TL (p<0.05). Vasectomy increased serum MDA remarkably after 45 days, 3 months, and 6 months (p<0.05). After vasectomy, serum PAB also increased although not significantly. Serum estradiol and progesterone decreased remarkably in the TL group compared to the sham group (p<0.05).

CONCLUSION

Bilateral TL and vasectomy both increase the serum oxidative stress; however the imbalance after TL was very noticeable. As for the TL, the reduction of serum estrogen levels can be involved in this imbalance. Complications followed by TL or vasectomy could be due to increased levels of oxidants. Thus, prescribing antioxidants during and or after surgery may be a solution.

Depression and percent body fat in American women, ages 39-49

I investigated the association between depression and percent body fat, two major global problems. Participants are 1,704 American women, ages 39-49, who responded to a detailed self-administered mailed questionnaire. My results showed a positive correlation; the adjusted OR = 1.70, 95% CI (1.20, 2.39), p = .002. Percent body fat was estimated from age, height, and weight, a cost-free method that may be useful in areas in which dual energy X-ray absorptiometry, or other procedures are too costly or unavailable. My findings may aid health and mental health care providers in the management and treatment of patients seen in settings with limited resources.

Percent body fat, fractures and risk of osteoporosis in women

OBJECTIVES

Globally, in an aging population, osteoporosis and fractures are emerging as major public health problems; accessible and affordable recognition, prevention and treatment strategies are needed. Percent body fat is known to be associated with bone mineral density and fractures. This paper uses an innovative, virtually cost-free method to estimate percent body fat from age, height and weight, and assesses its validity by examining the association between percent body fat and fractures among women 39 and older.

DESIGN

An epidemiologic study.

PARTICIPANTS

3940 college alumnae, median age 53.6, participated by responding to a mailed questionnaire covering medical history, behavioral factors, birth date, weight and height.

STATISTICAL METHODS

T-tests, chi-square and multivariable logistic regression.

MEASUREMENTS

Percent body fat estimated from age, weight, height and gender.

RESULTS

Associations of fractures with percent body fat are expressed as odds ratios: for osteoporotic (wrist, hip and/or x-ray confirmed vertebral), the adjusted OR = 2.41, 95% CI (1.65, 3.54), P < 0.0001; for wrist fractures, the adjusted OR = 2.56, 95% CI (1.65, 3.96), P < 0.0001; for x-ray confirmed vertebral fractures the adjusted OR = 4.69, 95% CI (2.05, 10.77), P=0.0003).; and for non-osteoporotic, he adjusted OR= 1.00, 95% CI (0.76 1.32), P=0.999.

CONCLUSION

The findings are consistent with methods using DXA and/or other technologies that show percent body fat is associated with fractures of the wrist and vertebrae. Identification of risk factors is necessary for the prevention and treatment of osteoporosis and osteoporotic fractures. Estimation of percent body fat from age, height and weight may be a valid, cost-saving, and cost-effective alternative tool for screening and assessing risk of osteoporosis in settings where Dual x-ray absorptiometry (DXA) or other radiological techniques are too costly or unavailable.