Ligadura tubárica

La esterilización sigue siendo el método más común de planificación familiar entre las mujeres casadas. Casi el

50 % de las intervenciones de esterilización femenina se realizan mientras las mujeres están hospitalizadas por otras razones o con motivo de un parto. Los avances en las técnicas quirúrgicas ofrecen a las mujeres la comodidad de una hospitalización breve y una recuperación rápida.

Es importante informarlas, de que algunas veces se producen cambios menstruales después de la intervención. Los trabajos aparecidos en la literatura especializada sobre un “síndrome postesterilización tubárica” han descrito anomalías como alteraciones del flujo menstrual, intensificación de los síntomas premenstruales y dolor pélvico en el 10 % al 50 % de las mujeres después de la ligadura tubári-ca.92 Esos primeros trabajos presentaban defectos metodológicos y no tenían en cuenta el hecho de que muchas mujeres sometidas a ligadura tubárica han suspendido recientemente el uso de anticonceptivos orales o de un DIU, y que por lo tanto pueden estar volviendo a los patrones menstruales existentes antes de iniciar la anticoncepción. Los diversos estudios no han aclarado por completo la naturaleza y la extensión de los cambios clínicos, ni las causas de tales cambios. Entre las etiologías propuestas se incluye la destrucción tisular, que podría alterar la vascularización y conducir a variación de los niveles hormonales, aunque ninguna proposición se ha acompañado de datos convincentes que la apoyen. Preocupa la posibilidad de que las mujeres sometidas a ligadura tubárica experimenten más adelante trastornos menstruales que hagan necesarias otras intervenciones quirúrgicas, como la histe-rectomía.93 Hasta que se completen ensayos prospectivos seguirá sin aclararse la etiología del síndrome postesterilización tubárica.

Bibliografía

1. Trussell J, Leveque JA, Koenig JD, et al. The economic value of contraception: a comparison of 15 methods. Am J Public Health 1995; 85: 494-503.

2. Alvarez F, Brache V, Fernandez E, et al. New insights on the mode of action of intrauterine contraceptive devices in women. Fertil Steril 1988; 49: 768-73.

3. Larsson B, Ljung B, Hamberger L. The influence of copper on the in vitro motility of the human fallopian tube. Am J Obstet Gynecol 1976; 125: 682-90.

4. Segal SJ, Sanchez FA, Adejuivon LA, Mejia VB, Leon P, Faundes A. Absence of chorionic gonadotropin in sera of women who use intrauterine devices. Fertil Steril 1985; 44: 214-18.

5. Moyer DL, Mishell DR. Reactions of human endometrium to the intrauterine foreign body. Am J Obstet Gynecol 1971; 111:66-79.

6. Kjos SL, Ballagh SA, La Cour M, Xiang A, Mishell DR. The copper T380A intrauterine device in women with type II diabetes mellitus. Obstet Gynecol 1994; 84: 1006-9.

7. Sivin I. Dose and age-dependent ectopic pregnancy risks with intrauterine contraception. Obstet Gynecol 1991; 78: 291-8.

8. Cramer DW, Goldman MB, Schiff I, et al. The relationship of tubal infertility to barrier method and oral contraceptive use. JAMA 1987; 257: 2446-50.

9. Kessel E. Pelvic inflammatory disease with intrauterine device use: a reassessment. Fertil Steril 1989; 51: 1-11.

10. Sinei SKA, Schulz KF, Lamprey PR, et al. Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion. Br J Obstet Gynaecol 1990; 97: 412-19.

11. Darling JR, Weiss NS, Metch BJ, et al. Primary tubal infertility in relation to the use of the intrauterine device. N Engl J Med 1985; 312: 937-41.

12. Evans DTP. Actinomyces israelii in the female genital tract. Genitourin Med 1993; 69: 54-9.

13. Firorino AS. Intrauterine contraceptive device-associated actinomycotic abscess and Actinomyces detection on cervical smear. Obstet Gynecol 1996; 87: 142-9.

14. Larsson G, Milsom I, Jonasson K, Lindstedt G, Rybo G. The long-term effects of copper surface area on menstrual blood loss and iron status in women fitted with an IUD. Contraception 1993; 48: 471-80.

15. Zhang J. Factors associated with copper T IUD removal for bleeding/pain: a multivariate analysis. Contraception 1993; 48:13-21.

16. Ben-Rafael Z, Bider D. A new procedure for removal of a “lost” intrauterine device. Obstet Gynecol 1996; 87: 785-6.

17. Tatum HJ, Schmidt FH, Jain AK. Management and outcome of pregnancies associated with the copper T intrauterine device. Am J Obstet Gynecol 1976; 126: 869-79.

18. Craig S, Hepburn S. The effectiveness of barrier methods with and without spermicide. Contraception 1982; 26: 347-59.

19. Hooton TM, Hiller S, Johnson C, Roberts PL, Stamm WE. Escherichia coli bacteriuria and contraceptive method. JAMA 1991; 265: 64-9.

20. Baehler EA, Dillon WP, Cumbo TJ, Lee RV. Prolonged use of a diaphragm and toxic shock syndrome. Fertil Steril 1982; 38: 248-50.

21. Powell MG, Mears BJ, Deber RB. Contraception with the cervical cap: effectiveness, safety, continuity of use and user satisfaction. Contraception 1986; 33: 215-32.

22. Moran JS, Janes HR, Peterman TA, Stone KM. Increase in condom sales following AIDS education and publicity, United States. Am J Public Health 1990; 80: 607-8.

23. Schechter MT, Craib KJ, Willoughby B, et al. Patterns of sexual behavior and condom use in a cohort of homosexual men. Am J Public Health 1988; 78:1535-8.

24. Trussell J, Kost K. Contraceptive failure in the United States: a critical review of the literature. Stud Fam Plan 1987; 18: 237-83.

25. Gerofi J, Shelley G, Donovan B. A study of the relationship between tensile testing of condoms and breakage in use. Contraception 1991; 43: 177-85.

26. Albert AE, Hatcher RA, Graves W. Condom use and breakage among women in a municipal hospital family planning clinic. Contraception 1991; 43: 167-76.

27. DeVincenzi I, for the European Study Group on Heterosexual Transmission of HIV. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. N Engl J Med 1994;31:341-6.

28. Diaz T, Schable B, Chu SY, Supplement to HIV and AIDS Surveillance Project Group. Obstet Gynecol 1995; 86: 277-82.

29. Trussell J, Sturgen K, Strickler J, et al. Comparative contraceptive efficacy of the female condom and other barrier methods. Fam Plann Perspect 1994; 26: 66-72.

30. Louv WC, Austin H, Alexander WJ, Stagno S, Cheeks J. A clinical trial of nonoxynol-9 for preventing gonococcal and chlamydial infections. J Infect Dis 1988; 158: 518-23.

31. Fischl MA, Dickinson GM, Scott GB, Klimas N, Fletcher MA, Parks W. Evaluation of heterosexual partners, children and household contacts of adults with aIdS. JAMA 1987; 257: 640-4.

32. Louik C, Mitchell AA, Werler MM. Maternal exposure to spermicides in relation to certain birth defects. N Engl J Med 1987; 317: 474-8.

33. Hemrika DJ, Slaats EH, Schoemaker J. The response of the pituitary-ovarian axis to pulsatile administration of gonadotropin-releasing hormone in long-term oral contraceptive users. Am J Obstet Gynecol 1994; 170: 462-8.

34. Vessey MP, Villard-Mackintosh L, Jacobs HS. Anti-estrogenic effect of cigarette smoking [letter]. N Engl J Med 1987; 317: 769.

35. Baron JA, La Vecchia C, Levi F. The antiestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol 1990; 162: 502-14.

36. Rosenberg MJ, Waugh MS, Long S. Unintended pregnancies and use, misuse and discontinuation of oral contraceptives. J Reprod Med 1995; 40: 355-60.

37. Rosenberg MJ, Waugh MS, Stevens CM. Smoking and cycle control among oral contraceptive users. Am J Obstet Gynecol 1996; 174: 628-32.

38. Hatcher RA, Trussell J, Stewart F, et al. The pill: combined contraception. In: Hatcher RA, Trussell J, Stewart F, et al, editors. Contraceptive technology. New York: Irvington, 1994: 230-1.

39. Louv WC, Austin H, Perlman J, Alexander WJ. Oral contraceptive use and the risk of chlamydial and gonococcal infections. Am J Obstet Gynecol 1989; 160: 396-402.

40. Mishell DR. Oral contraception 1990: taking stock. Dialog Contraception 1990; 3: 1-7.

41. Parazzini F, Negri E, Vecchi CL, Fedele L, Rabaiotti M, Luchini L. Oral contraceptive use and risk of uterine fibroids. Obstet Gynecol 1992; 79: 430-3.

42. Vessey M, Metcalfe A, Wells C, McPherson K, Westhoff C, Yeates D. Ovarian neoplasms, functional ovarian cysts, and oral contraceptives. BMJ 1987; 294: 1518-20.

43. Grimes DA, Godwin AJ, Rubin A, Smith JA, Lacarra M. Ovulation and follicular development with three low-dose oral contraceptives: a randomized controlled trial. Obstet Gynecol 1994; 83: 29-34.

44. Frassinelli-Gunderson EP, Margen S, Brown JR. Iron stores in users of oral contraceptive agents. Am J Clin Nutr 1985; 41: 703-12.

45. Hazes JMW, Dijkmans BAC, Vanderbroucke JP. Reduction of the risk of rheumatoid arthritis among women who take oral contraceptives. Arthritis Rheum 1990; 33:173-9.

46. Grodstein F, Colditz GA, Hunter DJ, et al. A prospective study of symptomatic gallstones in women: relation with oral contraceptives and other risk factors. Obstet Gynecol 1994; 84: 207-14.

47. Haenggi W, Casez JP, Birkharuser MH, et al. Bone mineral density in young women with long-standing amenorrhea: limited effects of hormone replacement therapy with ethinyl estradiol and desogestrel. Osteoporos Int 1994; 4: 99-103.

48. Woods ER, Grace E, Havens kK, Merola JL, Emans SJ. Contraceptive compliance with a levonorgestrel triphasic and a norethindrone oral contraceptive in adolescent patients. Am J Obstet Gynecol 1992; 166: 901-7.

49. Casper RF, Powell AM. Evaluation and therapy of breakthrough bleeding in women using a triphasic oral contraceptive. Fertil Steril 1991; 55: 292-6.

50. Upton GV. Lipids, cardiovascular disease, and oral contraceptives: a practical perspective. Fertil Steril 1990; 53: 1-12.

51. Godsland IF, Crook D, Simpson R, et al. The effects of different formulations of oral contraceptive agents on lipid and carbohydrate metabolism. N Engl J Med 1990; 323: 1375-81.

52. Croft P, Hannaford PC. Risk factors for acute myocardial infarct in women: evidence from the Royal College of General Practitioner’s oral contraceptive study. BMJ 1989; 298: 165-8.

53. Stampfer MJ, Willett WC, Colditz GA, Speizer FE,Hannekens CH. A prospective study of past use of oral contraceptive agents and risk of cardiovascular diseases. N Engl J Med 1988; 319:1313-17.

54. Skouby SO, Anderson O, Kuhl C. Oral contraceptives and insulin receptor binding in normal women and those with previous gestational diabetes. Am J Obstet Gynecol 1986; 155: 802-7.

55. Bracken MB. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol 1990; 76: 552-7.

56. Peipert JF, Gutmann J. Oral contraceptive risk assessment: a survey of 247 educated women. Obstet Gynecol 1993; 82: 112-17.

57. Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. Oral contraceptive use and the risk of breast cancer. N Engl J Med 1986; 315: 405-11.

58. Williams JK. Oral contraceptives and reproductive system cancer. J Reprod Med 1991; 36: 247-52.

59. Schlesselman JJ. Net effect of oral contraceptive use on the risk of cancer in women in the United States. Obstet Gynecol 1995; 85: 793-801.

60. Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. The reduction in risk of ovarian cancer associated with oral contraceptive use. N Engl J Med 1987; 316: 650-5.

61. Gross TP, Schlesselman JJ. The estimated effect of oral contraceptive use on the cumulative risk of epithelial ovarian cancer. Obstet Gynecol 1994; 83: 419-24.

62. Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. Combination oral contraceptive use and the risk of endometrial cancer. JAMA 1987; 257: 796800.

63. Negrini BP, Schiffman MH, Kurman RJ, et al. Oral contraceptive use, human papillomavirus infection and risk of early cytological abnormalities of the cervix. Cancer Res 1990; 50: 4670-5.

64. Gerstman BB, Piper JM, Tomita DK, Ferguson WJ, Stadel BV, Lundin FE. Oral contraceptive estrogen dose and the risk of deep venous thromboembolic disease. Am J Epidemiol 1991; 133:32-7.

65. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study. Lancet 1995; 346:1575-82.

66. Jick H, Hick SS, Gurewich V, et al. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestogen components. Lancet 1995; 346: 1589-93.

67. Spitzer WO, Lewis MA, Heinemann LAJ, et al on behalf of Transnational Research Group on Oral Contraceptives and

the Health of Young Women. Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study. BMJ 1996; 312: 83-8.

68. Farmer RDT, Preston TD. The risk of venous thromboembolism associated with low oestrogen oral contraceptives. J Obstet Gynaecol 1995; 15:195-200.

69. Mishell DR, Kaunitz AM, Sulak PJ, et al. Oral contraceptives and venous thromboembolism: consensus conference statement. Dialog Contraception 1996; spring: 1-8.

70. Chi IC. The safety and efficacy issues of progestin-only oral contraceptives: an epidemiologic perspective. Contraception 1993; 47: 1-21.

71. Smith RD, Cromer BA, Hayes JR, et al. Medroxyprogesterone acetate (Depo-Provera) use in adolescents: uterine bleeding and blood pressure patterns, patient satisfaction and continuation rates. Adolesc Pediatr Gynecol 1995; 8: 24-8.

72. Cundy T, Cornish J, Evans MC, et al. Recovery of bone density in women who stop using medroxyprogesterone acetate. BMJ 1994; 308: 247-8.

73. Sharma JB, Newman MRB, Smith RJ. Depot medroxyprogesterone acetate and osteoporosis: smoking may explain findings [letter]. BMJ 1994; 308: 1567.

74. Su-Juan G, Ming-Kun M, Ling-De Z, et al. A 5-year evaluation of Norplant contraceptive implants in China. Obstet Gynecol 1994; 83: 673-8.

75. Konji JC, Otolorin EO, Lapido OA. The effect of continuous subdermal levonorgestrel (Norplant) on carbohydrate metabolism. Am J Obstet Gynecol 1992; 166:15-19.

76. Sivin I, Stern J, Diaz S, et al. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCU 380A intrauterine contraceptive devices. Am J Obstet Gynecol 1992; 166: 1208-13.

77. Cullins VE, Remsburg RE, Blumenthal PD, Huggins GR. Comparison of adolescent and adult experiences with Norplant levonorgestrel contraceptive implants. Obstet Gynecol 1994; 83: 1026-32.

78. Van Amerongen D. Removal rates of subdermal levonorges-trel implants. J Reprod Med 1994; 39: 873-6.

79. Polaneczky M, Slap G, Forke E, et al. The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers. N Engl J Med 1994; 331: 1201-6.

80. Faundes A, Alvarez F, Braache V, Jimenez E, Tejada AS. Hormonal changes associated with bleeding during low dose progestogen contraception delivered by Norplant subdermal implants. Adv Contracept 1991; 7: 1-10.

81. Diaz S, Croxatto NB, Pavez M, et al. Clinical assessment of treatments for prolonged bleeding in users of Norplant implants. Contraception 1990; 42: 97-109.

82. Alvarez-Sanchez F, Brache MT, Thevenin F, Cocnon L, Faundes A. Hormonal treatment for bleeding irregularities in Norplant implant users. Am J Obstet Gynecol 1996; 174: 919-22.

83. Archer DF. Management of bleeding in women using sub-dermal implants. Contemp Obstet Gynecol 1995; July:11-25.

84. Trussell J, Stewart F. The effectiveness of postcoital hormonal contraception. Fam Plann Perspect 1992; 24: 262-4.

85. Grou F, Rodriques I. The morning-after pill: how long after? Am J Obstet Gynecol 1994; 171: 1529-34.

86. Young DC, Wiehle RD, Joshi SG, Poindexter AN. Emergency contraception alters progesterone-associated endometrial protein in serum and uterine luminal fluid. Obstet Gynecol 1994; 84: 266-71.

87. Harper CC, Ellertson CE. The emergency contraceptive pill: a survey of knowledge and attitudes among students at Princeton University. Am J Obstet Gynecol 1995; 173:1438-45.

88. Geerling JH. Natural family planning. Am Fam Physician 1995; 52: 1749-56.

89. Kambric RT. Natural family planning use-effectiveness and continuation. Am J Obstet Gynecol 1991; 165: 2046-8.

90. Wade ME, McCarthy P, Braunstein GD, et al. A randomized prospective study of the use-effectiveness of two methods of natural family planning. Am J Obstet Gynecol 1981; 141: 368-76.

91. Fehring RJ, Lawrence D, Philpot C. Use effectiveness of the Creighton model ovulation method of natural family planning. J Obstet Gynecol Neonat Nurs 1994; 23: 303-9.

92. Shain RN, Miller WB, Mitchell GW, et al. Menstrual pattern change 1 year after sterilization: results of a controlled, prospective study. Fertil Steril 1989; 52: 192-203.

93. Shy KK, Sterrgachis A, Grothaus LG, et al. Tubal sterilization and risk of subsequent hospital admission for menstrual disorders. Am J Obstet Gynecol 1992; 166:1698-706.