Does Tubal Ligation Stop Endometriosis?
No, tubal ligation does not stop endometriosis and may paradoxically be associated with endometriosis development at the ligation site itself, though it appears to reduce the risk of developing moderate-to-severe disease elsewhere in the pelvis.
Effect on Existing Endometriosis
Tubal ligation does not treat or eliminate existing endometriosis. The procedure only occludes the fallopian tubes and has no direct therapeutic effect on endometriotic implants already present in the pelvis 1.
Protective Effect Against Severe Disease
- Tubal ligation is associated with reduced risk of developing endometrioid and clear-cell ovarian carcinomas, which are the endometriosis-associated subtypes of ovarian cancer 1.
- In multiparous women with chronic pelvic pain, tubal ligation was associated with less severe endometriosis (moderate-severe disease found in only 8.7% of sterilized women versus 36.4% of non-sterilized women, with adjusted OR 0.21) 2.
- The protective mechanism likely involves preventing retrograde menstruation from reaching the peritoneal cavity, thereby limiting new implant formation 2.
Paradoxical Risk: Endometriosis at the Ligation Site
Tubal ligation can actually cause endometriosis to develop at the sterilization site itself through several mechanisms:
- Tuboperitoneal fistula formation occurs when endometriosis develops at the ligation site, creating epithelium-lined channels from the tubal lumen through the tubal wall to the peritoneal surface 3, 4.
- This risk is highest when ligation occurs within 4 cm of the uterine cornu and increases with time elapsed since sterilization (particularly after 3 years) 3.
- Laparoscopic cautery methods show higher rates of fistula formation and endometriosis development compared to other sterilization techniques 3.
- The mechanism involves implantation of menstrual products expelled through the open proximal tubal lumen into the healed ligation area 4.
Clinical Prevalence After Sterilization
- Endometriosis is found in 11.8% of women undergoing tubal sterilization, with 90.9% histologically confirmed 5.
- Among asymptomatic parous women seeking sterilization, the prevalence is approximately 10% 5.
- In multiparous women with chronic pelvic pain who had prior tubal ligation, 45.1% still had endometriosis at subsequent laparoscopy 2.
Important Clinical Pitfall
Women who develop dysmenorrhea after tubal ligation may have retrograde menstruation causing dilation of the proximal tubal stumps with blood, which can mimic endometriosis symptoms 6. This requires diagnostic laparoscopy during menstruation to identify, and may respond to re-occlusion of the proximal tube at the cornua 6.
Bottom Line for Clinical Practice
Tubal ligation should not be recommended as a treatment or prevention strategy for endometriosis. While it may reduce the severity of disease that develops elsewhere in the pelvis 2, it does not treat existing disease and can paradoxically cause endometriosis at the sterilization site itself 3, 4. Women with endometriosis seeking permanent contraception should be counseled that sterilization will not improve their endometriosis symptoms and may occasionally worsen dysmenorrhea through tubal stump complications 6.