Higher hysterectomy risk for sterilized than nonsterilized women: Findings from the US Collaborative Review of Sterilization

Objective: To compare the risk of hysterectomy among previously sterilized women and women whose husbands had undergone vasectomy, and to evaluate whether this risk differed by age at surgical procedure or by method of tubal occlusion. Methods: Our study population comprised 7718 women enrolled in a prospective, multicenter cohort study between 1978 and 1986. After stratifying by the woman's age at surgical procedure, we used the life-table approach and adjusted hazards ratios to examine whether the relative risk of hysterectomy during the 5 years after enrollment differed between the 7174 women who had been sterilized and the 544 women whose husbands had undergone vasectomy. Results: The 5-year cumulative probability of hysterectomy was 8% among the previously sterilized women and 2% among the women whose husbands had undergone vasectomy. Among women 34 years of age and younger at enrollment, sterilized women were 4.4 times as likely to have a hysterectomy as women whose husbands had undergone vasectomy (95% confidence interval [CI] 1.9, 10.0). Findings were similar for women 35 years of age and older (rate ratio = 4.6; 95% CI 1.4, 14.5). Each of the six most commonly used methods of tubal occlusion was associated with an increased risk of hysterectomy. Conclusion: Women undergoing tubal sterilization were more likely than women whose husbands underwent vasectomy to undergo hysterectomy within 5 years after sterilization, regardless of age at sterilization. An increased risk of hysterectomy was observed for each method of tubal occlusion.