April 1, 2015

Hysteroscopic sterilization is a relatively new alternative to laparoscopic sterilization. During the often-outpatient procedure, a metal coil is implanted, causing permanent blockage of the fallopian tubes. Recent media reports, however, have described instances of prolonged pelvic pain in women who have undergone hysteroscopic sterilizations.

Mitchell Conover

Mitchell Conover

A new paper, “Incidence of opioid-managed pelvic pain after hysteroscopic sterilization versus laparoscopic sterilization, US 2005-2012,” published online March 31 in Pharmcoepidemiology & Drug Safety, addresses this concern by comparing the incidence of pelvic pain managed with opioids in patients during the 12 months following either hysteroscopic or laparoscopic sterilization.

This research is especially important because hysteroscopic sterilizations have become increasingly common over the last decade. The procedure requires no surgical incisions and can be performed in the outpatient setting, making it a convenient option for women. As of 2012, hysteroscopic sterilizations represented 50 percent of all sterilizations completed in the study population.

Alan Kinlaw

Alan Kinlaw

Dr. Jonsson Funk

Dr. Jonsson Funk

The paper represents the largest study to date evaluating adverse events after hysteroscopic sterilization. Mitchell Conover, a doctoral student in the Department of Epidemiology at the UNC-Chapel Hill Gillings School of Global Public Health, is the primary investigator. Co-authors include Alan Kinlaw, a doctoral student, and Michele Jonsson Funk, a research associate professor, both from the same department at the Gillings School.

Referencing entries from a large health care claims database, the researchers analyzed the cases of over 70,000 eligible women who had undergone one of the two sterilization procedures between the years 2005 and 2012. Using diagnosis codes and prescription drugs from anonymized insurance claims, they identified the patients from this group who had received at least two separate diagnoses of pelvic pain and had filled at least two prescriptions for opioids during the year after sterilization.

During the year following sterilization, the researchers identified that 0.88 percent of (or 8.8/1,000) women in the hysteroscopic group and 0.93 percent of (or 9.3/1,000) women in the laparoscopic group with pelvic pain used opioids to manage it. After adjusting for other differences between the groups, the authors did not find a clinically meaningful or statistically significant difference between the groups in terms of risk of opioid-managed pelvic pain.

“We did not find evidence that women who have a hysteroscopic (instead of laparoscopic) procedure are more likely to have pelvic pain requiring opioids in the year following sterilization,” said Conover. “The risk was low overall: in the adjusted analysis, about 1.2% of both groups had the outcome within one year. Further studies are needed to evaluate the risk of other adverse health outcomes that women have described.”


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Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

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