Association between tubal ligation and hysterectomy: Findings from a prospective cohort study

OBJECTIVE: Although several studies have examined the sociodemographic and reproductive correlates of hysterectomy, evidence on the association between tubal ligation and hysterectomy from prospective cohort studies remains limited. Most studies were retrospective and were conducted several decades ago; moreover, they have reported inconsistent findings. This study examined the association between tubal ligation and the likelihood of hysterectomy using a population-based prospective cohort of Australian women of reproductive age. STUDY DESIGN: Participants comprised 8270 women born from 1973 to 1978. Data were drawn from the Australian Longitudinal Study on Women's Health, collected every three years from 2006 (participants aged 28-33 years) to 2021 (participants aged 43-49 years). A Cox proportional hazards model was used for the analysis. MAIN OUTCOME MEASURE: Time to hysterectomy. RESULTS: The Kaplan-Meier estimated cumulative incidence of hysterectomy was 7.14% (95% confidence interval 6.55-7.78) at 16.6 years of follow-up. Women who had undergone tubal ligation had a higher likelihood of hysterectomy than those who had not (hazard ratio 3.04, 95% confidence interval 2.29-4.04). This association remained after adjustment for menstrual symptoms (hazard ratio 2.42, 95% confidence interval 1.81-3.22) and hormonal contraceptive use (hazard ratio 2.91, 95% confidence interval 2.19-3.88). CONCLUSIONS: This study provides contemporary evidence on the association between tubal ligation and hysterectomy and suggests a higher likelihood of hysterectomy among women who have undergone tubal ligation. The higher prevalence of both procedures among women from socioeconomically disadvantaged backgrounds suggests that socioeconomic and healthcare access factors may influence both contraceptive choice and the surgical management of benign gynaecological conditions.