Dr. Cattanach successfully treated those problems by giving affected women a combination of estrogen and progesterone replacement hormones.

Dr. Cattanach believes that the lowered hormone levels may have been the result of damage to the blood supply to the ovary during the operation, which may occur more often with certain surgeons and certain surgical techniques.

Critics of Dr. Cattanach say that the studies he did were too small to warrant any definitive conclusion. They also point out that a review of well designed studies involving 5,000 women with tubal ligation showed no increase in health problems when compared to a group of women who didn't have a tubal ligation.

Meanwhile, Dr. Cattanach has started DCAHS, Doctors Concerned About Human Sterilization, to promote research into premature menopause following both tubal ligation and hysterectomy. He says there is no way of knowing which women will be most affected after surgery. However, certain surgical techniques, such as electrocautery, seem to cause more damage.

Janine O'Leary Cobb, author of Understanding Menopause (Key Porter, 1988), comments in her newsletter (Feb/92), "There are a number of procedures used to sterilize women and some seem less harmful than others; even so it is rare to find a physician willing to acknowledge such consequences, or indeed, warn about potential long-term effects."

Resources:

• DCAHS, Doctors Concerned About Human Sterilization, c/o Dr. John Cattanach, 37 Vista St, Bulleen, Vic 3105, Melbourne, Australia. 03-852-0644. Fax: 03-852-0096.