Regret Lowest Among Nulliparous Women The landmark CREST studies found that, among women aged 30 or younger at the time of sterilization, regret "was lowest among women who had no previous births" at...
Sterilization regret is lowest among nulliparous women.
The landmark CREST studies found that, among women aged 30 or younger at the time of sterilization, regret "was lowest among women who had no previous births" at 6.3%. Among women aged 30 or younger, nulliparous women are less likely to regret sterilization than those who have had children.
Sterilization regret & age: If I'm childfree, how likely am I to regret being sterilized?
Regret Lowest Among the Childfree (Nulliparous)
The landmark CREST studies found that, among those aged 30 or younger at the time of sterilization, regret "was lowest among [those] who had no previous births" at 6.3%. Among those aged 30 or younger, nulliparous patients are less likely to regret sterilization than those who have had children.
Compare to 5.9% for those over age 30 at sterilization (all parities), and 5.4% for nulliparous aged over 30 at sterilization.
(All are cumulative probabilities at 14 years post-sterilization.)
This means that among those who haven't had children, the risk of sterilization regret is not meaningfully reduced by waiting until after age 30 for sterilization.
Among the childfree who have been sterilized, about 6% change their minds, but 94% don't.
We used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18-44 years who had tubal sterilizations between 1978 and 1987. [...] For women aged 30 or younger at sterilization, the cumulative probability of regret decreased as time since the birth of the youngest child increased (2-3 years, 16.2%, 95% CI 11.4, 21.0; 4-7 years, 11.3%, 95% CI 7.8, 14.8; 8 or more years, 8.3%, 95% CI 5.1, 11.4) and was lowest among women who had no previous births (6.3%, 95% CI 3.1, 9.4).
Source: "Poststerilization regret: findings from the United States Collaborative Review of Sterilization" One major caveat with the CREST studies is that they were published in the 1990s based on sterilizations performed in the 1980s (but going back as far as 1978).
Professional Statements/Guidances
However, regret was lower in women who had never had a child, compared with women with at least one, suggesting "a woman who is child-free and wishes to remain so is less likely to regret sterilization than a mother who wants no additional children," the McMaster duo write in the JOGC. "Therefore, declining to refer or provide permanent contraception because of the risk of regret is a decision based on conscience and not evidence."
Source: "Doctors denying 'tubals' to women under 30 opting out of motherhood"
Nulliparity should not necessarily be considered a contraindication to sterilization, because motivation and other patient needs do not parallel the age and parity of the candidate. It is simply not borne out statistically that the younger the woman at the time of sterilization, the greater the chance she will change her mind or regret the procedure. In fact, we have found that the nulliparous woman, regardless of age, who opts for sterilization is often more motivated toward child-free living than her parous counterparts of similar age.
Source: "Laparoscopic Sterilization: Clinical Aspects" (Note: This source is older, and it cites older studies and resources in some parts of the article, so some of the information may not be accurate.)
Smaller Studies
"Elective sterilization in childless women" found that "Feelings of unhappiness with regard to sterility were not related to age at the time of the request" (Note: study is almost 40 years old and n = 35)
Multiple studies report that sterilization regret is associated with marital disharmony/conflict, relationship issues, pressure from partner, decision made during difficult pregnancy or delivery, choosing sterilization for health reasons, death of a child (e.g. 1, 2) - some of these don't apply to single people and others don't apply to the childfree/those who do not have children.
The book "Childfree and Sterilized: Women's Decisions and Medical Responses" by Annily Campbell, published 1999: Campbell interviewed 22 women who were sterilized without children in the 1980s-90s. Only one woman expressed regret. That's 1 in 22, or 4.5%. Much of the book is available free of charge via Google Books (linked above).
Nulliparity & early menopause? Factors influencing age at menopause
Basically, the studies below show that age at menopause is affected by the total number of ovulatory cycles in one's lifetime. More ovulatory cycles correlates to earlier menopause, and fewer ovulatory cycles correlates to later menopause.
Those who remain nulliparous (no births) and especially nulligravid (no pregnancies) have more ovulatory cycles in their lifetimes than those who had children because there are no pauses in ovulation during pregnancy.
The second major factor is long-term use of hormonal birth control, which is associated with older age at menopause because HBC suppresses ovulation, which means fewer ovulatory cycles.
The other main factors are cycle length and age at menarche (first period), but these aren't specific to nulliparous individuals.
It seems that if you used HBC long-term, then you wouldn't be at increased risk of early menopause.
But if you didn't use HBC long-term, or at all, then that can increase your risk of early menopause. For example, if you used non-hormonal forms of birth control instead or you did not need and did not use birth control at all, then you would have ovulated incessantly with no suppression, which means a greater number of ovulatory cycles, which correlates to earlier age at menopause.
Does sterilization lead to early menopause? (No)
Having undergone a tubal sterilization procedure (tubal ligation or bilateral salpingectomy) will not itself impact the age at which you reach menopause. However, having been sterilized generally means two things:
You will no longer be taking HBC, which means long-term non-use of HBC (except in some cases to control periods or for backup)
You won't become pregnant (except in cases of sterilization failure)
Both of these factors are associated with a greater number of ovulatory cycles in one's lifetime and thus also associated with earlier menopause.
The effect is especially pronounced for those sterilized at a young age. If you were sterilized at a young age and stopped using HBC then (or you never used HBC even before sterilization), you could have 2-3 decades of not using HBC and not getting pregnant, which does correlate to an earlier age at menopause.
Sources:
Lifestyle and dietary factors determine age at natural menopause - published 2014
The age at natural menopause (ANM) depends on various factors [...] nulliparity, vegetarian diet, smoking, high fat intake, cholesterol, and caffeine accelerates; while others like parity, prior use of oral contraceptive pills, and Japanese ethnicity delays the ANM.
Nulliparity accelerates menopause while parity or use of oral contraceptives - but really this would apply to HBC in general because they all suppress ovulation - delay menopause.
Factors associated with early menopause - published 2000
Lifetime number of ovulatory cycles (indicative of oocyte depletion) is also predictive of the age at natural menopause (ANP). This is consistent with the many studies that have reported early ANP among women with shorter menstrual cycles, and a later ANP among multigravid women or those who used oral contraceptives.
More ovulatory cycles in your lifetime is predictive of earlier menopause, and this is consistent with other research that has found later menopause among those who have been pregnant multiple times (multigravid) or used HBC.
Does "incessant" ovulation increase risk for early menopause? - published 1995
[Subjects who experienced early menopause] had a greater number of presumed ovulatory cycles, as estimated from age at menarche, average cycle length, and years of anovulation associated with pregnancies or oral contraceptive use [...]
and
[...] ovulatory cycles were a significant predictor of early menopause [...]
Qu'une femme (ou toute personne disposant d'un utérus) veuille un enfant ou non, ce choix est le sien, et si avoir un enfant est tout à fait respectable, ne pas en avoir l'est aussi et ne devrais pas être tout le temps remis en question par l'entourage !
Rappelons-nous qu'avoir un enfant n'est pas une fin en soi, ce n'est pas le but de notre existence, une vocation génétique, ce n'est pas un devoir, ce n'est pas une obligation pour être normal.e.
Ne pas avoir d'enfant est aussi respectable, aussi normal et acceptable que d'en avoir.
