When does fertility end? The timing of tubal ligations and hysterectomies, and the meaning of menopause

We applied a biocultural lens to examine the temporal order of biological, behavioral, and medical events related to fertility across the female reproductive lifespan in three sites, two in Mexico and one in the United States.  Using a mixed-method design, we expanded our thinking about the end of fertility in order to examine the timing of hysterectomies and tubal ligations.  We discovered that menopause is not the end of fertility for a surprisingly high number of women.  Across the three sites, between 43% and 50% of women underwent tubal ligations at mean ages of 32 years (in Campeche, Mexico) and 33 years (Puebla, Mexico).  In Puebla, 23% had a history of hysterectomy at a mean age of 42 years, similar to Hilo, Hawaii, where 20% had undergone a hysterectomy at a mean age of 40 years.  We hypothesized that women who underwent tubal ligations would less frequently describe menopause as the end of fertility.  This was true in Hilo, Hawaii, where women with a history of tubal ligation were almost half as likely to choose “loss of fertility” to describe menopause.  However, in urban and rural Campeche, Mexico, there was no indication – from either quantitative or qualitative responses – that individuals with a history of tubal ligation or hysterectomy were less likely to describe menopause as the end of fertility.