Tubal Ligation Reversal Blog

Diagnosing Menstrual Problems After a Tubal Ligation

The origin of post tubal ligation symptoms can be confusing.Has your body gone ‘haywire’ after having your ‘tubes tied’? Many women report a variety of changes occurring after a tubal ligation. There are various gynecologic conditions that may be the cause and deserve proper evaluation by your doctor.

Problems that can occur after a tubal ligation

Previously, we introduced the topic of Post Tubal Ligation Syndrome (PTLS) as a suspected cause of problems that can occur after a tubal ligation. Women who experience problems after a tubal ligation may not have PTLS. If women have problems after a tubal ligation they commonly have two complaints: changes in their periods (menstrual pattern) and/or more painful periods. If you have had a tubal ligation and are experiencing these complaints, you could be suffering from an undiagnosed medical condition.

To determine if you have an underlying medical condition causing the above symptoms, it is helpful to be aware of the medical terminology for menstrual disorders.

Medical terminology

The medical terminology for changes in the frequency or amount of bleeding with your periods are:

• Oligomenorrhea
• Hypomenorrhea
• Hypermenorrhea (menorraghia)

Menstrual periods that are infrequent or irregular is termed oligmenorrhea. Periods that are scanty in amount of bleeding is called hypmenorrhea. Periods that are heavier in the amount of bleeding is termed hypermenorrhea or menorraghia (both terms refer to heavier periods).

The medical terminology for painful periods is dysmenorrhea.

Dysmenorrhea is divided into two categories:

• Primary (since puberty)
• Secondary (developed as you became older)

More painful periods developing after a tubal ligation would be categorized as secondary dysmenorrhea.

Medical causes of menstrual disorders

There can be many medical causes for oligomenorrhea, hypomenorrhea, or hypermenorrhea:

Uterine fibroids
Endometrial polyps
Uterine infections
Thyroid abnormalities
Endometrial hyperplasia
Endometrial cancer
Blood abnormalities (platelet disorders)
Ovulation disorders?
Polycystic Ovarian Syndrome?
Anorexia nervosa*
Congenital adrenal hyperplasia*
Pituitary abnormalities?

* Marked items are mostly associated with oligomenorrhea
? Marked items can be associated with both oligo and hypermenorrhea

Most women who develop abnormalities in their menstrual cycle after a tubal ligation will not have a serious medical condition. Most will have hormonal abnormalities, uterine fibroids, or anovualtion as the cause for changes in their menstrual cycle. These are common conditions that occur as a person either ages or experiences significant changes in weight.


There can be many medical causes for dysmenorrhea. These are the major causes of secondary dysmenorrhea:

Gynecologic disorders
Ovarian cysts
Pelvic adhesions
Pelvic inflammatory disease
Uterine polyps
Congenital obstructive Müllerian malformations
Cervical stenosis
Nongynecologic disorders
Inflammatory bowel disease
Irritable bowel syndrome
Uteropelvic junction obstruction
Psychogenic disorders

Secondary dysmenorrhea can be experienced by many women. The most common causes are endometriosis, adenomyosis, and ovarian cysts. Causes of secondary dysmenorrhea can sometimes be difficult to identify. Sometimes, women may need to be referred to other medical specialists to diagnose the cause of secondary dysmenorrhea.

Changes in one’s menstrual cycle are common and can also occur after a tubal ligation procedure. When a woman has a tubal ligation and then develops any of the symptoms discussed above, it is tempting to attribute them to Post Tubal ligation Syndrome; however, there may be other underlying medical or gynecological conditions responsible for these changes.

The tubal ligation reversal experts at Chapel Hill Tubal Reversal Center recommend you see your medical provider if you develop any of the above symptoms after a tubal ligation. Tubal Reversal SurgeryThe purpose of your visit will be to diagnose any medical conditions which could the cause of your symptoms. If your doctor is unable to determine any medical explanation or if your symptoms are more extensive than those listed above, the doctor might attribute your symptoms to depression, anxiety, post traumatic stress disorder, or regret over your prior decision to have a surgical sterilization.

PTLS Articles on the Tubal Reversal Blog

This is the third article of a fourteen part series about Post Tubal Ligation Syndrome. Our next article is Guilt or Regret About Tubes Tied.

Readers can also view patient submitted stories about their menstrual symptoms, reasons for reversing tubal ligation, and outcomes after reversal reversal surgery. Each patient’s story is listed below:

Meet Momzilla
Meet Andrea
Meet Rebecca
Meet Praybelieving
Meet Katherine

We invite readers to join the Tubal Reversal Message Board and discuss and share personal experiences with tubal ligation. We also would like patients to join our PTLS Forum and share their personal experiences with worsening physical or mental symptoms noticed after tubal ligation.

Comment by Dr. Berger

The terms introduced in this article – such as oligomenorrhea, hypomenorrhea, hypermenorrhea, and dysmenorrhea – are descriptive medical terms for common menstrual disorders. When they occur, they deserve a thorough medical evaluation. As Dr. Monteith has described, there are many underlying causes or diagnoses for these conditions.

The question that seems to be at issue regarding Post Tubal Ligation Syndrome is this: when symptoms develop after a tubal ligation, are they attributable to the tubal ligation itself or to some other underlying condition? If no other underlying causes are found, then is PTLS the diagnosis remaining by exclusion? If a doctor does not believe in the existence of PTLS and no underlying medical or gynecologic diagnosis is evident, is attributing the symptoms to depression, anxiety, post traumatic stress disorder, or sterilization regret reasonable, accurate, or sufficient?

Articles About Post Tubal Ligation Syndrome

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150 thoughts on “Diagnosing Menstrual Problems After a Tubal Ligation

  1. chelsey

    I had my fourth baby in 2012 and had a tubal a week later. I breastfed for a year and a half but my period returned when he was about 8 months old and ever since then they have been so painful It’s worse than labor. Worse decision I ever made and I regret it every day. My periods are painful and heavy and irregular. I never had issues before the tubal.

  2. Dr. Monteith Post author

    A tubal reversal would help you get pregnant and also allow for evaluation of why you are having pain…your symptoms sound suspicious for endometriosis.

  3. Shaneka

    Good evening I have read all of the above stories. I too had a TL after delivery in 1999. As all the other ladies I was told I had all these different things I have been to specialist at the the jones Institute. The last time I went to see my specialist I given the option to have a hystorectomy and have my eggs frozen. Im too young to have a hystorectomy! To harvest the eggs cost more than a reversal. Either one I cant afford. My biggest problem is how will or will a TR work for me with a section of my tubes removed and burned? Will it ease or stop the pain that I go threw 5 days before my cycle and 3 days into my cycle. I have to take time off from work because of the pain. Its been 10 years and counting and its getting worst. Please help

  4. Dr. Monteith Post author

    You should be evaluated by your doctor for other correctable causes. The first diagnosis which comes to mind is endometriosis. If they cannot diagnose any other condition then you can consider tubal ligation reversal.

  5. Cathie

    I had a complete tl 21 yrs ago after my 3rd baby. Before i had the procedure my periods were as they are now except with severe cramps in abdomen,lower back and legs. And sometimes seriously heavy clots. I’ve read the other stories above and i have a lot of the same symptoms. I see that insurance won’t cover a reversal,which im not sure i even want for the simple fact i do not want anymore children,i just want to know what i can do about the pain. As i get older the pain gets worse almost unbearable. Please if you can help in anyway possible.

  6. Dr. Monteith Post author

    These are difficult situations. In general I advise patients to see their doctors and be evaluated for all possible causes. If the symptoms started soon after tubal ligation (weeks to months) and no other cause can be identified then it is possible you may see improvement after tubal reversal. You need to be evaluated for uterine fibroids and an ovulation (not ovulating). If you are ovulating and don’t have fibroids then we may be able to help you.

  7. Amber Thompson

    Good evening Dr. Monteith
    I had a TL performed in 1997 after delivery. Up until my TL my menstrual cycles were normal 3-5 days with little or no warning when it was coming. After my TL I experience horrible menstrual cycles to include excessive blood clots, severe cramping, back pain and extreme heavy bleeding. In addition, I am extremely weak even with my taking iron pills daily. This is awful.

    I am 42 years old and I don’t particularly want any more children. However, I am wondering will a Tubal Reversal allow me some relief with my menstrual period? I am willing to do what it takes in an effort to see some relief. And I know insurance will not cover this. I am miserable every month for 5-7 days.

    Please advise.

  8. Dr. Monteith Post author

    Many of our patients have similar concerns but unfortunately insurance will not pay for tubal ligation reversal…no matter what the reason.

  9. Mikaela

    I got my tubes tied after my second son on Dec 30th 2004, they cut tied and cauterized both tubes they went in through a small incision in my belly button and another incision just below. It has been 10 years since my tubal ligation and the pain I have been feeling has not let up. It all started about 6 months after my tubal ligation, it started with irregular periods and severe cramping, I would go one, two, sometimes three months without a period and would be in bed for days due to the “cramping” pain. I figured it would eventually let up and passed it off to my body healing from the TL. I am now in year 10 and the same symptoms are present in fact they have gotten worse over time. I have been to doctors and they say I have bleeding ovarian cysts, I find it hard to believe that up until the tubal ligation my periods were like clockwork, pain free, and even flow. Post TL- about a week before my period is expected to come I get severe cramping that radiates from lower abdomen to thighs and sometimes the pain is so bad in my lower stomach that it is hard to tell if it is my lower abdomen or back, the day my period is supposed to come I sometimes get my period and then other times I will go three months without a period, I also get periods that are dark red at first then turn red then at the last days brown (which I am guessing is old blood from not getting my period for a couple months). I am at a loss, I am not sure what to do anymore. I am quite confident I have PTLS and started the process to try and get it reversed but insurance does not cover it even though they had no problem covering the whole surgery to get it done. I think TL should never be an option if the outcome is this pain and unpredictable periods. Please help me if you know of any way to get insurance to cover the procedure.
    Thank you

  10. Mattie

    I am a 23 year old mother of 2 and I had my TL in April of 2012 after my son. He was a natural birth so i had my tubal the following day. Since my TL I have had horrible menstrual cramps and very heavy bleeding. Then about a week before and a week after my menstrual i have really bad sharp pain that comes and goes on my left and right side (around where my ovaries are i think). I was told i have cyst on my ovaries. I’m moody and don’t feel my self any more. I’m not sure what i should. I really regret it now.

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