Diagnosing Menstrual Problems After a Tubal Ligation
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
Adenomyosis
Uterine infections
Thyroid abnormalities
Endometrial hyperplasia
Endometrial cancer
Blood abnormalities (platelet disorders)
Ovulation disorders?
Polycystic Ovarian Syndrome?
Pregnancy*
Anorexia nervosa*
Congenital adrenal hyperplasia*
Perimenopause?
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.
Dysmenorrhea
There can be many medical causes for dysmenorrhea. These are the major causes of secondary dysmenorrhea:
Gynecologic disorders
Endometriosis
Adenomyosis
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. 
The 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?
June 16th, 2009 at 4:19 pm
I wish I would have found out about this sooner. I only recently learned how a TL can affect your menstrual cycle. Since I have had my TL(1996) I have had very regular periods, like clockwork. BUT, they are so very painful and there are so many clots, most often it scares me. But I just put up with it for the last 13 years. I am about to embark on the journey of having my Tubal Ligation reversed. It is mainly because I would like to have another baby in the near future, but I hope and pray that after the surgery the cramps, pain, anxiety, etc. will go away and no longer affect my life they way it has. I’m one of those people who made the decision under someone else’s influence and really regret having had TL. If I had another choice I would tell him to get a vasectomy instead of me getting any type of surgery.The article above were very helpful and its good to know now that I’m not alone. Good luck for everyone out there that is having their surgery reversed.
June 14th, 2009 at 1:53 pm
I have had four children one in 1999 one in 2000 one in 2002 and the last in 2005 I got my tubal ligation done six weeks after my fourth child was born. It has been nothing but awful starting six weeks after I healed from the surgery. My periods are crazy. I have to use two boxes of the ultra tampons a month. I have no energy. I’m aggravated most of the month. My mood swings are terrible. I’m very nervous. It’s hard to do anything when I’m on my period its so heavy. I have a hard time shopping and standing for long periods of time without messing up my clothes. I have lots of clots.I have a line that has appeared above my lip that looks like a mustache but there is no hair, it’s just a dark pigment.
June 2nd, 2009 at 5:51 pm
Some woman may skip a cycle after stress or surgery…talk with your doctor if this keeps happening.
June 2nd, 2009 at 10:43 am
I had my tubal done on the 13th of May and I have yet to have my period. Is that normal? I took several OTC pregnancy tests and all came back negative.
April 20th, 2009 at 7:05 pm
I had a tubal done in Feb 2005. I have had numerous problems: the hard knot in my stomach just under my belly button; periods are heavy one month, fine the next; have gas every single day and stay bloated. I have 4 children. After the first two, I lost all my weight, Now, I can’t lose the weight. My back constantly hurts. Have you got any ideas about this?
April 6th, 2009 at 6:27 am
Your tubal ligation is probably not causing these problems. Most commonly the reason is anovulation- or not ovulating. You should discuss this with your doctor to prevent future problems.
April 6th, 2009 at 3:18 am
I had a c-section and tubal ligation after my 3rd child. I was used to regular periods and 4-5 day bleeding. It has been 4 months since I had the tubal ligation and my periods are super light – more like spotting for a day and irregular. Also now I have a month and a week between each one. Now I am kinda worried I might be pregnant but my husband thinks I am just depressed because more children are no longer an option. Is my tubal causing these problems ??
March 28th, 2009 at 8:03 pm
I had my tubes tied July 12th 2007 after a c-section. My periods are awful. They have been painful since about August of 07 and now we are at 2009 and just this month I have had 2 periods. I had just gotten off my last period about the 21 and 2 days later I have started again….what is the deal here… If anyone knows let me know… Thanks.
March 27th, 2009 at 8:02 pm
I have had a tubal and a c-section together. Now my periods are really weird. I have the first one and its really heavy.Then I have a second one and its really light. Plus I can feel something like a needle in my side at times and a knot under my belly button when I am standing but not while I am sitting or laying down. What could this be? I also have Crohn’s Disease. Could that have something to do with it?
February 22nd, 2009 at 9:05 pm
[...] to reverse her tubal ligation to have more children. Like some women, she has also experienced changes in her menstrual cycle. She will be documenting her journey so others may benefit from her [...]
February 5th, 2009 at 7:00 pm
I had a TL in October of 2006 after the birth of my fifth child,I didn’t have any trouble until he was about a year or so, then my periods would be two days of heavy bleeding and then for the rest of the week or longer, I would be so light that it was like spotting and then are days that I get a bad headaches the day before I start,I know that this is not normal by any means, and my doctor is the type to tell me that it is all in my head and it hasn’t a thing to do with my TL! All the stuff that I’ve been reading can’t be in our heads! I’m only 32…not crazy!! Something is wrong! There are many women I’ve talked to that have most of the same problems. Thanks for the feed back!!!
January 31st, 2009 at 11:56 am
I did not know of complications following a tubal ligation. Mine was done October 2003 – over 5 years ago. Since then, I have had increasing problems with menstruation I’ve always attributed to a past preliminary diagnosis of endometriosis (never confirmed through laparoscopy). But, now I am wondering if it is something directly related to the tubal ligation, since my prior symptoms ceased before even having children. I have 3 children, my last 2003. My cycles are fairly regular (27-29 days), but I have disabling uterine contractions lasting 3-5 days and HEAVY bleeding with lots of clots. I’m usually on bedrest for a few days. I also struggle to maintain emotional stability for 2 weeks out of each month. I feel normal or like myself only 25-50% of each month. I would really like to have a reversal done and am praying about it and the ability to afford it.
January 13th, 2009 at 9:24 am
I toughed my way through the physical and mental issues that followed a tubal ligation as a young wife, not realizing I needed medical help. Even now as a grandmother,I am grateful for the insight into what was happening to me that your article provides.
January 7th, 2009 at 10:35 am
I had my tubal ligation on 10/16/08 since then I have not had a menstrual cycle. I also noticed that my attitude has changed towards everyone. I am very irritable and get agitated right away. I am only 27 yrs old. Is this normal?
January 5th, 2009 at 8:23 pm
I too had a tubal ligation… cut and cauterized. After severe pain in my left side, abnormal periods and a couple of ultrasounds over a period of time, I had a d&c. The pain still continued until I became pregnant two years later. The tubes grew back together. Lab tests showed that the procedure had been done correctly. The good news is that after my son was born, I no longer had the pain. And I had this beautiful little boy who is a blessing to this day. I would encourage those who are thinking about the procedure to really really think about it.
September 17th, 2008 at 10:50 pm
I had a tubal ligation 6 years ago and my periods have been abnormal ever since. I haven’t been stressed and didn’t regret my decision until this last month. However, I read a lot about symptoms on PTLS and out of a list of 32 signs, I had 19 of them. I am currently having some bad cramping and have for a week. Not sure what the deal is but I can’t even get into the doctor for a month.
September 17th, 2008 at 6:10 pm
What great information. It just goes to show how information can help women determine the direction of their own health care. I am hoping that the more information that is available will help others get away from catch all terms and that physicians will quit relying on the diagnosis of depression for problems that women have with their menstrual cycle. Thanks for the information.
September 15th, 2008 at 1:06 pm
Very informative article. It seems that to arrive at the diagnosis of PTLS thorough examination and testing is necessary to keep PTLS from becoming the catch all term when a physician doesn’t want to take the time to find out the source of a women’s complaints.