Post Tubal Ligation Syndrome: Past and Present
It is difficult to identify the first reported instance of a patient with Post Tubal Ligation syndrome (PTLS). The early literature from the 1950 – 1970’s has sporadic reports of patients who underwent tubal ligation and, subsequently, developed menstrual irregularities. In the mid – twentieth century, PTLS seems to have been discussed more that it was studied by the medical community.
Several medical studies from the 1980’s and 1990’s suggested there was no association with tubal ligation and menstral irregularities. These studies have been criticized because they involved a small number of patients, had methodological problems, and were not designed to critically evaluate for the existence of PTLS.
U.S. Collaborative Review of Sterilization Study
The most conclusive medical study to evaluate female sterilization and the effects upon American women was the U.S. Collaborative Review of Sterilization study. This study is commonly referred to as the CREST study. A synopsis of this study can be found on-line at the medical research organization Contraception Online.
The CREST study conducted by the Center for Disease Control and Preventions (CDC) and was published in the New England Journal of Medicine in 1996. To date, the CREST study has been the largest and most comprehensive evaluation of women who have undergone surgical sterilization in the United States. The study was primarily designed to evaluate the types of sterilization methods that were commonly being performed by U.S. doctors and the failure rates associated with each of the different methods of sterilization.
The study examined over 14,000 women who had tubal sterilizations (tubal ligation) from 1978 to 1986. Women were examined for up to 14 years after their sterilization procedures. The investigators specifically looked at the method of tubal ligation and failure rates (pregnancies) based on each method. They also examined the number of women who regretted their decision to undergo sterilization.
CRESTÂ Findings
The main findings of the CREST study were that pregnancies after tubal ligation and sterilization regret were both more frequent than had been previously thought.
Women were also asked questions about changes in their menstral patterns after tubal ligation. The study compared 9514 women who underwent tubal ligation to 573 women whose partners underwent vasectomy. The women were asked about changes in their menstral patterns for up to five years after sterilization. The women who underwent sterilization were found to have fewer irregularities with their menstral patterns. The authors’ conclusion was there were no significant differences in menstral patterns in women who had tubal sterilization. A commentary by the study investigators regarding these findings can be found at the National Institute of Health.
The existence of Post Tubal Ligation syndrome has been widely speculated by many but never substantiated in a rigorous fashion by medical investigators. Many poorly done small studies have suggested PTLS does exist; however, the largest study to date, the CREST study seems to suggest otherwise.
Limitations of the CREST Study
Although the CREST study has been the largest study with the longest follow-up of women who have undergone sterilization, some investigators have criticized the study.
The CREST study has limitations evaluating PTLS because of three reasons:
1. The study population is mostly from academic centers and is made up of a large number of African American women. This has led some cautious medical investigators to suggest the study has population bias and the findings of the study may not be applicable to the general population of United States women who undergo sterilization.
2. The study did not address the question whether women may develop menstral irregularities beyond five years after their tubal ligaiton. Most of the questions regarding menstrual irregularities were not asked after five years of follow-up.
3. The study was not designed to investigate the diverse symptoms of PTLS. The primary goal was to identify what the most popular methods of tubal ligation were and what the failure rates of each method were.
If PTLS does not exist then what is going on?
Many patients come to Chapel Hill Tubal Reversal Center requesting sterilization reversal for the sole purpose of treating symptoms they identify as PTLS. Many of these patients report substantial improvement in their symptoms after tubal ligation reversal. We are not certain why patients report improvement, but it is hard to ignore their reports of improvement in symptoms after ligation reversal surgery.
Most women who have tubal ligations will not have any problems. Some women will have difficulty after a tubal ligation. Many, or perhaps the majority of them will not have PTLS. Instead, they may have an underlying medical or gynecologic illness. To aid our patients in the evaluation of difficulties they may be having after a tubal ligation, our next article will have information for patients about abnormal bleeding, painful menstruation, and possible underlying causes.
This the second article of a fourteen part series. Our third article in this series is Diagnosing Menstrual Problems After Tubal Ligation.
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 where they can discuss and share personal experiences with tubal ligation. We also would like patients to join our PTLS Forum and share personal experiences regarding physical or mental symptoms noticed after tubal ligation.
June 7th, 2009 at 11:56 pm
I had my tubal igation done when I had my third child she is now 7 years old . I have been suffering from very heavy periods ,clotting ,dizziness, anxiety etc. My doctor told me it has nothing to do withthe “clips” I really need some answers. I live in a small town full of “quacks”.
May 11th, 2009 at 8:12 pm
I had my tubal ligation in March of 2009. My first period was only 3 days later. That one was very heavy, huge clots. The next month was strange. I have been bleeding pretty much every day. Mostly spotting and just enough to be annoying! Sometimes, out of the blue, I need a tampon. My biggest complaint is it makes my “romantic” life a bit difficult. I had it done so I wouldn’t have to worry about pregnancy. I am 42 and a widowed mom of 2. I had blood clots with pregnancy so I am unable to use any hormonal birth control. I figured this was the best!! But I never know what to expect. I am hoping I will develop a “cycle” again eventually…. any hope there?
December 21st, 2008 at 5:35 am
I am a 26 year old woman.I had the filshie clips for for 5 years now. I have had some really rough times since ..bleeding ..depression..guilt.Honestly I cannot say I felt this way before I had this procedure done..I have scheduled a consult with my new doctor in Hawaii to see if I can get my clips removed at the earliest convenience..Exercise feels like a pulling muscle inside ..I cannot even bend without a regular pain..I think their should be another effective way of sterilization without the drama…
November 26th, 2008 at 8:37 am
If you go to the Getting Started page on our website, it will give you step-by-step instructions about how to proceed. Please contact Julia Smith, RN at JuliaS@tubal-reversal.net for further assistance.
November 25th, 2008 at 10:48 pm
I had a TL 10 years ago. I was only 22 years old. I was convinced that this was the way to go.
Since then, I have been suffering and I’m tired of it! I can’t tell you how many times I have had to leave work and change my clothes because I bleed all the way down to my knees. I’m so embarrased! My periods are always so heavy and painful! I always pass huge blood clots. I wear a combination of super tampons and overnight maxi pads. I have been tempted to wear Depends underwear! I’m starting to cramp all month long! I have gained so much weight! I’m always so exhausted! I have constant headaches! I’m angry that doctors and insurance companies do not recognize that this is a problem. I can not afford to reverse the damage that has been done to my body! I want this reversed. If anyone knows a way out, please contact me.
drew.kimberly@gmail.com
October 20th, 2008 at 11:12 am
Gosh, I have been having all of these symptoms for almost 5 years now and after reading these articles and responses not only have I finally tied them all together, I know I’m not alone and maybe I can have some relief. Every month I have debilitating pains when I ovulate lasting anywhere from 2-6 hours. Just last period I asked my husband, “what’s the difference between hemoraging and heavy bleeding from my period?” It was awful and we nearly considered going to urgent care things were so bad for about a day of my period. It is on and off like this every month. Sometimes not so bad, sometimes, worse. This all not to mention my migraines around 18 in a month. That’s right. I’m miserable and sick of trying to figure out “what caused this one”. I did recently start Topomax, which has helped some, but, I want to know what is causing them. Add all that to the fact that I work my *%$ off at the gym and eat healthily and it ‘aint going nowhere! Truly! I keep thinking there’s got to be some reason, I’ve just gotten exhausted trying to figure it all out. This all connects it. My youngest is 5 next month. I had my tubes tied when she was born and that is just about when I recall noticing all these issues! Thank you for this information I truly want to look more into all of this! Maybe there is a solution out there. ~
October 14th, 2008 at 1:24 pm
I have been online for the last few hours researching PTLS. As with many others whose posts I’ve read; I had both a midwife and a doctor who told me there were NO side effects of TL. I had my TL done in March 2005, 2 mos after my youngest son was born. Due to breastfeeding I didn’t get a period until approx Jan 2006 and very soon after the symptoms of PTLS began. Very heavy periods with very large clots, periods arriving at varying intervals of time (prior they arrived at the exact same time each month), sometimes a month with no period at all, severe cramping, headaches, nausea, severe mood swings, feelings of dread, increased anxiety, and basically feeling like I was going crazy which all continues to this day. Prior to meeting my soon to be husband, I had already contacted Chapel Hill looking into a reversal, not because I wanted more children but because of the symptoms of PTLS. Now that I’ve met him I planned on getting the TR due to the symptoms but our desire to potentially have another baby after we’re married is also now part of the equation. However, even if we didn’t desire the potential of more children I would still get a TR in hopes that I could get myself and my body back to “normal”. It saddens and angers me that the medical community discounts PTLS and that so many women are suffering needlessly from this syndrome. However, it heartens me to know that I’m not the only one and that I may not be going crazy after all! As soon as we can afford to do so I will be scheduling my TR with Chapel Hill, hopefully next Spring after our wedding. Once it’s done I would be happy to keep anyone interested posted on any relief I experience. Good luck and God bless to everyone suffering with PTLS~
September 24th, 2008 at 8:49 pm
I honestly believe in PTLS. I had no problem with periods, no cramps, no real depression, no headaches. The moment after my tubaligation my life – changed, migraines, moodiness, irritability, horrible cramping with periods and bad PMS. For those of us who have this, it is real, not just a symptom to be ignored. I am planning on have a reversal asap. I thank God for these doctors who are out there that want to help women. Thank you for making it affordable. Thank you for your courage work in fertility. God bless, you, and your staff.
September 12th, 2008 at 2:40 pm
It’s good to read a little history on the data of PTLS and to see that the past research has been limited at best. The articles to come will open doors for those patients who have been suffering and with helpful information, there can be a beginning to happier health.
September 12th, 2008 at 2:10 pm
Most doctors discount the histories of women who report sudden changes in their menstrual patterns or other symptoms following a tubal ligation procedure. The CREST study is a significant factor in the general medical opinion that “there is no such thing” as Post Tubal Ligation Syndrome. Yet at Chapel Hill Tubal Reversal Center we hear story after story of changes reported by many patients starting after their tubal ligation; some of these women want their tubes untied to alleviate their symptoms. There is obviously a discrepancy between the conclusions of CREST and what we are hearing from many patients.
I hope that as this series of articles about PTLS will provide some insights regarding this discrepancy between the experiences of many women and some of the medical studies that exist. I also wonder if it would be better to use the abbreviation “PTLS” to stand for “Post Tubal Ligation Symptoms”. This might avoid getting into controversy with other doctors about whether there is a true “syndrome”. I am looking forward to the forthcoming articles that are being prepared by Dr. Monteith.
September 11th, 2008 at 7:24 pm
I am glad to see physicians who are willing to do research and provide information on a topic that is so often overlooked by other health care professionals. I think that this is a great service to lots of women out there.
September 11th, 2008 at 2:04 pm
I’m sure our patients will have an interest in reading all 14 parts of the series on PTLS. There is so little information on this subject. Education is the key to patients making informed decisions about their health and well being.
September 11th, 2008 at 12:33 pm
Very interesting stuff. I know that many women come here complaining of problems that resemble PTLS. Most say after their tubal reversal that they notice a huge change for the better in the way they feel. We will continue are study here and keep you all informed.