Tubal Reversal Blog ‘anxiety’

Katherine is planning to be a future reversal patient of Chapel Hill Tubal Reversal Center in the fall of 2008. She discovered us while searching the Internet.

Here Katharine tells her story in her own words…

My ligation was two years ago. A month later, while getting ready for a wedding, I destroyed my bathroom upstairs in my home!

My boyfriend was in total shock! He flew up the stairs to see what in the world was going on up there. I had a “fit of rage”. It was awful. It is still very embarrassing to talk about. I do not have a history of mental illness or mood disorders. This ‘fit’ was extremely terrifying for me and for my boyfriend. After calming myself enough to grab the phone, I called my gynecologist. It was a Saturday and the Doctor on call suggested I seek psychiatric help.

Still shaking, and holding the phone in my lap…I thought for a moment…”Maybe I am crazy.”
Needless to say I never made it to the wedding, as I was afraid that I might have another “episode”. A few months later…my boyfriend moved out because he never knew what kind of woman he would come home to. The sad part is I’d wake up and wonder what kind of woman I would be that day. My instinct told me the tubal ligation was the cause of my emotional instability. I just knew it. It was intuition.

I made an appointment with the Doctor who performed the ligation (Filshie clips). When my name was called, I was ushered into the Nurse’s office instead of my Doctor’s office. The nurse explained the Doctor heard I was there to talk about a reversal and wanted to relay to me he “does not do reversals and is not aware of any post ligation symptoms and that I should seek professional psychiatric help.” I left crying.

I then called a psychiatrist who put me on Depakote, Lamectil and Klonopin. I informed her I have Post Tubal Ligation Syndrome (PTLS) symptoms PTLS, but I think she feels I’m bi-polar. The medication does help with the violent mood swings and depression.

The main symptoms are:

daily headaches
2-week PMS
7-8 day HEAVY periods (pass clots the size of walnuts)
anxiety, panic attacks, depression
pitting edema in ankles
fits of rage
uncontrollable crying spells
during ovulation..I have to sit on a pillow while driving and can’t sit flat on my chair at work. Pain with walking
sharp pains in my right side
pain during and after sex (especially after…I curl up in ball and suffer)

I have a small 10-acre farm with horses, dogs, and cats and soon…pigs! I don’t have time to be a pain ridden Tasmanian devil. I love my job, my family, my farm and it is so hard to enjoy it all when PTLS rules my life. I feel all of this is about to change now that I have found Chapel Hill Tubal Reversal Center!

Most importantly…My boyfriend and I have started dating again after a year apart. I showed him all of the emails, websites, etc that explain why I am the way I am…

A complete discussion of Post Tubal Ligation Syndrome and the stories of other PTLS patients who have undergone tubal reversal can be seen in our blog series on PTLS. The first of fourteen articles is Pain After Tubal Ligation: A Symptom of Post Tubal Ligation Syndrome? .

Readers can also view other 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

We invite readers to join our Tubal Reversal Message board and discuss and share personal experiences with tubal ligation. We also have a dedicated PTLS forum for readers to share experiences of worsening symptoms after tubal ligation procedures.

I am a Registered Nurse and have worked most of my career in Cardiac Surgery Intensive Care Unit. I took a three year break and worked in Labor and Delivery and really loved that, as you can imagine…EVERY day was THE best day of each of my patient’s lives. I loved being a part of it and was emotional during just about all of my deliveries! My husband is a wealth builder…he owns his own financial firm and does investment/financial advising.

We have a happy family with 5 children and would feel blessed with another child biologically or through adoption; unfortunately both of us were sterilized during our previous marriages. No one ever plans for their spouse to leave, their marriage to be torn apart, and be left infertile. As my new husband and I had very similar stories, morals and beliefs and united in marriage and family, we thought long and hard about adding to our family to essentially “tie” our children together with a half sibling– so that when they are older and we are gone, they will still be close and not drift apart. This is what led me to do my research about tubal reversal surgery and what led me to Chapel Hill Tubal Reversal Center.

Before this point, I had NO IDEA that Post Tubal Ligation Syndrome (PTLS) existed and I did not know all of my many symptoms were probably linked together due to the decision I made to have my tubes tied in 2003 after the birth of my daughter. I researched PTLS even further and found a very long list of symptoms and just cried as I showed the list to my husband one night. I was literally astounded.

I remember my mom telling me before I had my tubal ligation she had always heard a “Tubal ligation makes you have much more severe cramps and heavier periods”.

I asked my OB/GYN this question as I was making my decision (I worked with this doctor in L&D at the time) and she said this was not true at all. It is evident that many physicians do not recognize PTLS as a true syndrome and it’s saddening. I am very blessed that my husband empathized with me and all the symptoms I had and supported me in having the tubal reversal for symptom relief, without a second thought. I had my tubal reversal 7/31/08 and if it is God’s plan to add to our family, He can provide that miracle…but if not or until then…I am extremely happy to have had the opportunity to be “reconnected” by Dr. Monteith.

Below is a list of symptoms that I found on a PTLS website and I listed the symptoms I have (there were many, many more).

1. Bouts of rapid heart rate: In 2005, I was having palpations so frequently that I saw a cardiologist that I worked with at the time. He did a stress echo, which was fine, but placed me on a beta blocker medication due to the symptoms interfering with my everyday life. I have since weaned off of the medication myself and it only happens on occasion now.

2. Irritability/mood swings/PMS: I was never this bad before…I’m a very pleasant, laid back person and the past 4 years or so, my PMS symptoms have increased in length more and more until it was about 2 weeks long, and it would go away two or three days after my cycle was over.

3. Trouble sleeping thru the night: Absolutely! I have had severe insomnia since 2003 or 2004. Of course, my doctor gave me another pill to help this symptom…but I hate having such trouble sleeping and try not to take the medicine. I have tried hypnosis, herbs, melatonin, Benadryl, and acupuncture…many things other than using the prescription medicine.

4. Irregular periods: Not so much irregular, meaning I have 25-28 day cycles, but HEAVY and EXTREMELY painful…To the point of being doubled over in pain for the first two days of my cycle and curled up in a ball. It’s worse than any labor I had before I had to have my C-section. A couple of years ago, I would bleed up to 11-14 days every month and I was advised to have a hysterectomy due to the pain and bleeding. Being age 32 at the time, I refused to go that route.

5. Anxiety: I was never a very anxious person before. I have had increased anxiety, to the point I talked to my doctor about it (I was also going through a difficult time)…and was given yet another medication to try. It did help, but it was an antidepressant used for anxiety and was very hard for me to get off of once I decided I did not want to be on medication anymore.

6. Decreased energy: My energy level has dropped so much, but I just figured it was from getting older. I’ve never been a morning person, but this is much worse…it’s like constantly being tired and sluggish.

7. Feelings of doom/apprehension/despair: Some months, not all (especially a couple years back), my PMS symptoms are so severe, that it makes me think very sad thoughts…and it’s always about 2 days at the end of my cycle (which is the same point my migraines come as well…so it could be related).

8. Depression: I’ve had some bouts of what I call depression (non diagnosed) over the last few years…my “depression” is more in the form of anxiety/overwhelming feelings and wanting to sleep and not face anyone.

9. Headaches: Migraines…I used to have them in college when I was on birth control pills. Finally, when they figured out it was probably the hormones and I came off the birth control pills; I did not have any more migraines, until AFTER my tubal ligation. I’ve been on a migraine medication for over a year and use a different one if it gets out of hand. They can be debilitating.

10. Weight gain: I have had a very difficult time trying to lose my ‘baby weight’ from my last pregnancy from 2003 and tubal ligation. Although I had always been proportioned before, the worst of my weight now is around the middle.

11. GI problems: I have had reflux or heartburn since my tubal ligation as well.

I have only had one cycle since my tubal reversal, so I will be watching for much symptom relief!

A complete discussion of Post Tubal Ligation Syndrome and the stories of other PTLS patients who have undergone tubal reversal can be seen in our blog series on PTLS. The first of fourteen articles is Pain After Tubal Ligation: A Symptom of Post Tubal Ligation Syndrome? .

Readers can also view other 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 Katherine

We invite readers to join our Tubal Reversal Message board and discuss and share personal experiences with tubal ligation. We also have a dedicated PTLS forum for readers to share experiences of worsening symptoms after tubal ligation procedures.

The ligation reversal specialists at Chapel Hill Tubal Reversal Center are experts in tubal ligation reversal. We evaluate and treat a large number of women who request sterilization reversal. While most women seek ligation reversal to have more children,  some seek relief from worsening physical and psychological symptoms experienced after they had their sterilization procedures. Many of these women report symptoms of Post Tubal Ligation Syndrome (PTLS). Previously, we described medical conditions that can mimic PTLS. This article describes common psychological conditions that can have symptoms similar to PTLS. These conditions can exist independently of a sterilization procedure or could be associated with the profound guilt and regret some women experience after sterilization.

Depression

Depression is a common condition affecting many people. Depression can be categorized into several types; however, for simplicity we will focus on major depression.

Major Depression

Symptoms of major depression last for a minimum of six months and may include:

• Loss of interest in normal daily activities
• Feeling sad or down
• Feeling hopeless
• Crying spells for no apparent reason
• Problems sleeping
• Trouble focusing or concentrating
• Difficulty making decisions
• Unintentional weight gain or loss
• Irritability
• Restlessness
• Being easily annoyed
• Feeling fatigued or weak
• Feeling worthless
• Loss of interest in sex
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems, such as headaches

There are many overlapping symptoms between major depression and Post Tubal Ligation Syndrome. Identifying the symptoms of depression can be easy, but identifying the cause of depression can be difficult.

Anxiety

Generalized anxiety disorder can be a common condition. Anxiety is characterized by excessive or exaggerated worry about life events. People with symptoms of generalized anxiety disorder tend to expect disaster and can’t stop worrying about health, money, family, work or school. The degree of worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear and dread. Eventually, the anxiety so dominates thinking that it begins to interfere with daily functioning, including work, school, social activities and relationships.

Generalized Anxiety Disorder

The symptoms of generalized anxiety disorder may include:

• Excessive, constant worry and tension
• An unrealistic view of problems
• Restlessness or a feeling of being “edgy”
• Irritability
• Muscle tension
• Headaches
• Sweating
• Difficulty concentrating
• Nausea
• The need to go to the bathroom frequently
• Tiredness
• Trouble falling or staying asleep
• Trembling
• Being easily startled

People with anxiety disorders have an extreme sense of nervousness, panic, and inability to concentrate or focus. They may have depression as well. Anxiety can be generalized (happens during most of the day without any apparent cause) or can be situational (triggered by a specific event).

Post Traumatic Stress Disorder

Post traumatic stress disorder (PTSD) can develop after a person has experienced a traumatic or terrifying event in which serious physical harm occurred or was threatened. PTSD is a lasting consequence of traumatic ordeals that cause intense fear, helplessness, or horror, such as a sexual or physical assault, the unexpected death of a loved one, an accident, or a natural disaster. Most people who experience a traumatic event will have reactions that may include shock, anger, nervousness, fear or guilt. For a person with PTSD, however, these feelings continue and even increase, becoming so strong that they prevent the person from living a normal life. Symptoms of PTSD often are grouped into three main categories:

• Reliving - This involves reliving the event through thoughts, memories, and dreams of the trauma. These may include flash backs, hallucinations, and nightmares. People with this form of PTSD may also feel great distress when events occur that remind them of the trauma they suffered.
• Avoiding - This involves avoiding people, places, thoughts or situations that are reminders of the trauma. This may lead to detachment from family, friends, and loss in interest in things that were once enjoyed.
• Increased arousal - This includes excessive emotions and problems relating to others, including difficulty feeling or showing emotion, difficulty sleeping, irritability, outbursts of anger, and difficulty concentrating. Physical symptoms may also occur.

Self Evaluation

Women seeking tubal ligation reversal may be at higher risk for the above conditions for various reasons, such as sterilization performed while in an abusive relationship, sterilizations done under pressure, or death of a child or spouse after a tubal ligation. It is helpful to discuss with yourself and your partner whether you may be experiencing symptoms of depression, anxiety, or Post Traumatic Stress Syndrome. The insights of a trusted friend or loved one help in this self evaluation. In some cases the advice and intervention of an experienced mental health provider may be helpful.

If you have had a tubal ligation and are experiencing any of the problems associated with Post Tubal Ligation Syndrome (PTLS), consider having an evaluation by your doctor for undiagnosed medical conditions. If  depression, anxiety or other symptoms interfere with your daily life, work, or relationships, then you may benefit by consultation with an experienced mental health provider.

PTLS Article Series

This is the fifth article in our fourteen part series on PTLS and associated medical conditions. Our next article, Post Tubal Ligation Syndrome|A Long Journey, will address our experience with Post Tubal Ligation Syndrome.

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 participate in the PTLS Forum to share personal experiences with physical or psychological symptoms following 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?

Articles About Post Tubal Ligation Syndrome

Women come from all over the world to Chapel Hill Tubal Reversal Center for reversing tied tubes – or more correctly put in medical terms, to have a tubal anastomosis. The majority of our patients desire sterilization reversal so they may naturally conceive more children. Many others, however, have ligation reversals to feel more complete again and/or to alleviate symptoms that have occurred after their surgical sterilization procedure. These patients report new physical and psychological symptoms after undergoing tubal ligation - symptoms that have been described as Post Tubal Ligation Syndrome (PTLS).

Symptoms of Post Tubal Ligation Syndrome

There are many symptoms attributable to PTLS. The most predominant symptoms are:

• Menstrual pattern changes
• Painful periods
• Hot flashes
• Irritability
• Mood swings
• Insomnia
• Decreased sex drive
• Anxiety
• Depression
• Memory changes

Does PTLS really exist?

The existence of Post Tubal Ligation Syndrome has been very controversial within the medical community. Early medical studies suggested that some sterilized women (women who had their tubes tied) had abrupt changes in bodily symptoms after their surgical procedures. These physical and mental changes were called Post Tubal Ligation Syndrome.

PTLS has been widely talked about by both women and medical professionals. Currently, PTLS information, advice, and ‘expert’ commentary saturate the internet. Conspiracy theories are prominent. Some people even believe sterilization is being forced upon women and there is a conspiracy, or lack of serious medical counseling, regarding the symptoms of PTLS.

More recent medical research has demonstrated that women do have changes in their menstrual patterns after tubal ligation; however, these changes are not as dramatic or as widespread as have been suggested in the past.

Observations from the Tubal Reversal Center

The tubal ligation reversal experts at Chapel Hill Tubal Reversal Center provide sterilization reversal to a large number of women from across the world. We also counsel and treat a substantial number of women who attribute their worsening menstrual patterns to their tubal ligation procedures. These patients report a multitude of PTLS symptoms.

We like for our patients to be well-informed. Since women seeking relief of PTLS represent an increasing percentage of the patient population we care for, we would like to dedicate a series of informative blog articles discussing the concept of PTLS. More specifically, we would like to discuss the common medical reasons for new symptoms noticed after tubal ligation, current understanding about PTLS, and common psychological conditions which can mimic PTLS.

This is article first of a fourteen part series. Our second article in this series is Post Tubal Ligation Syndrome: Past and Present.

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 to discuss and share their personal experiences with tubal ligation. Feel free to contribute to our PTLS forum dedicated to patients who have personal insight into worsening symptoms after undergoing tubal ligation.

Editorial Comment

The decision to add a series of articles about Post Tubal Ligation Syndrome on the Tubal Reversal Blog was prompted by requests and suggestions of many of our tubal reversal patients. Most doctors have been taught that no such entity as PTLS exists, much to the exasperation of women who are suffering from symptoms that began after a tubal sterilization. This series of blog articles will allow individuals to report about their personal experiences and case histories. Then, articles from the medical literature will be reviewed and discussed. Hopefully, this approach will help explain the discrepancy between what individual women have experienced and what medical doctors think about this complex subject. I encourage both patients and medical professionals to contribute their insights and opinions to this important series of articles.

Gary S. Berger, MD
Medical Director
Chapel Hill Tubal Reversal Center