Tubal Reversal Blog ‘ptls’

Some women will develop problems after a tubal ligation procedure. Many will attribute these symptoms to Post Tubal Ligation Syndrome (PTLS) and will consider sterilization reversal. Some of these women will not have PTLS but, instead will have other underlying  medical conditions.

We started this series of articles for women suffering from adverse symptoms developed after a tubal ligation. We discussed the symptoms of Post Tubal Ligation Syndrome (PTLS), current medical studies about PTLS, and common medical conditions that can closely mimic PTLS. Like a long bus ride, we have expected most passengers to have exited this bus trip at each of their respective and appropriate stops after a thorough evaluation of the possible causes of their symptoms. If passengers are still riding, then the only stop left is PTLS.

In the past, the existence of PTLS has been widely debated but not agreed upon in various medical studies. The largest study to date, the CREST study, found no significant difference in the percentage of women with menstrual problems after a tubal ligation with a “control” group of women who did not have a tubal ligation. The authors of the CREST study concluded that adverse symptoms do not ocurr as a  result of tubal ligation. This study, however, was not designed to study the multitude of symptoms that women report after surgical sterilization.

The end of the journey

Our experience at Chapel Hill Tubal Reversal Center suggests PTLS does exist for a select group of women for whom no contributing medical, psychological, or other causes have been identified. Among this group of women, the vast majority have reported dramatic improvement in their symptoms after a reversal of their tubal ligation.

We will report the stories of several of our patients (both before and after tubal ligation reversal) who have had worsening physical and psychological conditions after sterilization and who have come to us seeking tubal ligation reversal. They will share with us their symptoms and how they have fared after tubal ligation reversal (had their tubes untied).

This is the sixth article in our fourteen part series on PTLS and associated medical conditions. Our next several articles will present patients who have suffered from worsening menstrual, physical, and emotional symptoms after surgical sterilization procedures (women who had their 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

Visitors may join the PTLS Forum on the Tubal Reversal Message Board to share their experiences of symptoms after tubal ligation procedures and what happened to them after a tubal reversal.

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.

Is it PTLS or another medical or gynecologic problem?

The symptoms of Post Tubal Ligation Syndrome (PTLS) can be widespread and pervasive. Women who have problems after a tubal ligation, however, may not have PTLS. Another medical or gynecological condition may be at the root of the symptoms. The prior article in this series on PTLS reviewed medical and gynecologic disorders that may cause menstrual problems after a tubal ligation.

Over 7,000 tubal ligation reversals have been performed at Chapel Hill Tubal Reversal Center. We have had the opportunity to see the impact on these women whose tubes have been tied and who, having regretted that decision, have had their tubes untied.

Under what circumstances were the tubes tied?

Often, the decision to have a one’s tubes tied is made under stressful circumstances. Sometimes the decision to have the tubes untied is made under similar circumstances. The staff of Chapel Hill Tubal Reversal Center has compiled a list of stressful reasons women have had tubal ligations or have come to us seeking ligation reversal. Stressful circumstances under which patients sometimes have a sterilization procedure or a sterilization reversal include:

• Forced by parent or spouse
• Pressured by doctor
• Frightened by medical conditions or illness
• Mid-life crises
• Empty nest syndrome
• Infidelity
• Divorce
• Death of spouse
• Fear of birth control risks
• Decision while in poverty
• Decision during period of substance abuse
• Illness/death of close family member
• Sterilization while in an abusive relationship
• Death of a child
• Religious conversion

Regret and guilt can be powerful forces on any individual. Given the appropriate stressful circumstances these feelings can be amplified and can spread into other aspects of ones life. When decisions are made under stressful conditions, as listed above, one can easily see how this may leave a lasting sense of remorse upon any individual. The sense of remorse can be even more dramatic when the thought is suppressed and eventually emerges in the future during a stressful life event. Then consider the sense of regret and how these feeling could be increased as a person grows older and wiser when a person finds their ‘life’s match’ or if their pastor tells them they ‘violated the will of God’ by having their ‘tubes tied’.

How common is regret after tubal sterilization?

Most women do not regret their decision to have a tubal ligation. However, 1 out of 4 women will regret their decision about having their tubes tied. This was shown in the CREST Study mentioned in a previous article.

Offering Hope at Chapel Hill Tubal Reversal Center

The tubal ligation reversal experts at Chapel Hill Tubal Reversal Center help women in reversing these ‘permanent’ decisions when they are no longer the right decisions for individuals and couples. We have helped many patients come by restoring the hope of new life and the chance for some to relieve their burdens of guilt and regret.

This is the fourth article of a fourteen part series on PTLS and associated medical conditions. The fifth article, Psychological Conditions or Post Tubal Ligation Syndrome?, will address common psychological conditions that could be masquerading as 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 to discuss and share personal experiences with tubal ligation. We also invite women with post tubal ligation symptoms to join the PTLS Forum and share personal experiences with worsening physical or mental symptoms noticed after tubal ligation.

We are interrupting our 14 part Post Tubal Ligation Syndrome (PTLS) blog series to announce the first reported Monteith tubal reversal pregnancies and the arrival of the Monteith Miracle Tubal Reversal baby shirts!

Dr. Monteith’s Success at Reversing Tied Tubes

Dr. Charles Monteith started working full time as a tubal reversal specialist on July 21st 2008 at Chapel Hill Tubal Reversal Center. We have received four pregnancy reports from patients during his first two weeks of reversing tied tubes.  His tubal reversal pregnancies have started to roll in!

The First Pregnancies

These four patients are representative of the patient population Chapel Hill Tubal Reversal Center and they come from all across the United States. They have had different types of tubal ligations and tubal lengths measuring from 3 to 8.5 cms.

Alaska (Falope ring tubal ligation)
New York (Bipolar cautery)
North Carolina (Bipolar cautery)
Idaho (Filshie clip tubal ligation)

And The Winner Is…

There has been an unofficial competition among patients of our Tubal Reversal Message Board for who would be the first patient to report a Monteith tubal reversal pregnancy. A patient from Alaska was the first to report a positive pregnancy test. She has confirmed that a first trimester ultrasound showed the pregnancy is in the uterus and is doing well. We have asked her to share her story and experience with us in a future blog article and she has said she will do this once her life calms down and her morning sickness disappears.

Why Have Pregnancies Been Reported So Soon?

These pregnancies have all occurred within the first two weeks of his reversing tied tubes. We typically ask our patients to wait a month until they try to conceive. So these patients likely started to attempt to conceive mid to end of August. They obviously had success and conceived at their first ovulation after ligation reversal!

To the patients of Dr. Monteith who have not yet conceived: keep up the faith and it should happen in due time. Most people do not realize how long it may take to become pregnant until they actually try. It can sometimes take up to 10-12 months before a successful conception can occur.

Monteith Miracle Tubal Reversal Baby Shirts

The Monteith Miracle Shirts have just arrived and are hot off the presses. They are ready to be sent out when the babies are delivered. All you have to do to receive one is:

Be a patient of Chapel Hill Tubal Reversal Center.
Be a tubal reversal patient of Dr. Montieth.
Become pregnant after tubal reversal.
Report the pregnancy to us.
Report the birth to us.

The first shirt goes out April of 2009 and the rest shortly thereafter. We wish these women good luck and all of the women who have had tubal ligation reversals by the tubal reversal doctors at Chapel Hill Tubal Reversal Center.

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

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.

CREST  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 is the second article in 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.

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

My training in residency taught me that Post Tubal Ligation Syndrome (PTLS) was a dirty little phrase used by ill-informed doctors to describe the observed, normal aging process in women after a tubal ligation. No one who has taught me that concept has ever met Momzilla. Momzilla is her sign-on name, which she gave me permission to use, for the Chapel Hill Tubal Reversal Center message board.

Momzilla came to us at Chapel Hill Tubal Reversal Center seeking relief of problems that occurred after her tubal ligation. She is currently 43 years old, is happily married, and has three children. She is employed as a human resource manager and her husband is an attorney.

Momzilla had her tubal ligation three years ago and she describes the gradual onset of symptoms after her tubal ligation. I asked her if we could use her as the subject of a blog featuring our patients. She agreed and after her surgery she emailed me a comprehensive list of her physical problems. Below are her symptoms in her own words,

“Longer clotty periods with a day or so of flooding blood followed by nothing and then bleeding again. (My menstrual periods from the dawn of time prior to that had been regular and predictable to almost the day), horrible insomnia, light-headedness/dizziness (almost passing out on a few occasions), exaggerated PMS and mood swings, absence of libido and an aversion to sex, fatigue, a sense of dread or doom (not depression), withdrawal from my family (almost needing isolation from people), inability to concentrate, fogginess and an awful memory, tingling in extremities, very dry skin no matter how much I drink or how much lotion I used, more frequent headaches, bloating and GI issues, inability to lose my baby weight (I lost my waist), breaking hair that is more oily, breaking nails, changes in perspiration and body odor (sweating and smelling more easily), bad taste in my mouth, more sinusitis and allergies…I think that about covers it..”

She also had told us she had tingling in her legs, which required her to see a neurologist and have a brain MRI. She also increased sugar cravings and gained 15 lbs.

Momzilla told us her story of having a tubal ligation and then noticing the onset of these symptoms. She has seen several doctors and had a variety of inconclusive tests. She found information about PTLS on the Internet and discovered Chapel Hill Tubal Reversal Center as well. She was very clear she was not getting a ligation reversal so she could have more kids. She was trying to get her body to be like it was prior to the ligation. She desired a return to her normal state.

I am happy to report Momzilla had a successful tubal ligation reversal. Her surgery went well with Dr. Berger acting as the primary surgeon and me as the assistant. She had good tubal lengths and did well in the recovery room.

Momzilla has kept in touch with us since her surgery and we hope she has a good and speedy recovery. We hope her symptoms abate and we have asked her to keep us closely updated on her progress.

Submitted by Dr. Charles Monteith
Chapel HIll Tubal Reversal Center

Over a year ago, I approached Dr. Berger at Chapel Hill Tubal Reversal Center to start a new career as a tubal ligation reversal specialist. When I started to pursue my interest and training in tubal reversal surgery, I naively thought that only women who wanted to have another child had their tied tubes untied. I have come to realize that some women seek to have their tubes untied for many reasons other than to have another child after tubal ligation.

Of course the number one reason is to have more children, but there are many more and equally important reasons patients give. Some common reasons patients come for tubal ligation reversal are to:

• relieve symptoms associated with a tubal ligation (PTLS)
• feel whole again
• be like God intended them to be
• comply with their religious tenants
• feel more like a woman
• relieve regret of a prior mistake
• correct a decision made during a bad relationship
• fill the emptiness from the loss of a child or another loved one

As a generalist ob/gyn, I was always keenly aware of how many women bore both the burden of having children and the burden of sterilization. It was only after I became a ligation reversal specialist I saw how heavy the burden of tubal ligation could be. Now I have the opportunity to help in these situations and feel gratified that my training as a tubal reversal surgeon is progressing nicely under Dr. Berger’s mentorship.

Submitted by Dr. Charles Monteith
Tubal Reversal Specialist
Chapel Hill Tubal Reversal Center

PTLS Diagnosis and Tests

An email message received today about Post Tubal Ligation Syndrome (PTLS) from a patient who is scheduled for tubal reversal next month prompted this blog topic. I thought it would provide helpful information to others with similar concerns.

“My problem is horrible PTLS. I had my tubes tied in 05 at the time of my 3rd C-section. I understand that PTLS is not widely accepted or recognized in the medical community as a true syndrome or diagnosis, but could I expect to see something supporting that diagnosis in any blood work or hormone tests? Would it be normal to see abnormal hormone levels to some degree in support of this diagnosis or is it possible that all my levels would be ok but that the disruption in the flow of blood between ovaries and uterus could cause all of my symptoms and simply not show changes in hormone levels? Also, are there specific hormone tests I can have my ob/gyn check?

I only came across all this info on the net while desperately searching for answers to my growing list of symptoms that I never thought were related. This is very nerve wracking and exhausting. Three years is a long time and I look forward to this journey coming to an end and new one beginning, but I have so many questions and I was hoping you could steer me in the right direction so I can have any other diagnostics tests that may be helpful to my cause.”

Dr. Berger’s Response

One of the reasons that PTLS is not recognized as a true syndrome by most physicians is that there is no specific diagnostic test that is correlated with symptoms. If you search through the medical literature, you will find many studies with conflicting results. For example, you can do a search using Google Scholar for “hormones post tubal ligation syndrome” to review results from some recent medical studies.

Diagnostic Codes

There is no diagnostic code for Post Tubal Ligation Syndrome in the International Classification of Diseases (ICD). Without a specific diagnostic code, insurance companies do not provide reimbursement for testing or treatment. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) does have other diagnostic codes that can be used, depending upon the symptoms being experienced:

• ICD-9-CM #625.0  Dyspareunia - Painful sexual intercourse.
• ICD-9-CM #625.3  Dysmenorrhea - Painful menstruation.
• ICD-9-CM #625.4  Premenstrual tension syndromes -
  Distressing physical, psychologic, or behavioral changes that occur during the luteal phase of the menstrual cycle. Symptoms of PMS are diverse (such as pain, water-retention, anxiety, cravings, and depression) and they diminish markedly 2 or 3 days after the initiation of menses.
• ICD-9-CM #626.2  Menorrhagia  - Excessive menstruation.
• ICD-9-CM #626.6  Metrorrhagia – Irregular uterine bleeding.
• ICD-9-CM #627.0  Premenopausal menorrhagia
• ICD-9-CM #626.8  Disorders of menstruation, other

Insurance Coverage

Insurance companies do not recognize PTLS as a medical entity. Depending upon the symptoms you have, your doctor could use one or more of these diagnostic codes. The specific tests that may be appropriate will depend on your symptoms. For example, if you have pelvic pain, then ultrasound examination would be appropriate as part of an evaluation for pain. Abnormal menstrual bleeding would appropriately involve hormonal assays (FSH, LH, estradiol, progesterone). Based on the results of any preoperative testing, a diagnostic code could be listed on your operative report as a preoperative and postoperative diagnosis. This might influence the insurance company regarding possible reimbursement for tubal reversal surgery. Read your insurance policy carefully. If it specifically states that tubal reversal is not a covered benefit, no matter what information is sent to the insurance company, there will be no reimbursement. If the policy does not specify that tubal reversal is excluded, then there may be a possibility of getting reimbursement from your insurance carrier.

More Information about Post Tubal Ligation Syndrome

Post Tubal Ligation Syndrome is written about on many pages of the Chapel Hill Tubal Reversal Center website. There are also many discussions about PTLS on the Tubal Reversal Message Board. Another excellent source of information is Post Tubal Ligation Syndrome News.