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.
Susan is an international patient who traveled to Chapel Hill Tubal Reversal Center from Dubai, United Arab Emirates (UAE) for both tubal ligation reversal and ovarian conserving surgery. The day before her reversal surgery Susan and her partner, Stephen, sat with Dr. Monteith for a pre-operative interview. They have a unique story and we asked if they would allow us to share their story with our Tubal Reversal Blog and Tubal Reversal Message Board readers.
Tubal ligation reversal at 
