Tubal Reversal Blog ‘tubal ligation’

My name is Andrea, and I’m a 31 year-old home schooling mother to four children.

I’m married to my partner in Christ, Jeff, who is 36. Jeff has his own CPA practice here near our home. We live in beautiful Coeur d’ Alene Idaho, where we are a very close knit Christian family.

In 2005, against the advice of my doctor and with my husband cautioning against it, I had a Filshie clip tubal ligation at the planned c-section birth of my daughter. My doctor used clips because of my age at the time of tubal ligation, as well as the fact that he believed I would want more kids based on my nature.

Soon after the birth of my daughter, I began experiencing symptoms that independently wouldn’t have been alarming, but when gathered together, had me very worried and feeling terrible. Early after the birth, I felt very sad about not having more children. At times I thought the symptoms were just because I was sad about ending my fertility. Now I know they are separate, as well as the desire to continue to have more children, even if you already have “more than normal”, is a God given desire, and NOT something BAD.As my symptoms began to mount, I began a journal of NEW symptoms for me. While one or two of these may not be abnormal, each one of these was new for me, and together made a host of symptoms.

· Period returned 3 weeks after post-partum bleeding, despite breastfeeding full time.    The earliest I had a period while breastfeeding before was 8 months!

· Cyclical migraines or cluster headaches. Typically, one in the week before my period, one upon my period leaving, and one mid-cycle. Each took up to 4 days to clear completely, and each required prescription medication. Nausea and vomiting would accompany without treatment.

· First time I couldn’t lose my baby weight through breastfeeding, diet and exercise.

· Highly emotional, and easily brought to tears or sadness.

· Extremely dry skin.

· Mid-cycle cramping and breast tenderness.

· Terrible cramping for 1-2 days of menstruation, with moderate cramping before bleeding starts, with light cramping entire period. I’m a very active woman with high pain tolerance. This cramping was enough to nearly bring me to tears.

· Bleeding so severely, I would soak a pad in an hour. My doctor suspected menstrual anemia.

· Bleeding sometimes mid-cycle. Spotting would begin on CD 23-24 and continue through 28 when heavy period would start. Bleeding would last 7 full days, with spotting another 2-3 at the end.

· Persistent yeast infections, presumably from being “damp” due to having to wear pads much of the month to catch unexpected flow.

When looking at this journal, I sought the advice of my OB/Gyn and family physician. Both doctors acknowledged tubal ligation can and often does cause painful and heavy periods. However, my family physician went a step further. She conveyed that she had heard numerous cases of women having severe problems following tubal ligation, and was fully on board in my seeking a reversal. She did hormone screening and other blood work, and my OB/Gyn performed a pelvic ultrasound to rule out endometriosis, infections, fibroids, cancers and cysts. Both doctors gave me a clean bill of health, with no other cause for my new problems. Both doctors wrote to my insurance company, requesting payment for a tubal reversal on the sole basis of Post Tubal Ligation Syndrome (PTLS).

The insurance company, a national and well-known provider, wrote back these words:

“Although a tubal ligation reversal is medically necessary for the health of the insured, tubal reversals are not covered as the code falls under fertility treatment which is excluded. *Named insurance company* will authorize payment for treatments of hormone therapy, ablation, D&C and hysterectomy.”

Obviously, at 29 years old and also seriously mourning the loss of my fertility, these were not acceptable treatments for the physical manifestations of my tubal ligation.

We began the process of searching out the best doctor to perform a tubal ligation reversal, and saving the funds to do so. Some local physician’s, including my own, perform tubal ligation reversal. However, I was unable to feel satisfied about the outcome since none maintained accurate PTLS relief and pregnancy statistics based on their own work. Doctor’s in the Seattle area also do tubal ligation reversal, as well as many other cities in the nation. The local doctor’s were going to cost us about $12,000. Even with travel from Northern Idaho, Chapel Hill Tubal Reversal Center was a more affordable, and a more highly skilled facility.

Post Tubal Ligation Syndrome Series

This is the ninth article in our fourteen part series on PTLS and associated medical conditions. The first article, Pain After Tubes Tied: A Symptom of Post Tubal Ligation Syndrome? , introduces the most common symptoms some women attribute to their tubal ligation.

Andrea’s after surgery follow-up story will be published next week and she has some exciting news to share!

Our next several articles will present personal stories of some of our patients who have suffered from worsening menstrual, physical, and emotional symptoms after surgical sterilization procedures ( women who had their tubes tied).

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.

Momzilla is actually Tracy.  She is a 43 year-old married, mother of three and is employed as a Senior Human Resource Manager. Tracy is married to Glenn who is a Transactional Real Estate and Business Attorney. In the previous article, Meet Momzilla, Tracy described her symptoms of Post Tubal Ligation Syndrome (PTLS).

Tracy is currently four months out from her tubal ligation reversal surgery and both she and her husband describe her recovery.

In their own words….

Tracy

“Just weeks after my reversal the first thing I noticed was that I had lost the overwhelming sense of dread that had been shadowing me. As I was still healing from the surgery I was less fatigued and more energetic. My mood and outlook were “lighter”. My emotional healing began quickly and the physical healing soon followed. As the weeks passed I noticed improvement in my hair, skin and nails. I was sleeping again and my fogginess and inability to concentrate improved. I have not had a PMS headache, dizziness or tingling in my extremities. Each menstrual cycle since the reversal has gotten progressively better and more “normal”. My exaggerated and prolonged PMS symptoms have diminished. At about 6 weeks post reversal I got my libido back and, for that, my husband is eternally grateful (LOL!). I was no longer feeling like a stranger in my own body. Aside, of course, from getting my health back, the best part of my recovery has been re-connecting with my family. I feel like I have gone from the evil “Momzilla”, tired, moody and short-tempered all the time to just plain “Mommy” again. I feel at ease again in my own skin and with life. I no longer wake up dreading what symptom might take control of me. Shortly after the surgery, Glenn said to me “Welcome back, I missed you…”. In good times and in bad, he and I have always “loved” each other, but, for the duration of time that PTLS held me hostage, we “lost” our connection to each other. After the reversal, along with my obvious physical healing came the healing of my marriage and my family. It still amazes me that, after 3 years of suffering, I could see relief from my symptoms so quickly. I hope, through this series of blogs, that more women and their families as well as their physicians can be educated about PTLS and know that a reversal can bring them new hope for restoring their health and their lives.”

Glenn

Aside from the symptoms, the tragedy of PTLS is that we could have ended up divorced if Tracy didn’t have an inquisitive mind and, after almost three years, discovered PTLS online. From my viewpoint, PTLS transformed my best friend and wife into a detached unaffectionate roommate. Since the medical community did not recognize the possible effect of the tubal ligation procedure, we did marriage counseling which, of course, was unhelpful at best and could not succeed since the cause of the problem was biological. With no other explanation available from medical “experts”, we went through a series of episodes of “blame” with pop-psychology reasons to explain disinterest, depression and other symptoms that we didn’t know were symptoms. I received some truly bad advice from well-meaning sources. Symptoms like memory loss also put a strain on day-to-day living. In the end, we made it through because we started with love, a strong relationship and mutual respect. I have to wonder how many marriages have ended without ever knowing the reason?

I hope that the data compiled by the Chapel Hill Tubal Reversal Center can be used to provide proof to the medical community of this syndrome because it could help so many families if doctors provided pre-tubal ligation counseling and recognized this a possible cause of common symptoms experienced by women.

This is the eighth article in our fourteen part series on PTLS and associated medical conditions. The first article of this series, Pain After Tubes Tied: A Symptom of Post Tubal Ligation Syndrome?, discusses the most common symptoms associated with PTLS.

Our next several articles will present stories of our patients who have sufferred from worsening menstrual, physical, and emmotional symptoms after surgical sterilization procedures ( women who had their tubes tied).

A former Chapel Hill Tubal Reversal patient Andrea tells her story in the article entitled Meet Andrea.

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.

Momzilla came to us at Chapel Hill Tubal Reversal Center seeking relief of problems that occurred after her tubal ligation. Momzilla is her sign-on name for the tubal reversal message board. She is 43 years old, 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 Post Tubal Ligation Symptoms (PTLS) after her tubal ligation. We asked her if we could use her as the subject of a blog featuring several of our patients. She agreed and provided us a comprehensive list of her physical problems.

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 had 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 on June 2, 2008. Her surgery went well and was performed by Drs. Berger and Monteith. She had good tubal lengths and did well in the recovery room. She was released to the local Sheraton hotel for an overnight stay and was discharged home the next morning. She has recovered without any complications.

Our next article will be Momzilla’s report of how she has fared since her reversal surgery. We will also publish reports on patients who have suffered from worsening menstrual, physical, and emotional symptoms after surgical sterilization procedures (women who had their tubes tied).

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.

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).

Our first patient who will present her story is a frequent poster on our Tubal Reversal Message Board. Her story is entitled Meet Momzilla.

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.

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.

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.

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.

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 the second article of a fourteen part series. Our third article in this series is Diagnosing Menstrual Problems After Tubal Ligation.

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.

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

I started week number two at Chapel Hill Tubal Reversal Center with a beautiful ligation reversal.

Our patient was from North Carolina. She had a tubal ligation, which was done with bipolar cautery (burning) several years ago.

She went to her doctor to have her tubes tied, and after the surgery, her doctor told her, “The procedures I do are irreversible. You will never get pregnant again.” She told me she was fine with this at the time, but deep down she had feelings about why the doctor did such an aggressive procedure. She told me she thought to herself, what if she ever wanted to get pregnant again?

Well none of us can predict the future. As things so often go, she met a very special man who did not have any children. They married and together they desired a child. They came to us seeking to have her tubes untied.

I reviewed her operative note and things did not look good! Her operative note described cautery of the tube starting at the ampullary segment (the very end of the tube), and then cauterizing along the entire tube towards the side of the uterus. From the appearance of the operative note, it appeared most of the tube had been destroyed.

I recommended a screening laparoscopy to give us a quick evaluation before undergoing any surgical incisions. This would allow us to stop early if the tubes were not repairable. Unfortunately because of her Body Mass Index (BMI) issues, we were not able to proceed with a laparoscopy. Although we will perform tubal reversals for patients with BMIs up to 35, we do not perform laparoscopy for patients with a BMI over 30 due the possible increased risk of surgical complications.

This patient wanted a reversal and it was her personal decision to undergo a surgical incision so she could have an evaluation of her tubes.

As we started her surgery, we were uncertain if she would have repairable tubes. This was a wonderful patient who emanated a sense of enthusiasm and faith. She was someone you would characterize as having a beautiful personality. The entire surgical team was praying we would be able to help her.

As we started the incision, I was inwardly a little pessimistic that we would not be able to find any repairable tubes. I was afraid her doctor’s declaration about the nature of his tubal occlusions would be correct. I worried we would have to open her up, observe both her tubes having been obliterated and have to close her without doing her any good.

I was especially fearful of having to make the long surgeon’s walk. The long surgeon’s walk is the short, but measurable walk to the recovery/waiting room to give bad news to a patient’s family.

The worst thing for any tubal reversal surgeon is to have to tell a patient we could not repair their tubes. This is very comparable to a general surgeon having to tell a family their loved one did not make it through a risky surgery. To be honest, the two bad results are vastly different, but for a woman desiring tubal ligation reversal, it can feel very similar.

Things seem to happen for reasons. We found her to have good end segments and, as the operative note described, the tubes were cauterized to the very extreme side of the uterus. We were able to recover about 3cm of distal tube and found the remaining tubal lumens where they were hidden deep in the walls of the uterus. Isthmic-ampullary tubotubal anastamosis (tubal ligation reversal) was done on both sides and the average length of both tubes was about 3cm.

They ended up being short tubes. But short tubes are theoretically better than no tubes or closed tubes. We do have patients report pregnancies with tubal lengths much shorter than these.  We cannot create tubes. We can only work with what we find. Pregnancy for this patient is now very, very possible and prior to her reversal surgery, a natural pregnancy was impossible.

After the surgery, the entire team was thrilled. We never want to disappoint any patient, and we were able to give this woman both of her tubes back.

Dr. Berger and I were both very happy for this patient. We will be even happier when she reports a sticky bean to us (that’s a pregnancy for those who are not savvy to our Message Board lingo)!