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 talked about more than it was actually 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.
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 ligation. 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 A Personal Choice 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:
