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Tubal Ligation Pain
Can Endometrisosis Explain Some Cases?

As a practicing generalist, I frequently evaluated patients with acute and chronic pain because of endometriosis. Often this endometriosis was located in the anterior cul de sac (in front of the uterus) and posterior cul de sac (behind the uterus) and the ovary. I cannot recall diagnosing endometriosis involving the fallopian tube muscularis.

Subsequently, I began to exclusively perform tubal ligation reversal surgery and tubal repair surgery. I would often see women who complained of tubal ligation pain after sterilization. I frequently began to encounter pigmented endometriosis which exclusively involved the fallopian tubes and broad ligaments in the area where the tubal ligation was performed. Often these patients would have no other visible endometriosis. I began to wonder if endometriosis (both visible or microscopic) could be the cause to tubal ligation pain or other symptoms in many of my patients.

When I find endometriosis, approximately 50% of these patients report no symptoms and the other 50% report symptoms of tubal ligation pain. Mostly they report cramping that increased after their tubal ligation procedure. A few patients report urinary and GI symptoms which began after tubal ligation.

Anatomic Distribution of Pelvic Endometriosis

Endometriosis can be a cause of tubal ligation pain

Image adapted from Endometriosis: Pathogenetic Implications of the Anatomic Distribution. S Jenkins, D Olive, A Haney. Obstet Gynecol

A 1986 study by S Jenkins et al demonstrated the locations of visible endometriosis diagnosed by laparoscopy in 186 women who had a preexisting diagnosis of infertility and endometriosis. Most of these patients had not previously undergone tubal sterilization.

This was an important study because it was the first study to evaluate the location of visible endometriosis in a large cohort of women using laparoscopy.

The illustration above nicely demonstrates the typical locations of pelvic endometriosis. The most common locations for visible, pigmented endometriosis were the ovary, broad ligament, the anterior cul de sac , and the posterior cul de sac.

Endometriosis was not commonly observed to involve the fallopian tubes. The overall prevalence of endometriosis involving the fallopian tubes was less than 4%.

Endometriosis as a cause of tubal ligation pain: My observations

Since specializing in tubal reversal and tubal repair surgery I have frequently encountered pigmented visible endometriosis involving the fallopian tubes at the site of tubal ligation and involving the broad ligaments in the immediate area where the tubal ligation was performed. Most of these patients did not report a history of endometriosis and none of these patients had visible endometriosis at the time of their tubal ligation procedures.

tubal ligation pain caused by endometriosisIt is important to note my diagnosis of endometriosis is often made on visualization alone. Most commonly we observe superficial pigmented endometriosis and deep nodular pigmented endometriosis. We will also observe non-pigmented endometriosis. It is important to note we may under observe endometriosis because it is either non-pigmented or microscopic. We do not routinely send tissue segments to pathology because of the costs involved during tubal reversal surgery.

We do see a variation in the tubal segments in which the segments are visually normal but the tubal muscularis is hypertrophied and fibrotic. It is possible many of these patients have microscopic endometriosis involving the tubal muscularis.

I have collected a series of cases which suggest, for some women, there may be an association between having a tubal ligation and developing endometriosis.

For more information: Can Tubal Ligation Cause Endometriosis?

12 thoughts on “Endometriosis And Tubal Ligation Pain: Medical Literature”

  1. Erin says:

    I need advice. I had my tubes tied at 22. I’m 25 now. Friday my dr did laparoscopic surgery to remove endometriosis. He also removed my clamps from when I had my tubal done. Did not reverse the ligation… but now that my clamps are gone, what are my chances of pregnancy? I asked him and he gave me no direct answers. He said it’s possible and to see him if I miss a period. How possible are we talking from just having clamps taken out? If someone could give me a good answer I would appreciate. My hubby agreed to get snipped of he has to, but I want more answers before we proceed that way.

    Thank You!

    1. Dr. Monteith says:

      Erin

      The clips cause the tubes to permanently close. Even if the clips are just removed you will not get pregnant. The closed ends of each tube must be opened and then surgically rejoined (tubal reversal).

      We should be able to help you. We can reverse most tubal ligation procedures.

      You should send us your tubal ligation reports for a free review and we can let you know if you are a candidate for reversal surgery. Your reports can be obtained from the medical records department where your tubal ligation surgery was performed.

      We charge $6400 total plus $125 to schedule and we are located in Raleigh, North Carolina.

      Please be aware that starting April 1st 2019 the fee for reversal surgery will increase to $6,900 and the scheduling fee will increase to $150. If you want to avoid the higher fees then you should schedule your surgery before April 1st or start a Reversal Prepayment Account.

      Patients pay in full and out-of-pocket at the time of scheduling. All you have to pay for in addition to the surgical fee is the cost of travel, hotel, and food.

      On average the chance of pregnancy after tubal ligation reversal is about 60% if you are under age 42.

      We do have a prepayment tubal reversal plan that allows you to save towards your reversal over a 3 year period.

      Although $6,400 seems expensive…the alternative treatment in-vitro fertilization (IVF) average $12,000 to $14,000 and is about 40% successful!

      The main advantage to tubal reversal is that every month you have a chance and you can become pregnant more than once.

      The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal

      Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about tubal reversal at our facility.

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