Post Tubal Ligation Syndrome (PTLS)
Post tubal ligation syndrome (PTLS) is a term used to describe a variety of symptoms that may occur after a tubal ligation. Symptoms that women frequently report include increased menstrual bleeding and cramps, hot flushes, night sweats, irritability, and mood swings. These are thought to be due to changes in hormone levels. One theory about what may cause these symptoms after a tubal ligation has to do with interruption of blood circulation between the ovaries and uterus that affects the production of ovarian hormones.
Doctors differ in their opinions about whether post tubal symptoms constitutes a true syndrome. It has been a subject of controversy n the medical literature for decades. Studies have reported conflicting conclusions about whether these symptoms are more common among women who have had a tubal sterilization than among women who have not had a sterilization procedure.
Women who describe their symptoms are convinced that PTLS is real and they argue that doctors should recognize this as a true medical syndrome. Many of these women have been told by doctors that the symptoms they have developed after their tubal ligation could not be related to the surgery and often report that they feel they aren’t taken seriously. Some doctors recommend treatment with birth control pills, antidepressants, anti-anxiety medications, referral to a psychologist, or even hysterectomy.
During the past several years, increasing numbers of patients have requested tubal reversal surgery in hopes of finding relief from PTLS symptoms. A recent study of 91 women reporting PTLS used a standardized questionnaire prior to tubal reversal and at 6 month intervals following tubal ligation reversal to gather statistical data regarding the possible effects of tubal reversal on PTLS symptoms. The study found that 90% of reported improvement in their PTLS symptoms, 8% reported no change, and 2% reported an increase in symptoms after tubal ligation reversal.
Members of the Tubal Reversal Message Board often discuss PTLS and how tubal reversal surgery has helped alleviate symptoms. These women uniformly disagree with the concept that symptoms that they have experienced since their tubal ligation are “just in their heads”. They are certain that their symptoms are not imaginary and are grateful when their symptoms disappear after tubal reversal surgery. The Message Board members offer encouragement and support to women who have similar symptoms and feelings and it helps them to realize that they are not alone. Following are some examples of posts on the subject of PTLS on the message board.
“I want to say thank you… my PTLS is practically gone and gets better ever month. I did not realize how bad I was truly feeling until I felt better and I thank you. I thank you for ‘putting me back together’ and for giving me the opportunity to have another child.”
“My name is Rhonda I had the reversal done because of the Post Tubal Syndrome caused by my tubal ligation. Although I realize that some people think that this Syndrome doesn’t exist, I can tell you that is does. I am so grateful that I found you and your staff. The results I have had since the reversal surgery have been tremendous.”
Conclusion: Counseling before having a tubal ligation rarely includes the possibility of menstrual and other symptoms encompassed by the term “post tubal ligation syndrome”. When women develop problems following female sterilization, they are frequently informed that their symptoms have nothing to do with the tubal ligation procedure. The purpose of this article is to promote awareness of PTLS and the possibility that tubal reparative surgery may remedy the problems.
Gary S. Berger, M.D.
Chapel Hill Tubal Reversal Center
109 Conner Drive Suite 2200
Chapel Hill, North Carolina 27514