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PTLS: Why The Controversy?

Post Tubal Ligation Syndrome
A Long and Controversial History

Post Tubal Ligation Syndrome (PTLS) has a long and controversial history. Understanding the PTLS controversy will help women understand why many health care providers and health insurance companies are not supportive of a PTLS diagnosis.

Tubal ligation and symptoms

In the early 20th century there were medical case reports of patients who had tubal ligation surgery and then experienced changes in their menstrual cycle. These medical reports focused on individuals or small groups of patients and were based upon simple observation and patient self-reporting.

Within the medical community the symptoms experienced after tubal ligation were referred to as Post Sterilization Syndrome. Over time the syndrome became to be more commonly known as Post Tubal Ligation Syndrome or PTLS.

Does PTLS exist?

Although many women reported symptoms after having their tubes tied and small studies suggested a link between tubal ligation and the development of abnormal symptoms, much larger studies have suggested there is no convincing link between having a tubal ligation and developing abnormal symptoms.

U.S. Collaborative Review of Sterilization Study

The most conclusive medical study to evaluate female sterilization and 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 and was published in the New England Journal of Medicine in 1996. 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 commonly being performed by U.S. doctors and the failure rates associated with each of the tubal ligation methods.

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 procedures. The researchers 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: No convincing evidence for menstrual irregularities

Women were asked questions about changes in their menstrual 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 menstrual patterns for up to five years after sterilization. Women who underwent tubal ligation were found to have fewer irregularities with their menstrual patterns.

The authors’ conclusion was there were no significant differences in menstrual patterns in women who had tubal sterilization. To be phrased another way, among large groups of women tubal ligation did not overwhelmingly cause a noticeable problem amongst the group as a whole.

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.

A simple explanation for the PTLS controversy

PTLS is controversial because early studies suggested tubal ligation causes abnormal symptoms in some women; however, larger and better-designed population based studies suggest women who have a tubal ligation are no more likely to develop abnormal symptoms than women who do not have tubal ligation.

Regardless of the existence of PTLS the problems experienced by these women are very real for them. In our experience some women do have problems directly attributed to their tubal ligation. When women approach health care professionals about these side-effects they are often not well received and this creates conflict.

Unfortunately many of these women are victims of the PTLS controversy and are not being heard by the health care community.

For more information about PTLS tailored to medical professionals visit: For Physicians


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