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If you've clicked this tab then you are obviously searching for answers. I do my best to keep this page updated as often as possible with the newest articles/medical journals/research information I and others are able to find on the topic of PTLS. For the most up to date articles/links please visit our facebook education board by clicking here.
Please use this information at your discretion (It can have it's repercussions as it did for me at each dr. that snubbed my "proof." My advice is to educate yourself as much as possible and make sure you are ready to be turned down and told this "syndrome, is all in your head" however NEVER lose hope!)
Most recent research from the desk of Dr. Charles Monteith
https://www.tubal-reversal.net/for-physicians/tubal-ligation-syndrome-does-it-exist/
Please use this information at your discretion (It can have it's repercussions as it did for me at each dr. that snubbed my "proof." My advice is to educate yourself as much as possible and make sure you are ready to be turned down and told this "syndrome, is all in your head" however NEVER lose hope!)
Most recent research from the desk of Dr. Charles Monteith
https://www.tubal-reversal.net/for-physicians/tubal-ligation-syndrome-does-it-exist/
Filshie clip issues?
Please see my other page for Filshie clip infoHowever if you are looking for articles/studies indicating a link between tubal ligation and what you have been experiencing then read or print the following.
Perhaps one of the most revealing articles…an excerpt provided below the link
http://reducetheburden.org/risk-and-contraception-what-women-are-not-told-about-tubal-ligation/
Lyn Turney*
School of Social Inquiry, Deakin University, Geelong, Vic 3217, Australia
Abstract
Tubal ligation is a commonly used routine procedure for female sterilisation. It is promoted as a very safe and highly effective method of permanently controlling fertility. Yet, since the early 1930s, there have been reports in the medical literature indicating that there are both short-and long-term problems with the procedure. This article reviews the medical and scientific literature in which these problems are reported in an attempt to synthesise and make sense of the results and their implications for women. Contrary to the way it is promoted, tubal ligation is fraught with complications which place at risk the health and well-being of many women. Its sequelae includes many gynaecological problems ranging from torsion, hydrosalpinx, and endometriosis to irreversible interferences with the endocrine system. It is clear that tubal ligation is not the ‘clean cut’ procedure that it purports to be, and, in the interests of women, the myths about safety and efficacy need to be publicly dispelled.
The most common method of fertility control is tubal ligation. Physicians and some women promote tubal sterilization as an extremely safe and very effective method of permanent fertility control. Yet the medical profession has known since 1930 that significant numbers of women suffer serious and irreversible complications from tubal ligations; women have died from tubal ligation. Its mortality rates in Bangladesh, the UK, and US, are 1/5000, 1/10,000, and 1/25,000, respectively. Women experience complications both during and after surgery (e.g., twisting of the tube, sometimes accompanied by gangrene, and accumulation of fluid in a tube). After tubal ligation, many women develop endometriosis. Torsion, hydrosalpinx, and/or endometriosis contribute to increased menstrual pain. Disturbance of the local flora can cause sepsis (e.g., toxic shock syndrome). Some women have a severe inflammatory reaction to the silicone in clips and rings. Tubal ligation may be linked to an increased risk of cervical cancer.
Many sterilized women eventually undergo hysterectomy. Many women experience excessive bleeding during menstruation, but many physicians discount this as women not knowing their own bodies and subjective estimates of blood loss. Impaired ovarian blood supply and altered nerve supply to the tube and/or ovary are possible causes for post-tubal ligation menstruation problems. Many women experience memory loss, general decline in feeling of well-being, lethargy, and loss of libido after tubal ligation, indicating a spontaneous iatrogenic menopause. Yet physicians often attribute these symptoms to psychological problems, thereby denying women knowledge of their own bodies. Tubal ligation-induced problems should not be limited to the medical profession. We need to seriously examine the processes that keep this information from women.
Source: WOMEN’S STUDIES INTERNATIONAL FORUM. 1993 Sep-Oct;16(5):471-86.
Abstract: The most common method of fertility control is tubal ligation. Physicians and some women promote tubal sterilization as an extremely safe and very effective method of permanent fertility control. Yet the medical profession has known since 1930 that significant numbers of women suffer serious and irreversible complications from tubal ligations; women have died from tubal ligation. Its mortality rates in Bangladesh, the UK, and US, are 1/5000, 1/10,000, and 1/25,000, respectively. Women experience complications both during and after surgery (e.g., twisting of the tube, sometimes accompanied by gangrene, and accumulation of fluid in a tube).
After tubal ligation, many women develop endometriosis. Torsion, hydrosalpinx, and/or endometriosis contribute to increased menstrual pain. Disturbance of the local flora can cause sepsis (e.g., toxic shock syndrome). Some women have a severe inflammatory reaction to the silicone in clips and rings. Tubal ligation may be linked to an increased risk of cervical cancer. Many sterilized women eventually undergo hysterectomy. Many women experience excessive bleeding during menstruation, but many physicians discount this as women not knowing their own bodies and subjective estimates of blood loss. Impaired ovarian blood supply and altered nerve supply to the tube and/or ovary are possible causes for post-tubal ligation menstruation problems.
Many women experience memory loss, general decline in feeling of well-being, lethargy, and loss of libido after tubal ligation, indicating a spontaneous iatrogenic menopause. Yet physicians often attribute these symptoms to psychological problems, thereby denying women knowledge of their own bodies. Tubal ligation-induced problems should not be limited to the medical profession. We need to seriously examine the processes that keep this information from women.
Late effects of sterilization in women
http://www.ncbi.nlm.nih.gov/pubmed/9505666?report=abstract&format=text
1. Katilolehti. 1998 Jan;103(1):9.
[Late effects of sterilization in women].
[Article in Finnish]
Sumiala S.
Sterilization affects measurably the circulation and the functioning of the
ovaries, but further studies are required to estimate the clinical meaning of the
change.
PIP: In Finland, every year a total of 11,000 female sterilizations are carried
out, whereas worldwide 400 million such procedures are expected to be performed
by the year 2000. In the past decade, major changes have occurred in the
technical aspects of the procedure. Unilateral and bilateral endocoagulation of
the Fallopian tube used to be standard procedure, but at the present time, when
using the method of choice, laparoscopy, a clip ties the tube. Post-sterilization
symptoms include pain (10-26% of cases), pain irrespective of menstrual cycle
(6-40%), dyspareunia (4%), premenstrual tension (6-40%), and prolonged
menstruation. Arterial blood flow between the uterus and Fallopian tube may be
disturbed and tissue damage may result infrequently. Earlier methods of female
sterilization produced more tissue damage, as clips affect blood circulation. In
one study, lower abdominal circulation was measured by Doppler ultrasound and
compared with nonsterilized subjects 2 days before sterilization, 2 days after,
and 3 months later. The results indicated that patients whose uterine blood flow
had decreased subsequently returned to the previous normal value, but in the
ovaries the change was greater and return to the previous value did not occur.
The author's own study used salivary samples 1 month before sterilization, 3
months after sterilization, and 1 year afterwards during a whole menstrual cycle.
Total progesterone values slowly decreased 1 year after sterilization. Within the
menstrual cycle, the peak of the progesterone level was the lowest 3 months after
sterilization and it did not reach the pre-sterilization level. Sterilization
exerts a measurable effect on the ovaries, but more investigations are needed to
confirm this finding.
PMID: 9505666 [PubMed - indexed for MEDLINE]
A link suggesting other methods of birth control should be tried before sterilization!
http://www.ncbi.nlm.nih.gov/pubmed/20106612?report=abstract&format=text
1. Maturitas. 2010 Apr;65(4):372-7. doi: 10.1016/j.maturitas.2010.01.005. Epub 2010
Jan 27.
A prospective cohort study of menstrual symptoms and morbidity over 15 years
following laparoscopic Filshie clip sterilization.
MacKenzie IZ, Thompson W, Roseman F, Turner E, Guillebaud J.
Elliot Smith Clinic, Churchill Hospital, Oxford OX3 7LJ, United Kingdom.
ian.mackenzie@obs-gyn.ox.ac.uk
OBJECTIVE: To observe the incidence of menstrual symptoms and relevant surgery
after sterilization.
STUDY DESIGN: 1101 women sterilized with Filshie clips between 1983 and 2002 were
assessed prospectively comparing menstrual symptomatology documented immediately
before surgery and 5-14 years later by questionnaire.
MAIN OUTCOME MEASURES: Prevalence of menstrual dysfunction and subsequent surgery
related to pre-operative menstrual symptoms and contraception.
RESULTS: After excluding 232 (24%) of the 968 eligible women sent questionnaires
whose address had changed, 573 of the remaining 735 women (78%) completed the
questionnaire, 223 5-6 years after sterilization, 175 after 7-9 years and 175
after 10-15 years; the respondents were demographically representative of the
total population. Heavy periods increased from 9% before to 35% (P
sterilization, painful periods from 2% to 21% (P
hysterectomy or endometrial ablation. These findings were not influenced by the
pre-sterilization method of contraception but were inversely related to advancing
age (P
after sterilization.
CONCLUSION: Menstrual symptoms increased following Filshie clip sterilization
irrespective of pre-sterilization symptoms and contraception. Whatever the
causative mechanism, the progestogen-loaded intrauterine system (IUS), with
similar efficacy but with improved menstrual symptoms, should be considered
before sterilization.
Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20106612 [PubMed - indexed for MEDLINE]
Interesting info that admits the METHOD of TL should be considered to AVOID PTLS
http://www.ncbi.nlm.nih.gov/pubmed/12287233?report=abstract&format=text
1. J Abdom Surg. 1981 Sep-Oct;23(9-10):95-7.
The postal tubal ligation syndrome.
Faber E, Rocko JM, Timmes JJ, Zolli AF.
PIP: The frequency of symptoms following tubal ligation calls for an examination
of the basic problem with the methods now used. This discussion recommends a
modification of tubal ligation which as performed during the past 2-1/2 years has
been symptom free, post operatively. What is meant by symptom free is those
symptoms which can be directly related to tubal ligation. Symptomatology is
complex and insidious. Characteristically, there is a latent period of no
symptoms. This asymptomatic period may be totally subjective and may last several
years during which time the correlation between surgery and symptoms is obscured.
This is particularly the case if purely symptomatic therapeusis has had some
degree of success. The latest period is followed by the gradual development of
the following: menstrual disorders; abdominal pain which is usually located in
the lower abdomen and is of 2 varieties, i.e., dysmenorrhea and non-menstrual
pain; and infection. Physical examination demonstrates little. This set of
symptoms, which has been documented also by Poma et al., and when taken as a
whole, constitutes a syndrome which should be termed the post tubal ligation
syndrome. These patients give a history of repeat X-rays, biopsies, endoscopies,
and surgical exploration. Some of these patients have had 4 or 5 celiotomies. A
modification of the traditional method of tubal ligation definitely requires
consideration. The characteristics of the oviducts which need mention and
emphasis are reviewed. On the basis of the reviewed considerations, it becomes
obvious that smooth transport of the ovum is a necessity and that obstruction in
the tubes will cause a reaction similar to obstruction anywhere in the body.
Tubal ligation should be performed in such a manner so as not to obstruct the ova
from passing down the tube. The tubes should be cut fairly close to the uterus
and be tied. The rest of the tube from fimbria to the isthmus should be left
open. In this manner, the ovum passes into the fimbriated end of the tube and is
gently passed out back into the peritoneal cavity. A sort of blind loop is
created. Although this technique has been performed in only 6 cases, results have
been good.
PMID: 12287233 [PubMed - indexed for MEDLINE]
Endocrine profile of patients with post-tubal-ligation syndrome considering reversal/conception
http://www.ncbi.nlm.nih.gov/pubmed/7277344?report=abstract&format=text
1. J Reprod Med. 1981 Jul;26(7):359-62.
Endocrine profile of patients with post-tubal-ligation syndrome.
Hargrove JT, Abraham GE.
The endocrine profile of the midluteal phase was assessed in 29 patients with the
post-tubal-ligation syndrome, consisting of pain, bleeding and premenstrual
tension. Compared to normal controls, the patients had a high serum estradiol and
a low serum progesterone level. This abnormal luteal function may be responsible
for the symptoms observed and may also explain the failure to conceive following
successful reversal of tubal ligation. It is recommended that patients seeking
sterilization reversal be screened for abnormal luteal function preoperatively.
Selection of sterilization procedures that minimize alteration in luteal function
should be given high priority.
PMID: 7277344 [PubMed - indexed for MEDLINE]
Post-tubal sterilization problems correlated with ovarian steroidogenesis
http://www.ncbi.nlm.nih.gov/pubmed/3197418?report=abstract&format=text
1. Contraception. 1988 Nov;38(5):541-50.
Post-tubal sterilization problems correlated with ovarian steroidogenesis.
Cattanach JF, Milne BJ.
Computer Centre, Monash University, Clayton, Australia.
Mid-luteal phase total urinary oestrogen excretion was found to be significantly
reduced in women who had previously undergone tubal sterilization at least two
years before assay; pregnanediol levels at or below 2.0 mg/24 hrs were
significantly more frequent for the study group. These findings indicate that
reduced ovarian function is associated with that procedure. The major problems
declared as having been experienced subsequent to tubal sterilization were
classified into three categories; some women declared problems in more than one
category: (1) Abnormal uterine bleeding and/or menorrhagia, (2) Physical
problems, (3) Psychological and/or psychiatric problems. Category 1 was
associated with a significant fall in total oestrogen excretion, and category 2
with a significant fall in both total oestrogen and pregnanediol excretion.
Analysis of category 3 will be published elsewhere. A negative correlation
between total oestrogens and cholesterol was observed.
PIP: Mid-luteal phase total urinary estrogen excretion and pregnanediol levels
were monitored in 112 self-selected, regularly menstruating women who had been
sterilized 2 or more years before, and compared to 55 controls. The controls had
neither used contraception or ovulation identification methods within 3 months,
nor had they had gynecologic surgery. The mean total estrogen excretion of the
study subjects was significantly lower than that of the controls, 29.6 vs 36.0
mcg/24 hours (p0.0001). When the data were presented as histograms, 25% of the
study group had estrogen means below the 10 percentile value for controls. The
histograms were skewed to the right for both groups. Results for pregnanediol
analyzed in the same way did not differ significantly, although 23.4% did have
pregnanediol excretion below the 10 percentile level controls. The study subjects
were categorized into 3 groups: those with abnormal uterine bleeding, physical
problems, and psychological problems. Some other observations included the
negative correlation between estrogen and pregnanediol excretion and serum
cholesterol levels; as association of low estrogen with abnormal menstrual
bleeding; and an association of low estrogen and pregnanediol with physical
problems. The authors suggested a theory of localized hypertension and tissue
damage to explain poor ovarian function in these sterilized women. Female hormone
production has been linked with some of the problems found in these groups, such
as weight gain, osteochrondritis,gastritis, irritable bowel syndrome,
dysmenorrhagia and breast adenosis.
PMID: 3197418 [PubMed - indexed for MEDLINE]
Oestrogen deficiency after tubal ligation
http://www.ncbi.nlm.nih.gov/pubmed/2858712?report=abstract&format=text
1. Lancet. 1985 Apr 13;1(8433):847-9.
Oestrogen deficiency after tubal ligation.
Cattanach J.
4 of 7 women who had undergone tubal ligation within the past seven years were
found to have oestrogen excretion concentrations at ovulation below the tenth
percentile. A disturbance in the oestrogen/progesterone ratio as a consequence of
localised hypertension at the ovary, when the utero-ovarian arterial loop is
occluded at tubal ligation, is proposed as a possible cause of oestrogen
deficiency syndrome, dysfunctional uterine bleeding, and menorrhagia after tubal
ligation. Similar pathophysiology may occur after hysterectomy with ovarian
conservation.
PIP: In an effort to determine whether a disturbed estrogen/progesterone ration
is a likely explanation for increased incidence of menorrhagia, abnormal uterine
bleeding, and major surgery after tubal ligation, concentrations of estrogen and
progesterone at ovulation were measured in 7 women who had used the Billings
ovulation method to identify ovulation and who had subsequently undergone tubal
ligation. To qualify for inclusion the women had to be able to identify fertile
mucus and the peak sympton and be prepared to collect urine in 24-hour specimen
lots on the 3 days surrounding ovulation. Total estrogen levels on the day of
ovualtion were below the 10th percentile in 4 of the 7, while 5 of 6
post-ovulatory pregnanediol concentrations were within the normal range for
ovulation. 1 woman who had experienced gradually longer and heavier menses over 3
years following unipolar tubal ligation by cautery had a return to normal from
the 1st cycle after taking piperazine estrone .3mg from day 4 to day 25 of each
cycle. The menstrual duration and flow had remained normal for 6 months on
estrogen supplementation. A possible cause of the estrogen deficiency syndrome
might be a disturbance in the estrogen/progesterone ratio resulting from
localized hypertension at the ovary when the utero-ovarian arterial loop is
occluded at tubal ligation. Production of both estrogen and progesterone by the
ovary is dependent on blood supply; imbalance in the estrogen/progesterone ratio
presupposes that progesterone production is less markedly affected than estrogen
production. Between 3.3 and 8 times more oxygen is required to produce 1 mol of
estrogen than to produce 1 mol of progesterone. A similar situation may occur
after hysterectomy if 1 or both ovaries have been conserved. The hypothesis is
consistent with evidence from several published reports.
PMID: 2858712 [PubMed - indexed for MEDLINE]
From the CREST study
(Pg 2, second paragraph)
http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/CREST.pdf
Of the 1851 women included in this study, 1283 (69%) had abdominal hysterectomies and 568 (31%) had vaginal hysterectomies. Overall, 52% of the hysterectomies were performed for a preoperative diagnosis that could potentially be confirmed by pathologic examination. Pathologic examination actually confirmed the preoperative diagnosis of endometrial hyperplasia in 95% of the cases, cervical intraepithelial neoplasia in 89%, leiomyomas in 84%, pelvic inflammatory disease in 75%, adenomyosis in 48%, and endometriosis in 47%. Among all of the potentially confirmable diagnoses, 80% were confirmed. The remaining 48% of the women who had hysterectomies had preoperative diagnoses that were not amenable to confirmation by pathology. Most of these were for one of three diagnoses: menstrual bleeding disorders, pelvic pain, or pelvic relaxation. In 47% of these cases, pathologic examination showed leiomyoma or adenomyosis; no abnormalities were found in 38% of these cases.
Important to note about the CREST study
http://www.medscape.com/viewarticle/719264_11
The CREST study is an important contribution to the understanding of factors associated with long-term failure following sterilization. The strength of this study lies in the large number of women studied and the prolonged (10-year) follow-up. Until now, these data were available only for the IUD because such studies are extremely costly and difficult. Despite the importance of this information, caution must be exercised in applying the results of the study to the general US population because the study was conducted at teaching institutions and did not allow random selection. All women of childbearing age who have undergone sterilization, all women considering sterilization, and all providers caring for women of reproductive age should know that pregnancy and ectopic pregnancy do occur in women with history of tubal sterilization--even many years after the original procedure.
http://www.ncbi.nlm.nih.gov/pubmed/294528
1. N Z Med J. 1979 Dec 12;90(649):477.
Hysterectomy for sterilisation?
Swinnen J.
PIP: This article discusses the use of hysterectomy as a form of sterilization at
Hutt Hospital. Between the years 1960 and 1970, 70 women underwent tubal ligation
sterilization. The author followed these women with the interest in whether
further gynecological problems and operations could have been prevented by
hysterectomy at the time of sterilization. 25.7% (N=17) of the women did suffer
further problems which were preventable by hysterectomy, problems such as
menorrhagia, metorrhagia, fibroids, adenomyosis, etc. 22 additional operations
among these 70 women were needed, predominantly dilatation and curettage, with
all requiring anesthetic. Subsequent to tubal ligation, the rate of hysterectomy
was 17.1% or a total of 12 post-tubal ligation hysterectomies. These figures have
been compared to 2 other studies, one by M. J. Muldoon (BMJ, 1972, 1, 84-5) and
the other by R. J. Whitelaw (BMJ, 1979, 1, 32-3). In the 1st study, 18.7% of the
women or 70 of 374 underwent hysterectomy and 3.3% or 18 of 485 women underwent
hysterectomy in the Whitelaw study. The latter figures are so low, probably
because women who are 35 years of age with menorrhagia or irregular vaginal
bleeding are routinely treated by hysterectomy. While the author is not
recommending prophylactic hysterectomies, it does seem that hysterectomy at
sterilization would obviate the high rate of problems and surgery subsequent to
tubal ligation. Whitelaw's figures for post-tubal ligation difficulty imply that
a more carefully chosen sterilization method would be beneficial.
PMID: 294528 [PubMed - indexed for MEDLINE]
Tubal sterilization and pelvic venous stasis syndrome
http://www.ncbi.nlm.nih.gov/pubmed/12267331?report=abstract&format=text
1. Shengzhi Yu Biyun. 1985 Feb;5(1):21-3.
[Tubal sterilization and pelvic venous stasis syndrome].
Cai GZ.
This study indicates the relationship between tubal sterilization and pelvic
venous stasis syndrome. Exploratory laparotomy was performed in 24 patients with
symptoms of lower abdominal pain and intercourse pain after tubal ligation who
had failed to respond to medical treatment for a long time. During the operation
the author found that the venous vessels within the mesosalpinx had enlarged with
hyperemia and varicosities in 17 cases. All of them got satisfactory effects
after operative therapy. The etiology, prevention, and treatment of this syndrome
following tubal sterilization are discussed and emphasis is laid on how to take
precautions against pelvic venous stasis during tubal ligation.
PMID: 12267331 [PubMed - indexed for MEDLINE]
If you want more info on venous stasis syndrome here is an article explaining. Dilated pelvic veins are often found in premenopausal, especially parous (having given birth to one or more viable children), women. http://www.medscape.com/viewarticle/766074
Tubal ligation and your hormones
http://www.natural-hormones.net/articles/qa-tubal-ligation-and-your-hormones.htm
Is there any evidence for a post-tubal sterilization syndrome?
http://www.ncbi.nlm.nih.gov/pubmed/9496325
1. Fertil Steril. 1998 Feb;69(2):179-86.
Is there any evidence for a post-tubal sterilization syndrome?
Gentile GP, Kaufman SC, Helbig DW.
Author information:
Department of Obstetrics and Gynecology, State University of New York Health Science Center at Brooklyn 11203, USA.
OBJECTIVE: To review the literature on menstrual and hormonal changes in women
who under go tubal sterilization.
DESIGN: A systematic review through MEDLINE and a literature search identified
more than 200 articles in the English literature from which the most relevant
were selected for this review.
RESULT(S): Many authors have investigated the sequelae of female sterilization.
Increased premenstrual distress, heavier and more prolonged menstrual bleeding,
and increased dysmenorrhea have been reported. However, failure to control for
age, parity, obesity, previous contraceptive use, interval since sterilization,
or type of sterilization may have affected study results. Most studies that have
controlled for these important variables have not reported significant changes,
except in women who undergo sterilization between 20 and 29 years of age.
CONCLUSION(S): Tubal sterilization is not associated with an increased risk of
menstrual dysfunction, dysmenorrhea, or increased premenstrual distress in women
who undergo the procedure after age 30 years. There may be some increased risk
for younger women, although they do not appear to undergo significant hormonal
changes.
PIP: Evidence for a post-tubal sterilization syndrome was sought in a literature
review of over 200 English-language articles. This syndrome has been described,
variously, as encompassing symptoms such as abnormal bleeding and/or pain,
changes in sexual behavior and emotional health, exacerbation of premenstrual
symptoms, and menstrual symptoms necessitating hysterectomy or tubal
reanastomosis. It has been postulated that the destruction of the fallopian tube
and, in some cases, portions of the mesosalpinx, alters the blood supply to the
ovary, with consequent impairment of follicular growth and corpus luteum
function. Evaluation of the research literature is hindered by the failure to
control for age, parity, obesity, previous contraceptive use, interval since
sterilization, or type of sterilization. Despite the vast discrepancies in the
research findings, it does appear that women 20-29 years of age with pre-existing
histories of menstrual dysfunction are at increased risk of some post-tubal
sterilization symptoms. After this age, however, there is no consistent evidence
that tubal sterilization is associated with an increased risk of menstrual
dysfunction, dysmenorrhea, or increased premenstrual distress.
PMID: 9496325 [PubMed - indexed for MEDLINE]
Pituitary-ovarian function after tubal ligation.
http://www.ncbi.nlm.nih.gov/pubmed/7308505
Fertil Steril. 1981 Nov;36(5):606-9.
Pituitary-ovarian function after tubal ligation. Alvarez-Sanchez F, Segal SJ, Brache V, Adejuwon CA, Leon P, Faundes A.
Pituitary-ovarian function was evaluated by measurement of daily serum levels of luteinizing hormone (LH), 17 beta-estradiol, and progesterone in women with a previous history of tubal ligation. Normally menstruating women served as controls. The duration of the proliferative and luteal phase was similar for both groups. The midluteal progesterone level averages did not differ between the two groups. Preovulatory LH and 17 beta-estradiol peaks were significantly lower in the tubal ligation group; average midluteal LH and 17 beta-estradiol levels were also lower. These results reveal that pituitary-ovarian function can be altered following surgical sterilization.
PIP: Menstrual disorders have been reported following tubal surgery. This study investigates luteinizing hormone (LH), 17beta-estradiol, and progesterone levels in 30 women (age range, 24-38 years; average age, 32 years), who had had elective tubal ligation for fertility control. Elective surgical sterilization was performed between 1 month and 8 years previously. The controls consisted of 15 normally menstruating women (aged 20-32 years; average age, 24), seeking to become pregnant who had not used either oral contraceptives or IUDs for at least 1 month before the study. Daily blood samples were collected starting from day 10 of the menstrual cycle until the onset of the next menstruation. Case selection and specimen collections were done in Santo Domingo, Dominican Republic. Hormone determinations by radioimmunoassays were done on a double-blind basis at the Population Council in New York. Progesterone and 17-b estradiol were determined by radioimmunoassay according to the method of Thorneycroft and Stone, while human luteinizing hormone (hLH) was measured by the double antibody technique of Vaitukaitis et.al. Average duration of the proliferative and luteal phase were 14.4 + or - 3.0 and 13.3 + or - 2.9 days, respectively, for the control group and 13.5 and 2.4 and 14.2 + or - 1.7 days for the women with tubal ligation. The total length of the cycle, 27.7 days, is the same for both groups. The midluteal progesterone level averages did not differ between the 2 groups, although when the controls were compared with tubal ligated women 30 years of age or younger, the difference was significant. Preovulatory LH and 17beta-estradiol peaks were significantly lower in the tubal ligation group, as were the average midluteal LH and 17beta-estradiol levels. These results suggest that surgical sterilization can result in subtle changes in ovarian function, even though ovulation itself is not affected. Bleeding irregularities following tubal ligation may in part be due to the fact that different surgical procedures may have different effects on ovarian blood supply. Further research should be done to compare specific effects of different sterilization procedures on ovarian function. PMID: 7308505 [PubMed - indexed for MEDLINE]
This article presents a review of the literature on post-tubal sterilization syndrome
http://www.ncbi.nlm.nih.gov/pubmed/1541464
Image J Nurs Sch. 1992 Spring;24(1):15-8.
Post-tubal sterilization syndrome. Lethbridge DJ.
This article presents a review of the literature on post-tubal sterilization syndrome. Although studies have shortcomings they suggest the majority of women undergoing tubal sterilization do not experience changes in menstrual patterns after the procedure, but a minority do. Suggestions are made for further research, conducted from a nursing perspective. Implications for practice are suggested, given the tentative information on post-tubal sterilization syndrome.
PIP: Even though nurses care for women who complain of menstrual problems after undergoing tubal sterilization (ligation, electrocoagulation, or tubal occlusion by rings or clips), limited nursing literature exists on posttubal sterilization syndrome. Nurses should be interested in post TS syndrome, particularly in the menstrual changes and women's perceptions of these changes. Post TS syndrome consists of irregular menstrual cycles, dysmenorrhea, menorrhagia, and midcycle bleeding. Some scientists speculate that interference with the utero-ovarian blood supply and subsequent disturbance of ovarian function bring about post TS changes. Tubal ligation and electrocoagulation may be more likely to do so since they destroy more tissue than other procedures. In fact, an international study among 8486 post TS women found that those who underwent electrocoagulation were significantly more likely to experience menstrual changes than those who underwent other procedures. A case control study found much increased prevalence of abnormal cycles 49 and 87 months post TS (ligation and electrocoagulation). Yet there has not been any studies of actual pathophysiological changes in the ovary after TS. One can theorize, thought, that disturbance of the arterial blood supply may decrease the supply of follicle stimulating hormone and luteinizing hormone which in turn reduce estrogen and progesterone production. In a large multicenter study of 10,004 post TS women, as many as 30% noted either an increase or a decrease in 1 of 6 menstrual parameters. Most of these women took an oral contraceptive before TS, however. Other studied revealed that endometriosis is more likely to occur post TS than in non TS women. Health practitioners should encourage post TS women to keep a record of their menstrual cycles and to monitor irregularities. This reduce recall bias and bias associated with perceptions. PMID: 1541464 [PubMed - indexed for MEDLINE]
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1698-705; discussion 1705-6.
Tubal sterilization and risk of subsequent hospital admission for menstrual disorders.
Shy KK1, Stergachis A, Grothaus LG, Wagner EH, Hecht J, Anderson G.
Author information
Abstract
OBJECTIVE:
Our objective was to investigate tubal sterilization and subsequent hospitalization for menstrual disorders.
STUDY DESIGN:
Automated discharge data were used in a population-based cohort study of 7253 women aged 20 to 49 years with tubal sterilization (1968 through 1983) at Group Health Cooperative of Puget Sound. Comparisons were with an age-matched cohort of 25,448 nonsterilized women and a nonmatched cohort of 5283 spouses of men with vasectomies.
RESULTS:
In the sterilization cohort, 282 had hospitalization for menstrual disorders (curettage, n = 191; hysterectomy, n = 66; nonsurgical, n = 25). Risk of hospitalization for menstrual disorders was 2.4 times greater after tubal sterilization (95% confidence interval 2.0 to 2.9). This risk was 6.1 times greater for sterilized women aged 20 to 24 years (95% confidence interval 0.72 to 3.2). Compared with the risk for nonsterilized women whose spouses had a vasectomy, the risk was 1.6 times greater (95% confidence interval 1.3 to 2.1). Hospitalization for menstrual disorders was not more common after unipolar sterilization than after other methods, as might have been expected if the menstrual disorder was related to impaired uteroovarian circulation.
CONCLUSIONS:
Tubal sterilization is associated with a greater risk of hospitalization for menstrual disorders. A biologic association is not supported by these results.
Br J Cancer. 2013 Sep 3;109(5):1291-5. doi: 10.1038/bjc.2013.433. Epub 2013 Aug 6.
Nichols HB(1), Baird DD, DeRoo LA, Kissling GE, Sandler DP.
Author information: (1)Epidemiology Branch, National Institute of Environmental Health Sciences, PO Box 12233, 111 TW Alexander Drive, MD A3-05, Research Triangle Park, NC 27709, USA. nicholshb@niehs.nih.gov
BACKGROUND: Local inflammation after tubal ligation may affect ovarian function and breast cancer risk.
METHODS: We analysed tubal ligation, menopausal characteristics, and breast cancer risk in the Sister Study cohort (N=50,884 women).
RESULTS: Tubal ligation was associated with hot flashes (hazard ratio (HR) 1.09; 95% confidence interval (CI): 1.06-1.12) but not menopausal age (HR 0.99; 95% CI: 0.96-1.02). Tubal ligation did not have an impact on breast cancer overall (HR 0.95; 95% CI: 0.85-1.06), but had a suggested inverse relation with oestrogen receptor+/progesterone receptor+ invasive tumours (HR 0.84; 95% CI: 0.70-1.01), possibly because of subsequent hysterectomy/bilateral oophorectomy.
CONCLUSION: Tubal ligation does not influence overall breast cancer risk. PMCID: PMC3778289 [Available on 2014/9/3] PMID: 23922107 [PubMed - indexed for MEDLINE]
PDF's
Human endometrial perfusion after tubal ocduslon
http://humrep.oxfordjournals.org/content/13/2/445.full.pdf
Blogs/podcasts
Podcast from Dr. Charles Monteith of Chapel Hill (Now known as "A Personal Choice" ) discussing common anomalies found when performing all methods of tubal ligation as well as two women's struggles with their symptoms after ligation
Dr. Charles Monteith's blog
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