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.
Reproductive Surgeon
Medical Director
Chapel Hill Tubal Reversal Center
109 Conner Drive Suite 2200
Chapel Hill, North Carolina 27514
DrBerger@tubal-reversal.net
http://www.tubal-reversal.net/
http://news.tubal-reversal.net/ptls.php
April 3rd, 2008 at 9:01 pm
Many women I speak with report experiencing a variety of unpleasant symptoms. Most state they did not correlate the onset of the symptoms to the tubal ligation for several months — or even years — but finally realized that the symptoms began around the time of the tubal ligation. This information will be helpful for those women who know there is a problem, but have not been able to associate the problem with a possible cause.
April 4th, 2008 at 8:10 am
Thank you, Dr. Berger for this article. Not only will it promote awareness for PTLS, maybe it will open doors for insurance companies to recognize the diagnosis and assist with coverage for tubal reparative surgery.
April 4th, 2008 at 9:27 am
The controversy about whether or not PTLS is “real” has been going on for at least the past 30 years in medical circles. The definitive study that would settle this issue would be to have what is known as a prospective cohort study that compares the incidence or frequency of symptoms among two groups of women who are randomly assigned to either having a tubal ligation or not having a tubal ligation. Of course, such a study can never be done. I hope that we can help advance knowledge by studying the long term outcomes of tubal reversal procedures among women who come to Chapel Hill Tubal Reversal Center and self-report having post tubal ligation symptoms. So far, the results of this follow-up study seem very promising in associating tubal ligation reversal with a reduction in the percentage of women having post tubal ligation symptoms.
April 4th, 2008 at 11:12 am
It certainly is amazing how many woman come to us for tubal reversal specifically to improve their quality of life. The list of PTLS symptoms is almost the same for each patient, and truthfully, it sounds miserable. I am glad we are here to help these ladies get their lives back!
Pam Mills, CRNA
April 4th, 2008 at 11:15 am
We actually have quite a few patients coming for reversal surgery in order to alleviate symptoms of PTLS. We are studying how reversal helps relieve PTLS symptoms by following up with these patients months after surgery. Thus far, about 90% of patients report total or significant relief of PTLS symptoms after their reversal with Dr. Berger.
April 4th, 2008 at 11:57 am
I am so glad that there is now information in regards to Post Tubal Ligation Syndrome. It saddens me each time I speak with patients who say that when they try to explain what is going on with them, that they are told it is all in their heads. We have many patients come to have reversal surgery because of PTLS and it is wonderful to hear that there has been an improvement in their symtoms. This information will hopefully give many women hope and the assurance that they are not alone in all of this.
April 4th, 2008 at 12:32 pm
I think that its a shame that women are not told about the possibilities of PTLS before their tubal ligation. Im so glad that here on the message board the ladies have a chance to talk and share their stories and opinions on the matter.
April 4th, 2008 at 12:41 pm
Almost all of the women who come here for relief of their PTLS symptoms say that having tubal reversal surgery has changed their life. Women feel dramatically better and are able to get back to the important things in life they enjoy. I hope this article will help educate other women who are experiencing this syndrome.
April 4th, 2008 at 3:02 pm
PTLS is a very real problem for a lot of women and it is wonderful that a tubal ligation reversal can help ease PTLS symptoms in about 90% of our patients.
April 7th, 2008 at 9:13 am
Dr. Berger’s information regarding PTLS is a real service to women with this condition. So many PTLS sufferers have commented that the documentation of the syndrone has given them assurance that their symptoms are real and should be taken seriously. Anxiety is often the result of the unknown and to get answers for questions regarding PTLS is very helpful. Many thanks to Dr. Berger for this service and his concern for these women.
April 7th, 2008 at 3:01 pm
Dr. Berger has made available information on an important topic, PTLS, or post tubal ligation syndrome. Through data collected and documented by Dr. Berger and his staff, PTLS has been shown to exist in many women who have had a tubal ligation. Once again, Dr. Berger has taken a serious interest in the care and concerns of his patients by creating this study on PTLS. So many of his patients appreciate his awareness of this issue and to have the opportunity to share their symptoms and to get and give support on the CHSC message board.
September 8th, 2008 at 12:43 pm
[...] Women come from all over the world to Chapel Hill Tubal Reversal Center for reversing tied tubes – or more correctly put in medical terms, to have a tubal anastomosis. The majority of our patients desire sterilization reversal so they may naturally conceive more children. Many others, however, have ligation reversals to feel more complete again and/or to alleviate symptoms that have occurred after their surgical sterilization procedure. These patients report new physical and psychological symptoms after undergoing tubal ligation – symptoms that have been described as Post Tubal Ligation Syndrome (PTLS). [...]
September 23rd, 2008 at 1:16 pm
I was 24 yrs. old when I had my tubal ligation. I was told it was permanent but never was I told about the other side effects. I think that there should be a required info session or counseling prior to signing off on such a life changing surgery.
October 1st, 2008 at 12:23 pm
Is it possible that the women who display PTLS were taking birth control before the Tubal Ligation?
October 3rd, 2008 at 3:28 pm
My wife and I are one of the few lucky couples to have been made aware of PTLS by our OB before delivery and the procedure (interestingly, she does not do any surgeries – her colleague in the practice did, and therefore our OB had no financial incentive for my wife to have the tubal). We decided “why take the chance” and are leaning towards vasectomy now for our contraception options. I am an RN and had never heard of PTLS. Whether it is “medically recognized” or not, is not the issue. Clearly there are a sufficient number of women out there who have reported this problem and patients deserve to be informed “that some women have experienced adverse menstrual and other post-tubal symptoms but these have not been definitively linked with tubal ligations” BEFORE the procedure. That disclosure should be required in informed consent session for all tubal ligations. The FDA requires warnings (and even some recalls) on medications where serious effects have been reported but not definitively proven to be associated with the medication. Why isn’t the same standard applied to surgical procedures?
To all OBs: do the right thing and make the PTLS disclosure during your informed consent discussion with the patient and let the patient decide. Be sure you’re not putting your finances first.
October 9th, 2008 at 12:09 pm
I had my tubes tied when I was 19yrs but was not made aware of PTLS. I was told that it was all in my head. My Dr. does not support PTLS. So now at 31years old I’m on medication for depression, insomnia, and mood swings. The physical and emotional effects are very real and I live with them everyday. I’ve weighed every other possibility and agreed to different types of treatment and there has been no improvement. I am currently trying to raise the money for a tubal reversal and the procedure is not one covered by many insurance companies. My advice to the young – research and don’t be afraid to ask questions.
January 22nd, 2009 at 4:23 pm
I had a tubal at age 26 after having twins and regret it daily. The symptoms started gradually, so I thought it was post partum symptoms or just harder because I had twins. I am a totally different person. Ive tried 4 or 5 antidepressants, have menopausal symptoms, am extremely emotional, have abdominal pain an enlarged liver and gastritis. I was even diagnosed with congestive heart failure on one ER visit. Now at 30 Im starting 2 put the pieces together and think im not psychotic because I had 2 babies at once, but because of PTLS! I would love to have a reversal solely to get my life back and let my hormones flow normally. This has interrupted my enjoyment of life. I would not recommend a tubaligation / sterilization to ANYONE! Find another method.
January 27th, 2009 at 4:32 am
Hello! I had a tubal done 3 months ago. And started having hot flashes, night sweats, and now I don’t have a period. Just wanting to know if that was one of the symptoms.. I don’t have insurance so I can’t call doctor! Please help! By the way I am 29 years old if that helps. TY Crissy
March 6th, 2009 at 3:02 am
Okay so now I’m freaking out. I actually just got my tubal ligation a little over a week ago. I got my stitches removed today. Ever since I had it done, I’ve been getting these horrible hot flashes and feeling like I’m going to faint. I’m also still getting very bad abdominal pains. When I brought these things up to my doctor today, he assured me it had nothing to do with the surgery, and assured me I was all healed by now. He almost seemed like he didn’t want to discuss it. This is how I found your site on the internet. I don’t want to reverse anything though…is there anything else that can be done to stop the pain and hot flashes? I hope it doesn’t get worse.
March 14th, 2009 at 11:55 am
CRISSY – You may be experiencing post tubal ligation symptoms or it may be premature menopause. In either case, you should notify the the doctor who performed your tubal ligation.
April 9th, 2009 at 7:07 am
It’s certainly not a good idea to go in for tubal ligation (TL) as a permanent contraceptive method, not when there are various other options around, options that are more effective and much less painful than TL. When I say pain, I don’t mean that the procedure itself is painful; it’s the symptoms that plague you after the surgery that you need to be worried about.
The medical fraternity is divided about what is commonly referred to as post tubal ligation syndrome (PTLS) and its associated symptoms. While some doctors agree that women suffer as result of having their tubes tied, others pooh-pooh the idea and insist that it’s all in the women’s heads, that they think they have the symptoms, and therefore they do. But a recent study of 91 women who underwent a tubal ligation and subsequently a tubal reversal (untying the Fallopian tubes) showed that 90 percent of women felt an improvement in their PTLS symptoms after the reversal, 8 percent felt there was no significant change, while 2 percent reported an increase.
Unfortunately for women, PTLS is a very real condition that is characterized by the one or more of the following symptoms:
• You may get pregnant, but it’s most likely to be an ectopic pregnancy
• Your heart beats rapidly and you’re subject to hot and cold flashes and break out in sweat
• You’re irritable and extremely moody.
• Your periods are irregular and characterized by pain.
• You’re not interested in sex
• You suffer from insomnia
• Your vagina is dry and itchy and you may develop rashes in your pubic area.
• You’re anxious or depressed
• You cannot concentrate or recollect things
• You’re extremely tired all the time
• You may be incontinent
• Your skin may itch and your joints and muscles may ache
• Your breasts may pain
• You may experience a gain in weight
• You’re likely to develop allergies
• You suffer from increased hair fall
• You have pain in your pelvic region
• Your gums bleed
• You may develop ovarian and tubal cysts
PTLS is caused by the rapid decline of the hormones estrogen and progesterone when the blood supply to your ovaries is cut off or decreased because of damage to veins and capillaries during the TL surgery. These hormonal imbalances are what lead to symptoms that mimic menopause. The surgery may have also caused damage to the muscles and tissues in your uterus. Some doctors believe that TL surgeries are also capable of destroying or damaging receptor cells that relay hormonal messages to your brain.
If you’re not sure if you’re undergoing menopause or suffering from PTLS, get a hormone test done. And if you are a victim of PTLS, you could go in for a tubal reversal surgery. Whatever your decision, talk to doctors who are understanding and capable before you put yourself under the knife again.
April 9th, 2009 at 3:37 pm
I had a tubal done in 10/07 and ever since I have had nothing but trouble. After my tubal I have expected very heavy periods I bleed for 8 straight days. I use two forms of protection and sometimes that isn’t enough. I also go through the mood swings and the night sweats. I went back to the doctor just recently after finally being fed up with all of this. He told me that only option for me was to take my utures out. The insurance company has turned it down saying that. I was to young I’m only 32 with one child. So he put me on birth control he said not to take the last week of pills and just start a new pack. This way I don’t have the heavy bleeding. YEA right when I started to take the new pack of pills my period came anyways with the blood clots and all. He told me it was just break through bleeding. I’m really thinking about getting a reversal just so that I can return to normal. I didn’t have any this before my tubal. I had the procedurce done where I had the rings placed on my tubes. Well I’m glad to find a site like this.
April 14th, 2009 at 8:40 pm
My name is Emma. Seventeen (17) years ago I had a Bilateral Tubal Ligation done. I have been having pains very bad in my pelvic and ovaries area. I have had night sweats hot flashes. Heavy periods, skip periods, light periods, mood swings/ I have sleep insomnia, hair loss and thinning, rapid heart beats, breast pain and enlarged breasts, pain in my joints, weight gain, muscle pains, cold flashes, chills, incontinence, difficulty concentrating, tears, dry vagina, headaches, stabbing pain in pelvic area sometimes with ovulation, allergies, depressed times, gastrointestinal distress, indigestion, gas pains, nausea, irregular bowel movements, body odor, and so much more problems. I have been to many doctors and none of them could diagnose my problem. It has taken me 17) years to find out what my problem is after reading The information on the internet from The Chapel Hill Tubal Reversal Center. And reading individuals stories and comments. Thank You Chapel Hill Tubal Reversal Center. I am 48 Years of age. I desire a Tubal Reversal to BE Whole Again and be relieved of my pain and suffering. I am going to save the money to have the surgery done. Thank You for your information.
April 29th, 2009 at 3:28 pm
I totally agree with PTLS. I did not put it all together until I read the symptoms of PTLS. I also hae more heavy bleeding for a day, then hardly none the next day. Then all of the sudden its back. I have severe cramps in my back, abdomen, and legs. I am moody, cry for no reason and I do not feel like a complete woman anymore. I feel now that I had my tubes tied in 2001 that I am defective in some way. I wish I had never gotten my tubes tied. Biggest mistake ever. One, because of the physical side affects, let alone the emotional and psychological affects. I regret it for two reasons. One mainly because I desire more children. I have remarried June of 2007 and I am not able to have any children with the man I love. He doesn’t have any children and I do not feel like a real woman anymore. I truly believe PTLS exists and there are definetly physical and psychological affects to TL. Please, please ladies think twice and then think again before gettig the tubal ligation. If I had to do it over again, I would chose another form of birth control. One final comment, I wish insurance companies would cover some of the cost of the tubal reversal surgery.