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 reveresal.
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.