WOMENS-HEALTH Messages for August, 2000: Re: Post Tubal Ligation Syndrome

Re: Post Tubal Ligation Syndrome

From: Martha2Mary (anonymous@obgyn.net)
Thu, 31 Aug 2000 18:11:58 -0500 (CDT)

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Reply: D. Ashley Hill, MD: "Re: Post Tubal Ligation Syndrome"

At Thu, 31 Aug 2000, D. Ashley Hill, MD wrote: >Unfortunately, you have ended your valid request for information with an
>inflammatory question that is unnecessary and offensive. All of the
>doctors on this forum volunteer their rare free time "listening" to
>women on the Internet, because they believe in the value of sharing
>information. Physicians have an ethical responsibility to suggest
>treatment based, whenever possible, on highly suggestive scientific
>information. We receive bogus information on a daily basis from
>companies and individuals suggesting that a particular disease is caused
>by this or that, or a specific treatment "works 100% of the time" even
>though research has never been done. Why should my patients trust me if
>I give them information not proven by medical science? So, when you
>suggest that doctors are not listening, it is much more likely that they
>have done what I just did, and review medical journals for information
>about the potential for menstrual irregularities and other problems
>after tubal ligations.

Firstly, my 'question' was put to Doctor's *who do not believe* that there is such a thing as PTLS. I maybe should have rephrased it so that it wrote "Doctor's who do no believe that Tubal Ligations *may* cause Menstrual problems in some women".

>Although I have published a paper on a particular tubal ligation
>technique, I have not done any research on the potential aftereffects of
>tubal sterilization. However, there are dozens of such papers, and I
>just spent 40 minutes reviewing abstracts of these papers on Medline
>before responding to your question. I found a couple of very
>interesting papers suggesting a link between BTLs and menstrual problems
>(and even painful periods), but I found a couple of dozen that refuted
>this link. It concerns me that tubal ligation might confer protection
>against ovarian cancer, perhaps (and this is unproven) by altering the
>blood supply to the ovaries. Maybe this same mechanisms effects =som women who have had BTLs. But, despite this interesting theory, there is
>little evidence that this is a major problem. In fact, another study of
>a small number (20) of patients, actually measured the blood flow to the
>tubes before and after tubal ligation, and found no difference in blood
>flow. We don't know how common this is, or if the BTL even caused the
>problems, but one study showed that about 4% of women who had a BTL
>reported menstrual problems afterwards. Not a high percentage, but if
>you are one of those 4%, it's a big deal to you.

Yes, as you say, it is not shown to be a 'major problem', and also as you say, if I am one of those 4%, then it *is* a big deal to me. Therefore, it makes it extremely upsetting when some Doctor's refuse the possibility that there *is* a correlation between Tubals and changes in the Menstrual Cycle. It is upsetting to be told that there must be other reasons for my problems, because Tubals do NOT cause such things, when I, who know my body better than anyone, *know* that things changed as soon as I underwent my Tubal Ligation. You have done what other Doctor's haven't - admitted that there may be a *possibility* for 4% of Women who have had Tubals to experience some Menstrual problems, and for that, I thank you.

>I have been counseling my patients who wish to undergo a BTL that they
>=might= experience menstrual irregularity and other hormonal problems
>after their surgery. I have done this for 6 years. Not one patient has
>ever changed her mind about having the procedure performed because of
>this. My suspicion is that a small percentage of women who undergo
>tubal ligation have an altered blood flow to the ovaries, and this may
>cause menstrual problems or perhaps occasional painful periods. I
>cannot think of any valid reason why it would directly cause fatigue,
>depression, or even PMS. Hopefully someone will conduct a huge study,
>looking for symptoms both before and after tubal sterilization, that
>will answer this question once and for all.

Please know that even if I had known about these problems before my Tubal, I still would have had it. I am not here to deter women from undergoing Tubals, I just want there to be an acknowledgment in the Medical Community that *something* happens to *some* women when they undergo a Tubal Ligation that causes Menstrual problems, for when that has happened, Doctor's may start looking for adequate treatment methods for women like myself. I don't care what it is called - Post Tubal Syndrome, Post Tubal Ligation Syndrome etc - the Name doesn't matter in the slightest, the acceptance of *something* does. You sound like you have accepted the 'possibility' of 'something', and as a result inform Women when they come to you for a Tubal - we need to see more Doctor's out there who are willing to do this, and once again, I thank you.

Putting all that aside, do you have any suggestions on how my problems can be best treated? So far I have tried some kind of hormonal pill that I had to start on day 19 (?) of my Cycle, and take 3 times a day for 7 days, which did lengthen my short cycle, but was too cumbersome in that it had to be started on a specific day and taken three times a day. Six weeks ago, on the advice of my GP, I went on the Depo Provera injection, as I was told that this may balance my hormones a bit, but as I sit here and type, I have been bleeding for the past 3 weeks, and cramping off and on during that time. So far, that is not working........

Your advice would be appreciated, and thank you for your time. >--
>David Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>http://home.cfl.rr.com/dahmd
>
>My apologies, but due to time constraints I am unable to answer private e-mails.
>

Next message: R. Daniel Braun, MD: "Re: Question...."
Previous message: R. Daniel Braun, MD: "Re: What Do You Think?"
In reply to: D. Ashley Hill, MD: "Re: Post Tubal Ligation Syndrome"
Next in thread: R. Daniel Braun, MD: "Re: Post Tubal Ligation Syndrome"
Reply: R. Daniel Braun, MD: "Re: Post Tubal Ligation Syndrome"
Reply: D. Ashley Hill, MD: "Re: Post Tubal Ligation Syndrome"

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