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Re: Post Tubal Ligation SyndromeFrom: R. Daniel Braun, MD (anonymous@obgyn.net)Thu, 31 Aug 2000 20:42:23 -0500 (CDT)
At Thu, 31 Aug 2000, Martha2Mary wrote: > >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 This is the most common side effect of Depo-Provera(30-40%). RDB
working........
>
-- R. Daniel Braun, MD FACOG FOG
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