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

Re: Post Tubal Ligation Syndrome

From: D. Ashley Hill, MD (anonymous@obgyn.net)
Thu, 31 Aug 2000 17:28:59 -0500 (CDT)

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Reply: Martha2Mary: "Re: Post Tubal Ligation Syndrome"

At Wed, 30 Aug 2000, Martha2Mary wrote:

I >have always believed that the Tubal Ligation was responsible for these
>changes, due to the fact that they occurred immediately following the
>Tubal, but the Doctors I spoke to did not acknowledge that.

>For any Doctor's here who do not believe that there is such a thing, I
>would like to ask you this Question:
>Why wont you listen to Women?

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.

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 =somewomen 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.

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.

--
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: Claudia Twisdale RN: "Re: Estratest effects"
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