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Re: Post Tubal Ligation Syndrome
From: anonymous@obgyn.net
Thu, 31 Aug 2000 21:23:36 -0500 (CDT)
I am almost afraid to enter this discussion, as I have been flamed on
the subject many times in the past. I agree with the docs in the lack
of corrolation between the BTL's and the symptoms that some women
complain of. I had a BTL 6 years ago and have never experienced the
effects that some have written about. I have, on occasion, noticed that
some of the women posting to this forum on the subject have also
expressed regret for having had the BTL. I have often wondered what
came first the symptoms or the regret.
At Thu, 31 Aug 2000, R. Daniel Braun, MD wrote:
>
>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........
>>
>>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.
>>>
>--
>R. Daniel Braun, MD FACOG FOG
>
>This is for educational purposes only, and is not intended to be replacement or substitute for consultation and examination by an appropriate medical professional. Due to time constraints, private e-mails cannot be answered.
>
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