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Back To Vidyya The Other Side Of The Debate:

Bibliography Excerpts: Side Effects of Tubal Ligation Sterilizations

Side Effects of Tubal Ligation Sterilizations
'No More Hysterectomies'
by Vicki Hufnagel,M.D
Published By Plume 1989
Pages 228-229 Post Tubal Ligation Syndrome

. Many post-tubal patients who come to her office seeking relief complain bitterly of more severe cramps,heavier,longer periods,dysfunctional uterine bleeding,pain with intercourse,and pelvic pain or pressure. Three theories explain why these problems occure; 1.Tubal ligation destroys the blood supply to the ovaries. 2. Certain types of tubal sterlization procedures are more likely to result in endometriosis. 3. An increase in the blood pressure within the ovarian artery can create an estrogen-progesterone inbalance.

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 'Once A Month The Original Premenstrual Syndrome Handbook'
By Dr. Katharina Dalton's
Page 28.

( Recently it has been recognized that premenstrual syndrome often increases in intensity following tubal ligation. Radwanska,Hammond and Berger of Illinois University showed that after women had the simple operation to block their tubes they subsequently produced less progesterone from their ovaries).

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PMS Questions and Answers
By Stephanie DeGraff Bender
M.A.Clinic Psychology

 Page 12 (Some studies have suggested that a tubal ligation triggers PMS symptoms. It is suspected that the blood supply to the ovaries and the uterus is interrupted by the surgical procedure.)

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'Listen To Your Body'
A Gynecologist Answers Womens Most Intimate Questions
By Neils Lauersen,M.D.
And Eileen Stukane

 Page 354

 (Researchers who have started to study the after effectsof tubal sterilization have named the postoperative condition post-tubal ligation syndrome (PTLS).Women who experience this syndrome after surgery may have pelvic pain,irregular menstrual bleeding severe premenstrual syndrome(PMS),and galactorrhea,amilky discharge from the nipples. Some times women are so incapacitated by the pain of PTLS that they undergo further surgery. Most likely ,PTLS is caused by hormonal imbalance. If a physician cauterizes,removes ,or damages to large a portion of the Fallopain tubes and their blood vessels , he will reduce blood flow,the ovaries might shrink, and women may bleed less menstruation. A hormonal inbalance might result in abnormal ovulations with irregularmenstrual bleeding. Whe ovulation is off, there can be decreased progesterone production which brings on premenstrual syndrome with its excessive mood swings and depressions.)

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 The New Our Bodies, Ourselves
Complications and Negative Effects of Tubals

 (Some women experience a post -laparoscopic syndrome including heavy irregular bleeding and increased menstrual pain, which may create the need for repeated dilation and curettages or,in some cases complete hysterectomies).

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 My Body My Decision
(What you should know about the most common female surgies)
Written By: Lindsay R. Curtis
: Glade B Curtis,M.D.
: Mary K Beard, M.D.

 PAGE 257

( Although sterilization is simple,safe and certain,it occasionally causes changes in menstrual flow- making periods heavier or lighter - and it may cause adhesions.If there is enough interference with blood supply to your ovaries{ovaries and fallopian tubes share the same blood supply},the sterilization procedure can cause a permature menopause.While these complication are uncommon ,they are a possibility).

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 PMS
Premenstrual Syndrome and You
By : Niels H. Lauersen ,M.D.
Page 74

 ( If a physician cauterizes ,removes or damages too large a portion of the Fallopian tubes and their blood vessels ,he will reduce blood flow . The ovaries might shrink ,and women may bleed less during menstruation. A hormonal inbalance might result in abnormal ovulation with irregular menstrual production which brings on premenstrual syndrome. Research has shown,in fact that tubal ligations women have high serum estradiol{estrogen}and low serum progesterone in the second half of their menstrual cycles,the same monthly hormonal inblance that Drs.Israel and Dalton have cited as the caused of PMS. This hormonal dysfunction in the second half of the menstrual cycle,which is also called the luteal phase).

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 It's Your Body
By: Niels Lauersen M.D.
 : and Steven Whitney
Page 266

 (Tubal sterilization in a women involves destruction of part of the fallopian tube.If this destruction is too extensive, interference with ovarian blood flow may occur and systemic effects can follow. A women might experience certain menopausal sympyoms such as "hot flashes". A change in the pattern and the amount of menstrual bleeding may occur,and there is some indication of increased susceptibility to the development of the ovarian cysts. Adhesion formation is also possible.These adhesions can caused pain, and in rare cases,necessiate a hysterectomy).

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Every Womens Body
Everything you need to know to makes informed choices about your health

 

(It is unknown how often the controversial'post-tubal-ligation syndrome' which includes pelvic pain,spotting,and cramps occurs,though some research shows it may take up to five years for menstrual symptoms to occur. However, as many as half of women report changes in their menstrual cycle, including an increase in bleeding,irregular cycles, and cramps. Part of the explanation for immediate menstrual changes may be that many women had used the pill previously, which usually reduces menstrual symptoms,so that reports of increased bleeding and pain may be due to going off the pill.Some women who became sterilized in their twenty's have hysterectomies later and those women who've been sterilized with cautery techniques {burning the tubes closed, instead of tying them off} have higher hystercetomy rates as well.Cautery sterilization can interfere with blood supply to the ovaries, which may effect their function. Hormonal output could decrease, causing irregular ovulation. The end result might be an abnormal pattern of uterine bleeding that can lead to a hysterectomy. Endometriosis{an often painful condition in which normally found in the uterus is found in other nearby parts of the body, causing irregularand painful menstruation or pain during sex} occasionally occurs following tubal ligation. However, sterilization most often occurs in the age group of women who are most likely to be diagnosed with endometriosis, so this factor may not be a cause}.

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 Sexual Sterilization
The Couple To Couple League
P.O.Box 111184
Cincinnati,Ohio 45211-1184

 {A follow up study of 374 patients with tubal ligation revealed that 43% had subsequent gynecological treatment for such conditions as menorrhagia ( heavy menstrual bleeding),menstrual disturbances requiring hormal treatments, cervical erosion, ovarian tumors, and recanalization of the fallopian tubes requiring a second operation.)

There is an increased incidence of women with tubal ligations undergoing subsequent hysterectomy because of severe menstrual problems. Of the 374 patients followed in the study cited above ,70- or 18.7% - return for a hysterectomy. A study by James G. Tappan found a 40.7% incidence of menorrhagia and suggested that cystic degeneration of the ovary as a result of an interruption of the uterine artery might account for this. In any case,the figure of a 40% increase in menstrual problems as the results of tubal ligation seems standard. In addition the rate of cervical cancer experienced by one group of 489 women three and a half times the normal rate).

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 When To Say No To Surgery
By:Robert G.Schneider,M.D.
Page 31

( A women who is obese, who has ascites{abdominal fluid from,for example liver disease)who has had previous abdominal surgery or peritonitis or adhesions or umbilical hernia or heart or lung disease is not a good candidate for laparoscopic tubal).

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 Nontraumatic tubal occlusion as a new technique for female voluntary sterilization.
Author : Manuaba IB
Department of Obstetrics and Gynecology, School of Medicine, Udayana University, Denpasar, Indonesia.
Source : Adv Contracept, 1993 Dec, 9:4, 303-11

Abstract

Female voluntary sterilization is the most popular method of contraception worldwide. It is estimated that around 138 million or 16% of fertile couples, have been sterilized by this method. Female sterilization has been widely employed in Bali since 1970, in accord with '100' formula. The acceptance rate of female sterilization as a family planning method is 7.8% in Bali, and 5.1% nationally in Indonesia. But late complications associated with psychosomatic, psychosexual and menstrual disturbances are not infrequently found, complications attributed to the damage of ovarian blood vessels during the operation.

Over the years the female sterilization acceptance rate has kept increasing, especially among the younger age group (around 30 years). A nontraumatic tubal occlusion technique has been developed to preserve the ovarian blood vessel during surgery. With the new technique, late complications could be overcome so women could enter a normal menopausal period. This new technique described here needs further study.
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 Changes in ovarian function after tubal sterilization.
Hakverdi AU; Taner CE; Erden AC; Satici O
Department of Obstetrics and Gynecology, Dicle University, Medical Faculty, Diyarbakir, Turkey.
Source : Adv Contracept, 1994 Mar, 10:1, 51-6

Abstract

Changes in ovarian function were evaluated in 43 women, before and after tubal ligation. Midluteal endocrine profiles and endometrial biopsies were investigated before and at 3, 6 and 12 months after the operations. During postoperative follow-up there was significant increase in luteal phase deficiency and midluteal FSH, LH and E2 levels (p < 0.001). Progesterone levels significantly decreased (p < 0.001) and anovulation was observed in 13 (30.2%) of 43 cases. Our data suggest that tubal sterilization carried increased risk in ovarian function, particularly luteal phase deficiency and anovulation.
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 Long-term risk of hysterectomy among 80,007 sterilized and comparison women at Kaiser Permanente, 1971-1987
Goldhaber MK; Armstrong MA; Golditch IM; Sheehe PR; Petitti DB; Friedman GD
Division of Research, Kaiser Permanente Medical Care Program of Northern California, Oakland 94611.
Source : Am J Epidemiol, 1993 Oct 1, 138:7, 508-21

Abstract

To study the long-term risk of hysterectomy after tubal sterilization, the authors analyzed historical hospital discharge data on 39,502 parous women sterilized during 1971-1984 and 40,505 comparison women matched on age, race, parity, and interval since last birth.

 Sterilized women were significantly more likely than were comparison women to undergo hysterectomy (relative risk (RR) = 1.35, 95% confidence interval (CI) 1.26-1.44), especially for diagnoses of menstrual dysfunction and pelvic pain (RR = 1.88, 95% CI 1.65-2.13). Higher relative risks were not associated with greater tissue-destructive methods of tubal occlusion. Relative risks were highest for women who were young on the reference date (RR = 2.45, 95% CI 1.79-3.36 for women aged 20-24 years), but declined steadily as age increased (RR = 0.96, 95% CI 0.72-1.28 for women aged 40-49 years). In all age groups, relative risks were significantly above 1.00 after 7 years of follow-up. Reasons for elevated risks may be related to a greater willingness of sterilized women to forgo their uteruses. The emergence of greater risk in all age groups, however, prevents the authors from ruling out a possible latent biologic effect of tubal sterilization.

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 Hematosalpinx with pelvic pain after endometrial ablation confirms the postablation-tubal sterilization syndrome.
Webb JC; Bush MR; Wood MD; Park GS
William Beaumont Army Medical Center, Department of Obstetrics and Gynecology, El Paso, Texas, USA.
Source : J Am Assoc Gynecol Laparosc, 1996 May, 3:3, 419-21

Abstract

Complications after endometrial ablation are uncommon, and published series show that the majority of women who are treated by this technique remain symptom free in the postoperative period. A 39-year-old woman with previous tubal ligation underwent laparoscopic-assisted vaginal hysterectomy for debilitating pelvic pain 1 year after endometrial ablation. Pathologic assessment of the surgical specimen showed bilateral hematosalpinges from continued cyclic occult bleeding. The symptoms and findings in this case confirm the postablation-tubal sterilization syndrome. ~~~~~~~~~~~~~~~~~~~~~~~~~

 Postablation-tubal sterilization syndrome. Bae IH; Pagedas AC; Perkins HE; Bae DS
St. Francis Hospital, 3201 South 16th Street, Suite 2008, Milwaukee, WI 53215, USA
. Source : J Am Assoc Gynecol Laparosc, 1996 May, 3:3, 435-8

Abstract

Operative resectoscopy and endometrial ablation are often performed to treat abnormal uterine bleeding, but little is known about the potential late complications of these procedures. We reviewed the records of 305 women who underwent endometrial ablation at a midwestern obstetrics and gynecology group practice and teaching hospital between July 1990 and October 1995. For 71 women, tubal ligation, salpingectomy, or tubal sterilization was performed at the time of ablation. Of these, six (8.4%) developed intense cyclic pain 5 to 40 months after surgery. Four subsequently underwent exploratory laparotomy and hysterectomy, and two others underwent laparoscopic tubal resection and destruction. Gross pathologic findings revealed hematosalpinx, and microscopic examination showed endometriosis, acute and chronic inflammation of the fallopian tubes, and acute and chronic myometritis. We believe these characteristic clinical and pathologic findings are consistent with postablation-tubal sterilization syndrome, a distinct clinical entity arising as a late complication of endometrial ablation in patients with a history of tubal ligations and/or obstruction.

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 Evaluating the effects of tubal sterilization on menstrual function: selected issues in data analysis.
Martinez-Schnell B; Wilcox LS; Peterson HB; Jamison PM; Hughes JM
Division of Reproductive Health, Centers for Disease Control, Atlanta, Georgia 30333.
Source : Stat Med, 1993 Feb, 12:3-4, 355-63

Abstract

We examined selected issues in data analysis in the Collaborative Review of Sterilization (CREST). CREST is a multicentre, prospective, observational study of women undergoing tubal sterilization. We analysed menstrual function after sterilization in over 5000 women who were enrolled in the period 1978-1983 and followed for 5 years with yearly follow-up interviews. To take into account the dependency among repeated responses from the same individuals, we used the generalized estimating equations (GEE) approach to longitudinal data analysis. Marginal modelling resulted in a statistically significant increase in the odds of menstrual dysfunction at 5 years after tubal sterilization. Transitional modelling produced rates of menstrual dysfunction given a woman's menstrual function at baseline, after adjusting for other baseline characteristics such as method of contraception before sterilization. To examine the direction of the bias that could result from non-random missing data, we refitted our models using imputed values. The models with imputed values showed the same trends as the original models.

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 From MSNBC Chicago Chanel 5

The hidden risk of tubal ligations
by Marion Brooks

CHICAGO – More than 600,000 American women will have their tubes tied this year. But there may be a rare side effect of the surgery, the most permanent type of contraception, which few patients may know about.

In August 1995, Susan Bucher’s surgical sterilization,which she got for the purpose of birth control, was uneventful. Patients are told about some of the potential side effects, like post-surgical pain, stomach cramps and fatigue. But another, more controversial side-effect may not get mentioned: the risk of being castrated from tubal ligation.
 
Gynecologist Dr. Vicki Hufnagel takes part in a Web site explaining what is called post-tubal ligation syndrome. She believes that in about two percent of all tubal ligations, surgeons closing the fallopian tube also inadvertently damage or destroy blood vessels to the ovaries. That can kill the ovaries, producing the post-menopausal symptoms of a woman who has undergone a hysterectomy.
 
Susan was just 36 years old when she signed her consent for tubal ligation. It didn’t mention it might alter her periods. But it happened, and it was two years before another doctor diagnosed her condition with a hormone test. Until then, Susan suffered from abnormal menses, memory loss, confusion, and mood swings. Her sex drive hit zero. “My husband would initiate a love-making session and I would want to have nothing to do with him,” she said.  Susan says her first doctor never mentioned hormones as the cause. “He told me I should go get porno movies, she said. Dr. Hufnagel says both hormone tests and laproscopic examinations can confirm damage to the ovarian arteries. Yet the American College of Obstetricians and
Gynecologists denies that post-tubal ligation syndrome is a medical condition.
 
Presbyterian fertility specialist Dr. Mary Wood-Molo explains why. “As many studies have indicated, there may be a problem,” she said. “It is still is a very controversial within the field of gynecology.” Controversial or not, Dr. Wood-Molo and Susan agree that patients should be told about potential hormone changes before the operation.  Those physicians who dispute the existence of the syndrome say many of the symptoms are just temporary, and probably because a patient stopped
taking birth control pills.


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