Getting Your Tubes Tied
Is this common procedure causing uncommon problems?
A Surprising Possibility continued...
David Grimes, MD, vice president of biomedical affairs at Family Health
International in Chapel Hill, N.C., and clinical professor in the department of
obstetrics and gynecology at the University of North Carolina School of
Medicine, agrees. "The pill can cut the amount of menstrual bleeding by as
much as half," he says. "It also reduces PMS symptoms, cramps, and
irregular bleeding." Given these effects, many of the symptoms reported by
women claiming to have post-tubal ligation syndrome could, in fact, be a result
of coming off the pill rather than a result of the surgery. In fact, many women
are put back on the pill after the surgery to control these very symptoms.
One landmark study published in 1976 in the Southern Medical Journal
compared women's postsurgery menstrual cycles, taking into account their
previous birth control method. They found that women who had been on the pill
reported heavier bleeding, cramping, and other symptoms after the surgery;
women on the IUD reported less; and women using barrier methods like diaphragms
reported no change in the amount of bleeding, cramping, or other symptoms.
These results have been duplicated in numerous other studies since the 1970s,
Because of this, Corson counsels women on the pill who want to have their
tubes tied to first stop taking oral contraceptives for several months to see
what their periods will be like. If a woman experiences problems and decides to
keep taking the pill to regulate her cycle and control other symptoms, she may
not want to undergo the surgery.
But what about Susan? What could explain her complete lack of periods
following the procedure? Like all laparoscopic procedures, tubal ligation
carries the risk of complications such as damage to the major blood vessels,
bowel or bladder infections, or hemorrhage. While these complications arise
very rarely (perhaps in two per 1,000 procedures, according to Herbert
Goldfarb, MD, assistant clinical professor at the New York University of
Medicine's department of obstetrics and gynecology), the patient should be
aware that they can and do occur -- which is why she signs a consent form
before the surgery.
"If a doctor burned too much tissue too close to the ovary, then yes, it
could damage [the ovary] and shut it down," Goldfarb says. "But this
would be a rare complication of the surgery, not a syndrome." Additionally,
this would have to happen to both ovaries for complete menopause to set in. He
points out that because of the remote possibility for complications, any woman
having pain or other symptoms such as bleeding, depression, mood swings, hot
flashes, or fatigue after the procedure should see her doctor right away.
The Debate Continues
The CDC continues its studies into the long-term effects of post-tubal
ligation syndrome, and women such as Susan Belcher continue to raise awareness
and demand answers. For now, a woman contemplating the surgery should consider
all of her options and be aware of the possible risks, Goldfarb says. Then she
should carefully weigh the available medical knowledge and discuss all concerns
with her doctor. If she has any hesitation or doubt that the procedure is right
for her, it probably isn't, he adds. Because of this, many states currently
require a 30-day waiting period and counseling prior to the procedure.
As for Belcher, she has started the Coalition for Post-Tubal Women. She's
also working with the Illinois National Organization for Women in an attempt to
have post-tubal ligation syndrome added to the informed consent form presented
before surgery in her state. "I'm not against tubal ligation," she
says. "I just think women need to be told about the possible negative
effects before they consent to surgery."