Post Tubal Ligation Syndrome
What Is Post Tubal Ligation Syndrome?
Post tubal ligation syndrome (PTLS) represents an iatrogenic condition. It is caused by certain medical procedures. The large percent of female population experience post tubal ligation syndrome afterwards a tubal ligation.
The aforementioned syndrome is due to a progressive decrease of estrogen/progesterone hormone concentration. Such decrease in hormone level is due to the impaired ovaries following the operative procedure such as tubal ligation.(1)
Post tubal ligation syndrome is caused by an impaired blood perfusion in the vicinity of the Fallopian tubes and ovarial tissue, pressure on nerves and intrapelvic adhesions.
Tubal ligation Procedure
It is necessary to adequately differentiate post tubal ligation syndrome from endometriois and other functional bleedings caused by hormonal disbalances as well as polyps and tumors.
According to the level of defect in the vein and capillaries, blood volume that reaches the ovaries could decline or eliminated entirely. Such condition is called isolated ovarian syndrome. It is a common condition upon hysterectomies in female population. In post tubal ligation syndrome, there are symptoms similar to menopause, hormone shock or estrogen and progesterone disbalance.(2)
The procedure of tubal ligation inhibits the male sperm to interact with the female eggs within the fallopian tubes.
The final result depends upon has the woman had regular or irregular cycles in the period before sterilization. In addition, in the female it is necessary to confirm the higher prevalence of menstrual irregularity in case they had experienced the post tubal ligation complications.
Etiopathogenesis
Currently, it is not yet understood what are the exact etiopathogenetic mechanism of post tubal ligation syndrome. In most cases, it is assumed that there is a structural damage to the ovaries in the operative period. If there is an impaired and decreased blood flow to the ovarial tissue, there will be as well a decrease in estrogen and progesteron concentrations.
Such situation occurs in the act of a total hysterectomy. In spite the fact that ovaries and uterus are not impaired in the terms of structure, there are still hormonal changes that may be present.
The most frequent defect is the one that affect the receptor cells localized in the tubes that are responsible for the production and secretion of the corresponding hormones.
In the certain studies, it has been noted that it is mainly iatrogenic complications due to inadequate surgical approach.
Signs & Symptoms
The most common signs and symptoms of post tubal ligation syndrome are anxiety, pain in the muscles, muscle cramps, joint ache, loss of libido, impaired menstrual cycle. Such symptoms are mostly present in the age of 30 in female population and it is due to decreased estrogen and progesterone concentrations as well as decreased blood supply.
Additional symptoms are the presence of ackward difficulties following tubal ligation, hot flashes, night flashes, insomnia, facial hair growth, loss of body hair, fatique, impaired memory, nausea, vomiting, mood change, pain in the pelvic region, vaginal disturbance, headache, weight gain, breast tenderness, incontinence.
Certain symptoms are due to an impaired blood flow that is in charge of the ovaries. There are emotional symptoms that are caused by psychological negation of the previous surgical procedure.
Sexual disturbances are caused by the variations in the vaginal pH homeostasis, whereas incontinence may be due to operative procedure in the pelvic region.
Such syndrome is characterized by severe periods of pain due to hormonal imbalance. The presence of pain may be characterized by the retro bleeding into the obstructed fallopian tubes.
Treatment
There are several available treatment options in case of tubal ligation syndrome.
Due to mild symptoms, the most common treatment of is symptomatic therapy. In certain cases, the operative procedure or reversal of tubal ligature might be successful.
As an additional option, there is an endoscopic approach.
The process of sterilization reversal is for the reversal of the previously performed tubal ligation. In case blood supply has been impaired during the primary operation, such intervention might not be applicable. In certain females the process of sterilization reversal will not lead to any relief in the ongoing symptomatology.
Uterine ablation is reserved in case of more severe symptomatology such as bleeding. In the majority of individuals, such intervention will lead to decrease of bleeding and pain. There are few side-effects that are due to uterine ablation. (3)
Hysterectomy is planned in the most severe cases.
Hysterectomy
After hysterectomy there may be necessary to introduce hormonal medicaments, most commonly in the form of oral regimens. patches, injectable solutions or creams.
Additional Treatment
There are recommended several healthy lifestyle modalities in females with post tubal ligation syndrome.
A healthy diet is comprised of higher fiber intake and limiting calories in about 1,500 calories daily. The most commonly advised food are fresh vegetables, fruits, fluids. Food rich in omega-3-fatty acids and numerous vitamins are of benefit. It is necessary to avoid food additives and other chemicals that may endanger the organism.
Progesterone cream is derived from Wild Yam. It may regulate hormonal levels and relieve symptoms such as hot flashes, loss of libido, impaired sexual drive and vaginal dryness.
Black Cohosh is a herbal remedy with antispasmodic and sedative effect. It acts also against inflammation and may relieve the menstrual symptoms.
Fenugreek may be of benefit in certain impairments of the reproductive system in female population. It may as well stimulate milk production, enhance sexual functions and improve circulation in the genitourinary system.
Maca is a vegetable similar to broccoli. It has been noted that it may stimualte sexual functions and regulate the ovulation cycle.
Dong Quai is a herbal remedy that may relaxe of the uterus and pain relief.
Complications
Post tubal ligation syndrome is associated with premature menopause, hormonal disbalance, atrophic ovaries, increased risk of heart disorders, osteopenia, osteoporosis, impaired uterine bleeding, premenstrual syndrome, endometriosis, pelvic adhesions, impaired lactation. (4)
REFERENCES
- Dr. Herbert B. Peterson. Factors seen as possible links to posttubal ligation syndrome.Contracept Technol Update. 1986 Feb;7(2):13-5.
- Boyd EM.Post-tubal-sterilization syndrome.J R Coll Gen Pract. 1987 Jun;37(299):272
- Satoh K, Osada H.Post-tubal ligation syndrome.Ryoikibetsu Shokogun Shirizu. 1993;(1):772-3.
- Mehri Jafari shobeiri. The risk of menstrual abnormalities after tubal sterilization: a case control study. BMC Women’s Health
