Tubal ligation syndrome

Abstract

It has been estimated that 20-40% of women who undergo sterilization experience longterm sequelae which as a group are known by terms such as ligation The sequelae include dysfunctional uterine bleeding dysmenorrhea dyspareunia pelvic pain premenstrual syndrome and amenorrhea. The cause of these symptoms is unknown. Extensive coagulation of the tube and implantation of the proximal tube into the uterus (Irving method) are considered more likely to cause symptoms than other techniques. The question is actually whether the tubal ligation syndrome exists. Frequently clinical impression is distorted because problem patients are most often seen and remembered. What may occur after ligation is the surfacing of menstrual irregularities that had been masked by the artificial cycles induced by oral contraceptives (OCs). Studies that have attempted to verify the existence of the tubal ligation syndrome were usually retrospective rather than prospective were biased in their patient selection contained a small number of subjects had follow-up of less than 5 years or lacked a control group. To answer the question about the existence of a tubal ligation syndrome it is necessary to include a control population of fertile women whose husbands are sterile but who are otherwise matched to the study population for menstrual and obstetric history prior contraceptive practices family history and the usual demographic factors. Thus far most well designed studies have failed to identify a unique syndrome associated with tubal sterilization. When women who have had a tubal ligation return with symptoms the complaints should not be automatically attributed to the operation. Dysfunctional uterine bleeding and irregular bleeding intervals is the most common symptom. Evaluation should begin with a complete medical history a detailed menstrual history and a complete physical including a pelvic examination. The patients basal body temperature and bleeding pattern should be charted for at least 1 cycle. If the temperature record and absence of molimenal symptoms suggest anovulation other possible causes should be considered. For the majority of women in whom no cause of anovulation is apparent administration of medroxyprogesterone acetate (Provera) 10 mg/day on calendary days 1 through 10 each month gives a regular withdrawal bleeding pattern protects the endometrium against future adenocarcinoma and does not override the patients ability to self correct. Treatment is continued as long as the patient is anovulatory. Pathology within the uterine cavity is excluded by diagnostic curettage. Current evidence suggests that the cause of ovulatory dysfunctional uterine bleeding is abnormal endometrial prostaglandin biosynthesis. Medical therapies are not always effective against bleeding or other perimenstrual symptoms attributed to the tubal ligation syndrome.