Women's Health Community

Dear Anon: Many of the first studies seemed to find that women who had a bilateral tubal ligation (BTL) noted: changes in menstrual bleeding patterns (e.g., changes in cycle length, changes in amount of flow, increased cramps, more erratic bleeding), worsening of PMS or other mood symptoms, and alterations in sexual function. Given the frequency of BTL these purported outcomes were concerning.

Since that time several hundred scientific articles have been published on "post tubal syndrome". The problem is that many of the studies tended to lump all women with tubals together. That is, young and old, recent BTL or long after BTL, number of prior pregnancies, and type of tubal surgery done. However, studies that did try and control for age, time since BTL, number of children, etc. did not find significant differences between women with tubals and those who used vasectomy, diaphragm, condoms, or other non-hormonal methods of birth control.

The one exception was younger women (aged 20-29) with previous menstrual problems. In that subgroup there did seem to be a worsening of menstrual changes.

One of the things I would wonder about Anon, would be if you were using birth control pills or some other type of hormonal birth control method before you had your tubes tied. IF this is the case with you, sometimes the mood swings before menstruation which are blunted by birth control pills suddenly flare after the Pill is discontinued.

I would urge you to go back to the GYN who performed your surgery and tell them about the new, severe, mood swings. There may be an underlying medical disorder (eg thyroid disease, depression, anemia, atypical migraines, etc) which is responsible symptoms which are worsened during the premenstrual week.

If symptoms are determined to be PMDD (Premenstrual Dysphoric Disorder) there are numerous prescriptive medication options. PMDD has a greater emphasis on the mood symptoms of "PMS". Your GYN should be able to give you some specific treatments to try for the new mood swings.

In Support,
Jane

Oh my gosh, I'm not the only one!

I had a tubal when I was 26. I was not on hormonal birth control at the time. I had a copper IUD, because hormones made me very depressed. Long story short, I got pregnant with an IUD, and decided I never wanted to go through that again (hence, the tubal).

Anyway, I had the WORST PMS symptoms from ovulation on for the next several years. I felt like, well, to try to be halfway delicate, an un-milked cow for three weeks each month (I have a long cycle, always have). What finally worked for me was Chaste Tree berry. I know they have an article here on WebMD about it (I've looked at it). It was like a miracle! Finally, I could get back to feeling normal.

I don't know if it will work for you, but it's worth a shot. I get it from Puritan's Pride as a liquid dropper. You just put a few drops in a bit of water or tea.

Good luck to you! I feel your pain - at least, I really did.

Try a natural remedy called vitex. It worked wonders for me.

Dear Jane,
I have had similar problems since my tubaligation 18 months ago after the birth of my second child. I thought it might be attributed to my age (I will be 41 in July). I went to my doctor, who is just outstanding. She thought I might have PPMD and prescribed something for it. After 3 days of taking the medication, I was out of my head weird and so sick to my stomach. I quit taking it and just made up my mind I had to get through a month at a time. My symptoms are: irregular, longer periods; extreme moodiness and total lack of patience; back cramps instead of frontal cramps. It's like I'm the b_tch from h_ll! I hate it! Any advice?
Sincerely,
JCainster

Dear jdistefano and sabrina: Vitex is chaste berry (chaste tree extract). There are numerous studies looking at its use as a treatment for both PMS/PMDD and perimenopausal complaints. It has also be studied for it's effect on subfertility related to ovulation problems. There are 323 citations at the National Library of Medicine site on the use of this product for women's health concerns.

It is also important to be aware of any risks as well as possible benefits (since it is an over the counter drug). Here is one citation which provides an overview:

Drug Saf. 2005;28(4):319-32.
Vitex agnus castus: a systematic review of adverse events.
Daniele C, Thompson Coon J, Pittler MH, Ernst E.
Source

Department of Pharmacology of Natural Substances and General Physiology, University of Rome La Sapienza, Rome, Italy.
Abstract

Vitex agnus castus L. (VAC) [Verbenaceae> is a deciduous shrub that is native to Mediterranean Europe and Central Asia. Traditionally, VAC fruit extract has been used in the treatment of many female conditions, including menstrual disorders (amenorrhoea, dysmenorrhoea), premenstrual syndrome (PMS), corpus luteum insufficiency, hyperprolactinaemia, infertility, acne, menopause and disrupted lactation. The German Commission E has approved the use of VAC for irregularities of the menstrual cycle, premenstrual disturbances and mastodynia. Clinical reviews are available for the efficacy of VAC in PMS, cycle disorders, hyperprolactinaemia and mastalgia, but so far no systematic review has been published on adverse events or drug interactions associated with VAC. Therefore, this review was conducted to evaluate all the available human safety data of VAC monopreparations. Literature searches were conducted in six electronic databases, in references lists of all identified papers and in departmental files. Data from spontaneous reporting schemes of the WHO and national drug safety bodies were also included. Twelve manufacturers of VAC-containing preparations and five herbalist organisations were contacted for additional information. No language restrictions were imposed. Combination preparations including VAC or homeopathic preparations of VAC were excluded. Data extraction of key data from all articles reporting adverse events or interactions was performed independently by at least two reviewers, regardless of study design. Data from clinical trials, postmarketing surveillance studies, surveys, spontaneous reporting schemes, manufacturers and herbalist organisations indicate that the adverse events following VAC treatment are mild and reversible. The most frequent adverse events are nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash. No drug interactions were reported. Use of VAC should be avoided during pregnancy or lactation. Theoretically, VAC might also interfere with dopaminergic antagonists. Although further rigorous studies are needed to assess the safety of VAC, the data available seem to indicate that VAC is a safe herbal medicine.

Yours,
Jane

Try primrose oil capsules to treat pain. Helps little with me but I also had an oblasion done which put me in more pain then you could believe and now waiting for a hysterectomy because of it. I still get my period for 7 to 10 days and am in extreme pain them and a extreme b---- then also. Almost a year now Dr. who did it didnt offer to fix me gave me birth control and pills for anixity. Really so another Dr. is going to fix me up. Just to wait.

Wow!! Your story sounds like mine!! I am so frustrated with the results of my ablation treatment. I have little or no flow most months, but the pain is still excruciating especially on day 2, and like you my cycle takes forever to completely go away. My doctor has prescribed oxycodone, earlier but feared that I would become dependent so he changed the prescription to hydrochodone, which also has an adverse effect because they are all strong NSAIDs....but they relieve the pain! I get some relief if I stay away from caffeine products and take evening primrose and lots of Vitamin C. and exercise. I have also tried the vitex/chaste berry which seems to help as well. I have thought about doing a complete hysterectomy, but I'd hate to speed up my menopause since it has it's own set of problems as well.

Yes, ablations can cause increased cramping and pelvic pain. You can find details here - http://hersfoundation.com/ . Scroll down mid-page and click on the Ablation link.

Please read up on the adverse effects of hysterectomy. The severing of the 4 sets of ligaments will change your physique/skeleton. This occurs as your spine compresses and your rib cage descends toward your hip bones causing a big belly and back, hip and leg/feet pain. There are many other adverse effects (including 3x risk of heart disease, 7x if ovaries are removed - castration). Please watch the female anatomy DVD on HERS website. I'm 5 years post-op and in the last 6 months or so started having back and hip pain and tingling in my legs and feet to the point it wakes me up at night. I have many other issues, all of which started after my surgery. My gyn removed everything for a benign ovarian cyst.

Here are some links that contain some information about hysterectomy consequences - http://hersfoundation.com/ and http://www.alternativesurgery.com/education/hysterectomy-complications/ (I know nothing about this doctor but am posting this link for the list of consequences).

Even ACOG says that 76% of hysterectomies are inappropriately recommended.

I wish you the best in finding a solution to your pain.