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Menstrual irregularities after tubal ligation
SRenee posted:
I am 22 years old and I had a tubal ligation May 4th, 2012, when I was 21. I have had one live vaginal birth (2009), and one abortion (2011). Prior to my tubal ligation I have always had a very predictable/regular menstrual cycle. It was almost always 28 days, but occasionally 27-29 days, and I had a pretty light to moderate flow with no dysmenorrhea. Since my sterilization I have had cycles ranging from 22-32 days, and I still do not have dysmenorrhea. My most recent cycle was 32 days and I menstruated for 1 day. Is this something that occurs often or is it something to be concerned about? I could find only find a handful of peer-reviewed articles on this and they stated that the results of their studies showed that there is no difference in menstrual abnormalities between women that have been sterilized compared to those that have not.
Anon_6061 responded:
Complaints about symptoms of Post Tubal Ligation Syndrome seem fairly common. I know some women who've had many of the symptoms starting shortly after their procedure and others who haven't had any. However, the several studies I've read haven't found nor ruled out a definitive link. Since the uterus and ovaries work together as a system, it would seem reasonable that any procedure or med that disrupts the normal functioning of this system can cause problems.
Jane Harrison Hohner, RN, RNP responded:
Dear SRenee: As you have correctly stated, some of the best studies of "post-tubal syndrome" have not found a statistically significant increase in menstrual problems. Here, from the National Library of Medicine site, is one of the largest studies:

N Engl J Med. 2000 Dec 7;343(23):1681-7.
The risk of menstrual abnormalities after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group.
Peterson HB, Jeng G, Folger SG, Hillis SA, Marchbanks PA, Wilcox LS; U.S. Collaborative Review of Sterilization Working Group.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.

The existence of a post-tubal-ligation syndrome of menstrual abnormalities has been debated for decades. We used data from the U.S. Collaborative Review of Sterilization to determine whether the likelihood of persistent menstrual abnormalities was greater among women who had undergone tubal sterilization than among women who had not.

A total of 9514 women who underwent tubal sterilization and 573 women whose partners underwent vasectomy were followed in a multicenter, prospective cohort study for up to five years by means of annual telephone interviews. All women were asked the same questions about six characteristics of their menstrual cycles in the presterilization and follow-up interviews. Multiple logistic-regression analysis was used to assess the risk of persistent menstrual changes.

The women who had undergone sterilization were no more likely than those who had not undergone the procedure to report persistent changes in intermenstrual bleeding or the length of the menstrual cycle. They were more likely to have decreases in the number of days of bleeding (odds ratio, 2.4; 95 percent confidence interval, 1.1 to 5.2), the amount of bleeding (odds ratio, 1.5; 95 percent confidence interval, 1.1 to 2.0), and menstrual pain (odds ratio, 1.3; 95 percent confidence interval, 1.0 to 1. and to have an increase in cycle irregularity (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.3). Among women who had had very heavy bleeding at base line, women who had undergone sterilization were more likely than women who had not undergone the procedure to report decreased bleeding (45 percent vs. 33 percent, P=0.03).

Women who have undergone tubal sterilization are no more likely than other women to have menstrual abnormalities.

As you can note SRenee, the confidence intervals
Jane Harrison Hohner, RN, RNP replied to Jane Harrison Hohner, RN, RNP's response:
(technical problem--> continuation)
the confidence intervals are barely significant so there are minimal differences.

Having said that, An_6061 is correct, some individual women do seem to have menstrual changes. In your specific case with cycles now 22-32 days apart, and without dysmenorrhea, you may be having more non-ovulatory cycles. There are also several POSSIBLE explanations for a "too-light" flow" in a woman not using hormonal forms of birth control:

1. Lowered estrogen levels--this is more likely to be the case in a woman around the time of menopause.

2. Elevated prolactin levels---prolactin is produced from the pituitary gland. Levels can be elevated from a benign pituitary adenoma or from certain psychiatric medications.

3. Missed ovulations--with a missed ovulation the lining of the uterus does not shed all at once. This can result in a missed flow, a too-light flow (just part of the top layer is shed), or even prolonged/erratic flows.

Bottom line, if your cycles become increasingly unpredictable or you develop pelvic pain (eg ovarian cyst) see your GYN or clinic. Hopefully this is just a transient change.

brittandbabies responded:
Hi! I have the exact same problem and I actually created an account just so that I could let you know hat you are not alone. I am on my 35th day of this cycle and have yet to see any sign of menstruation. My cycle before the current one was 32 days. I have also experienced a symptom that you have not mentioned. I have exagerated ovulation. I will see egg white cervical mucous for almost two weeks and have cramps which is not a common ovulation symptom for me. I have also had a negative urine pregnancy test with each late period. Normally I am a 28 day cycle and I know because I always timed them and timed ovulation as well.