Birth Control: Getting Your Tubes Tied (cont.)
No Clear Answers
Belcher says her struggle to find an answer has been difficult because many medical experts say that post-tubal ligation syndrome does not exist. "It is a medical myth," says Stephen L. Corson, MD, professor at the department of obstetrics and gynecology at Thomas Jefferson University and Women's Institute in Philadelphia. Corson led a study that compared hormone levels in women who had had tubal ligation versus those of women who had not had the surgery. His study showed no significant difference in the hormone levels of the two groups, indicating that the ovaries were not damaged by the surgery. Numerous other studies, including one conducted by the American Society for Reproductive Medicine with results published in the February 1998 issue of the Journal of Fertility and Sterility, also show no evidence to support the syndrome.
However, allegations that the surgery could lead to post-tubal ligation syndrome first surfaced in the 1950s. With the introduction in the 1970s of laparoscopy (the so-called "belly button surgery"), which was less invasive than previous surgeries, more women than ever before chose tubal ligation, and reports of postoperative symptoms increased, says Corson.
A Surprising Possibility
What could be causing the symptoms? According to Corson and other doctors looking into post-tubal ligation "syndrome," it may actually be a combination of discontinuing the use of birth control pills and age-related factors.
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, Corson says.
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.