This post previously appeared on Medium.
Some little-known and unlikely, but real possible negative consequences
Have you had or are you going to have a tubal ligation? With clips, rings, plastic grains of rice or other devices?
Pop quiz. Can you name three possible complications from these sterilization methods? How often to these devices move from their spot (migrate)? How will you recognize a bacterial infection or abscess around the device? Can you really have an MRI when you have a titanium device inside you? Can your chosen sterilization method really be 100% reversed? Read on and find the answers in this post.
Table of contents
This post is quite long. Looking for something specific? Here’s the list of section titles:
- Why this post
- Not just Essure
- Friendly names like ‘tying’, ‘clamping’ or ‘clipping’
- Foreign body inflammatory response
- Device migration
- Detecting device migration
- Imaging techniques made more difficult by metal devices
- Bacterial infections
- Titanium, silicone, nickel: Allergies and inflammatory responses
- ASIA: Autoimmune Syndrome Induced by Adjuvants
- Other gynaecological issues associated with tubal ligation
- Your personal risk may be higher (or lower)
- Bowel perforation
- Your belly button will change due to laparoscopic surgery
- Easier to get them placed than to get them out
- Not being told that you have clips inside you
- What to do
- There are better, much much better alternatives
Why this post
There are a few other Medium posts out there about problems that women experienced after tubal ligation. Even though my health had deteriorated sharply in the course of a few months, some of these posts felt like a conspiracy-theory. This actually made me doubt whether my health problems were related to my tubal and delayed me in getting the proper medical treatment to resolve them.
This post is here to properly inform you before they get sterilized with any type of device and afterwards. I will try to stay close to scientific findings, so that anyone who is looking for information just like I was and who has some trouble reading posts with a bit too many exclamation marks and red underlined text… may find some more concrete information here.
Not just Essure
You may have heard about the problems surrounding sterilization with Essure. Essure coils are devices inserted into the fallopian tubes. The procedure was supposedly simple: No general anaesthesia because the device could be inserted via the vagina. Scar tissue would develop and the tubes would be blocked.
After many women had very severe negative effects from the devices, the device has since been pulled from the market. A quick Google search will give you all the info you need on what happened and what problems women experienced.
Now, Essure is not the only method of female sterilization that uses a device to achieve the desired result. There are more: Filshie clips, Hulka Clips, Ovablock, Adiana and Falope rings. Don’t know if this list is complete. Anyway.. Essure is a method that very clearly had very negative consequences for a lot of women. But the other methods I just mentioned are, for many women, just fine. You won’t hear much about negative experiences, because it works well for many.
This makes it all the more difficult for women who feel that they are experiencing negative side-effects, most commonly pain and bowel troubles. It’s very difficult for healthcare professionals to accurately determine whether the devices could be at fault. Often, the discomfort or pain is not measurable with any diagnostic tests. And if it is, healthcare providers are hesitant to attribute your physical ailments to a medical device implanted in you. If you ask, however, whether they can guarantee that the device is not the cause, they will probably be equally hesitant.
Some of us feel discomfort, pain or we may even be very ill and the only thing we can trace it back to is our sterilization. “I didn’t feel this way before I got sterilized” is often heard. Sometimes, it takes years before we come to this realization.
I’m not writing this to completely discount any of these sterilization methods. As said, they apparently work well for many women. But I want to write this to support any woman who is having doubts about sterilization with any type of device, either before or afterwards.
I myself had Filshie clips placed and most of my post will be about this method. But a lot of what I write is applicable to other methods too.
Friendly names like ‘tying’, ‘clamping’ or ‘clipping’
The procedure of female sterilization often has a friendly name, like ‘getting your tubes tied’. In the case of Filshie clips, there’s even the mention that the procedure can be reversed. It almost seems like the sterilization is like closing a water tap: We can just open it again if you want to.
Although I’m a bit hestitant to use harsh words here, I see no other way to put this: Your tubes aren’t tied or clamped, they are obliterated. And the blood vessel that runs alongside it is, too.
Now, don’t get me wrong: It’s what you want, right? The tubes need to be closed off, one way or another. But I do think it’s good to be aware what is actually being done in your body. Yes, the procedure is keyhole-surgery or laparoscopy and it is rightfully called ‘minor surgery’. It’s perfectly doable, you can go home at the end of the day. So I’m not saying that it’s wrong to have this done.
I am, however, writing this for women who think “I’ll have the Filshie clips now, and if I decide to have a(nother) kid, I’ll just have the reversal”. Be aware that a reversal means they have to remove the clip, the scar tissue around it and however much of the fallopian tube is damaged beyond repair, and that they have to reach for a sewing kit to stitch your tubes back together. It’s a procedure that is done, again, with keyhole-surgery, but in this case apparently it doesn’t feel minor: Women report that it takes 4 to 6 weeks to recover. They push, pull and tug at your insides in an attempt to sew you back together. And the reversal isn’t guaranteed: If you search for the success rate, there is no definitive number. Don’t be fooled by the optimistic “80 to 100 percent!! :D”, because on the same search results page you find that it could be 50/50…
Women can report pain after sterilisation with medical devices. Although some pain right after the procedure is normal, ongoing pain that does not diminish after a week or so, is uncommon. But not impossible. If you are in ongoing pain, it may be best to print these out and share with your healthcare providers.
- Intractable pelvic pain following Filshie clip application
- Chronic Abdominal Pain After Laparoscopic Sterilization Clip Placement
Foreign body inflammatory response
A well-known issue with any type of device or implant, is that the body can try to fight it. Just like with a donor kidney, the body can recognize “Hey, this isn’t me!”.
In a case report titled Migrating Filshie clip: an unmentioned complication of female sterilisation by Emmanuel Kalu, Carolyn Croucher, Ramasamy Chandra, the following can be read:
Controlled studies undertaken in primates have shown that Filshie clips are capable of inducing a foreign body inflammatory response.
The most common symptom seems to be a dull pain.
Another article isn’t about sterilization, but about another procedure involving surgical clips. It’s an article titled Surgical clips: A nidus for foreign body reaction after hepatic resectionand the abstract states:
Although occurrence is rare, foreign body reactions to surgical clips have been reported, especially as a complication of laparoscopic surgery.
Signals of inflammation to be aware of are pain (any, be it dull or sharp and may or may not be linked to your cycle) and bowel troubles. Blood tests may show inflammatory markers. Most of your immune system is in the gut. If you have gut issues, the gut doesn’t have to be the root cause: it can be a symptom of an underlying issue. Listen to your gut.
Apparently, it is well-known in healthcare that any surgical clip can migrate. Any implanted device is not guaranteed to stay at the site where it was inserted. This doesn’t just hold for sterilizations, but to stick with sterilization, here are some examples:
- Essure coils that migrated to the uterus
- Filshie clips that migrated to a bladder, colon or liver
- Clips that the patient caught coming out of their vagina
I love searching for information online. There are actually quite a lot of papers on this. Most of them are case studies. Here are a few:
- Ann Acad Med Singapore — 2008 May;37(5):438–9. Spontaneous vaginal expulsion of a Filshie clip by Kale A, Chong YS.
- Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg MB. Spontaneous Expulsion of Tubal Ligation Clips: A Case Reportby Meriah Fahey, MD, BSc
- Ther Clin Risk Manag. 2014; 10: 963–968. Published online 2014 Nov 17. Risk of Essure microinsert abdominal migration: case report and review of literatureby Giuseppe Ricci, Stefano Restaino, Giovanni Di Lorenzo, Francesco Fanfani, Federica Scrimin, and Francesco P Mangino1
- Article in Gastroentérologie Clinique et Biologique 26(6–7):630–2 · June 2002. Intraperitoneal migration of filshie tubal sterilization clips: An uncommon cause of chronic abdominal pain
- BJOG Volume 111 Issue 12, December 2004, Pages 1322–1332. Failed sterilisation: evidence‐based review and medico‐legal ramifications by Rajesh Varma and Janesh K. Gupta
I won’t bore you with more links to papers, you can find them yourself. I just want to quote something from the last paper for you to read:
It is estimated that over 25% of women will experience a migration of one or more Filshie clips. The tissue between the Filshie clip jaws normally undergoes avascular necrosis and fibrosis, leaving two healed stumps, which tend to separate, permitting clip displacement.
Let me repeat: Over a quarter of us will have a migrated clip floating around in our body! If you have been sterilized with a medical device, and you have any physical illness or discomfort, an investigation is in order on whether the device migrated.
It seems that the most common symptom of a migrated device is pain. This often seems to be a sharp pain, but can also be a dull ache.
Detecting device migration
As if that wasn’t fun enough to realize, there’s something I want to add.
- An ultrasound can often see the fallopian tubes, but the sterilization clips or rings are either not visible because they are of soft material, or if they are metal devices, they show up as a repeated distortion of the image. They do not show up clearly as devices on the fallopian tubes, but rather as a weird stripe/distortion in the general vicinity of the tube. An ultrasound can therefore not determine whether the devices are still where they should be.
- An X-ray can often see the device, but not the fallopian tubes. An X-ray can therefore not determine whether the devices are still where they should be.
- An MRI without contrast either cannot see the device or the device distorts the image, I was told by an MRI tech. An MRI without contrast can therefore often not determine whether the devices are still where they should be. Some people have had success with MRI, as I have seen images of migrated devices. It may depend on the type of MRI scan, as there are several ‘flavors’ of scan. It also depends on the level of detail: On an ‘overview’-MRI, the tubes and devices are simply too small. You’d need an MRI specifically targeted at seeing the tubes.
- I don’t know about an MRI with contrast, but as far as I can find online, I don’t think you have any guarantees on whether or not the clip will show up or distort the scan.
- An HSG can only see the tubes, not the device. It’s a method that exists purely to determine whether the tube is blocked before sperm can reach the ovary. But a blocked tube doesn’t mean the clip is in place: it just means scar tissue has formed where the clip was initially applied. An HSG… you get the gist. Forget it.
Basically, as I understand it: The only thing that would be able to detect whether the devices have or have not migrated, would be a CT scan with contrast dye. Since this involves radiation, most healthcare providers are hesitant to order a CT scan, unless they agree that your symptoms could be due to a migrated device. In other words, in order to determine whether the device has migrated, you need a CT scan, which won’t be ordered unless it’s known that the device has migrated. A chicken-egg problem, which is especially difficult if your X-ray shows the clips somewhere in the vicinity of your tubes…
Imaging techniques made more difficult by metal devices
You should be aware that the clips and other medical devices can actually make all these imaging techniques more difficult to analyze.
Yes, there is this gorgeous question you can find online which says “Can I have an MRI with Filshie clips?” and the lovely answer is “Yes because they are titanium!!! 😀 😀 ”. This is actually a wrong answer. The real answer is: “Well, they’re not magnetic so you can have an MRI done without the clips being pulled from your body, but frankly they’ll mess up the image because they’re still.. you know, made of metal.”
Medical devices made of any metal, including titanium ones, will nearly always distort the image or create an artifact of some sort. The immediate surroundings of the device are therefore more difficult or sometimes even impossible to inspect with imaging techniques.
- on an ultrasound the clip shows up as a repeated visual echo, making what seems like a lot of scratch marks on the image
- on MRI they either don’t show up or they cause a disturbance of some sort, making the direct vicinity of the clip difficult to see
Any type of surgery carries with it the risk of bacterial infection. The scariest one is MRSA, of course, the antibiotic resistant staphylococcus aureus. But it doesn’t have to be MRSA. It can be MSSA, the antibiotic susceptible variant, or any other staphylococcus or streptococcus infection, or even other bacteria. Most of the time, the body can fight off those infections and there’s no need to worry. You have these bacteria on your skin and in your nose, for example, and you’re just fine. Even people carrying MRSA can be perfectly fine. As long as their immune system is strong, it can be kept in check.
The biggest trouble with implants and devices is this: The infection can ‘hide’ under there. The bacteria can take up residence under the clip or implant and it effectively means: your body can’t reach it. Often, these bacteria create what is called ‘biofilm’, a protective layer that the immune system can’t break down. There are many things that are done to avoid bacteria taking up residence on implants and devices: Antibiotics and a coating over the implant to kill off the bacteria are often applied. But still, there’s no guarantee
As mentioned before, the blood vessel running alongside the fallopian tube is often crushed with these procedures. Scar tissue develops around the clip or ring and the area is closed off. If there are bacteria there and they survived, they remain there, encapsulated in scar tissue that has no blood supply: Your immune system can have a hard time getting in there to clean up the bacteria. It could be bacteria that live for weeks and can survive with very little food. Not only that, this can stay ‘silent’ for a long long time. It could be more than a year before a so-called ‘colonization’ changes into an infection. There is a case where an abscess formed in the 10 years since the procedure was done. (“Chronic tuboovarian abscess due to Staphylococcus aureus: a case report and literature review”)
Titanium Filshie clips, used in laparoscopic tubal occlusion for female sterilization, have also been reported to cause local inflammatory reactions and abscess formation.
The odds are so low that you have such a complication, it may take a long time for health care providers to discover that this is the cause.
Signs to look out for that may indicate infection are:
- changes in bowel movements, for example very hard stool or indigestion
- If your infection is encapsulated around the clip (an abscess), you may have a very tight abdomen or hard belly, you won’t feel your bowels move freely (bowels tend to ‘lock up’ and move less). The abscess may be palpable as a lump or thickness.
- fatigue, for example difficulty walking up stairs where you didn’t have this trouble before, or waking up tired
- anxiety peaks with no clear cause or trigger (cortisol increases during infections, which can make you feel on edge or unsafe)
- shortness of breath or shallow breathing especially at night and in the mornings. This is called dyspnea, and it feels like your body is not making (enough of) an effort to breathe.
- when the infection gets worse: loss of appetite and nausea occur and shallow breathing may get worse.
- Blood work may show infection markers and your urine may contain bacteria. But this doesn’t have to be the case.
- You may have a fever. Or you may not.
The classic presentation of a TOA includes abdominal pain, pelvic mass on examination, fever, and leukocytosis. However, Landers and Sweet (1983) found that 35% of women with a TOA were afebrile and 23% had a normal white blood cell count. Furthermore, only 50% of women with a TOA presented with a complaint of fever and chills, 28% with vaginal discharge, 26% with nausea, and 21% with abnormal vaginal bleeding.
Tubo-ovarian Abscess — https://www.ncbi.nlm.nih.gov/books/NBK448125/
Although the chances of this occurring are veerry very small, you should be aware of it before you have any device implanted in you so that you can detect the symptoms and report these to your health care provider.
If you suspect you have an infection related to an implant device, be aware that antibiotics will not be sufficient to resolve this: Bacteria can hide under the device, after all. You will need a surgical intervention.
Something to note is that both cysts and abscesses are fluid filled sacs. An abscess is one filled with bacteria, a cyst is not infected. On an ultrasound, a cyst and an abscess look alike. If you have any symptoms of an infection and your healthcare provider diagnoses you with an ovarian cyst via ultrasound, I urge you to demand 100% certainty that it’s not an abscess.
Titanium, silicone, nickel: Allergies and inflammatory responses
For those of you with any kind of allergy, be it dust mite or lactose, be aware that you can be allergic to the materials used in these devices. Also be aware that the exact materials used in these devices are rarely disclosed. There are some mentions online of there being traces of nickel and copper in the silicone bedding of Filshie clips for example. I have not found a reliable source that confirms or denies this, all I know is that women report that they knew beforehand of their nickel allergy and later found out that there are trace elements of nickel in these devices.
Even if you have no known allergies at the time of the procedure, you could be allergic. It’s never tested before the procedure because it’s so uncommon. Your health care provider may never have heard of it, even. Not only that, allergies can develop at any time in your life: you can become allergic after having the clips placed. Repeated exposure to an allergen can make you allergic, like a beekeeper who develops a life threatening allergy to bee stings after years of keeping bees without any issue.. Even if you’re not allergic of have no inflammatory response, metals can accumulate in your body. That means that by the time your body becomes inflamed/irritated/initiates an allergic response, the response could be anywhere. Again, anecdotes online talk about skin rashes and other responses since having surgical clips. Don’t let your healthcare provider dismiss you if you have this, there is research out there that confirms this.
- Accumulation of aluminium in lamellar bone after implantation of titanium plates, Ti-6Al-4V screws, hydroxyapatite granules
- A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing Breast-conserving therapy
Note that allergies such as nickel, titanium and silicone are difficult to measure. Silicone allergy testing has been discontinued and tests for metal allergies are commonly criticized for having high false positive results. Skin patch testing is one method that doesn’t seem to be discredited, and if you suspect you have developed an allergy to materials in the clips, this method of testing may be your best option. Only in the worst cases can nickel poisoning be proven. It’s a difficult topic.
As with all the previous sections, the odds are very small, but they’re not zero and it’s rather difficult to figure out that this is what is ailing you. Let alone to find a healthcare provider who is willing to take the route of testing you for these sensitivities.
ASIA: Autoimmune Syndrome Induced by Adjuvants
I’ve talked about infections, allergies and foreign body responses. Maybe a recap is a good idea by now:
- Foreign body response: The body detects an object and tries to expel it
- Bacterial infection: A group of bacteria is growing stronger than they should, upsetting the balance of all the bacteria in your body.
- Abscess: A sac of fluid containing a bacterial infection.
- Allergies: The body overreacts to particles, from pollen to peanuts to metal. It treats these particles as an enemy and starts to fight these particles until they’re gone.
Which brings us to autoimmune conditions:
- Autoimmune illness: The body starts thinking that its own tissue is an intruder
There is research that indicates that food can be a trigger of autoimmune disease. I read somewhere that your body can first detect some foods as a threat, and later on it may look at its own tissue and go: “Hey, this stuff looks similar. Let’s fight that too!”
The ASIA syndrome is a rather new (2011) diagnosis. It initially dealt with vaccines that may trigger an autoimmune response. But later, research indicated that silicone breast implants can also trigger autoimmune illness. Which brings us to clips, rings and any other devices.
In one case study, a 23 year old woman developed full-on autoimmune problems, one year after having a nickel-titanium chin implant placed. She received autoimmune treatment with all sorts of medication. Two and a half years later, she decided to remove the implant and returned to good health.
Another paper, titled “Diagnosis and treatment of metal-induced side-effects” discusses not just nickel, but talks about metal implants in general.
In clinical praxis, metal-sensitive patients will present various symptoms ranging from oral mucosal changes and skin disease to excessive fatigue and autoimmune diseases.
Is it highly unlikely that you’ll have a full-blown autoimmune response to tiny implanted devices? Absolutely.
Is it possible? Definitely.
Other gynaecological issues associated with tubal ligation
On the topic of adenomyosis: A paper titled “Adenomyosis with history of bilateral tubal ligation” by Perry Michelle Y. MD and Schlafstein, Barry MD was published in Obstetrics & Gynecology in April 2003. (Volume 101 — Issue 4 — ppg 29)
Conclusions: In patients with histopathologic confirmation of adenomyosis, there does appear to be an association with prior BTL or tubal occlusion.
On the topic of endometriosis: Note that recently, a “bacterial contamination hypothesis” was coined. There is now a suggestion that bacterial infections may be involved when there is endometriosis. Not only that, there is a hint that endometriosis and bacterial infections may be a two-way street.
The most critical question may arise now: “Is this bacterial contamination the effect of endometriosis or the cause of endometriosis?” Based on the authors’ serial experiments, the conclusion is that bacterial contamination in menstrual blood could be the effect of endometriosis and, at the same time, also might develop endometriosis.
From the paper Bacterial contamination hypothesis: a new concept in endometriosisby Khaleque N. Khan, Akira Fujishita, Koichi Hiraki, Michio Kitajima, Masahiro Nakashima, Shinji Fushiki, and Jo Kitawaki.
This may perhaps mean that if you have endometriosis, you are at a higher risk of bacterial infections.
Your personal risk may be higher (or lower)
On the one hand, you can see a complication as ‘bad luck’. And some complications from surgery are just that. Bad luck. However if you have a high ACE score, or PTSD from trauma or struggle with mental health issues, be aware that your risk of illness, including infection, allergies and autoimmune diseases, is higher. Mental health issues can negatively impact your physical health. That includes your immune system, which is at the heart of all of the above.
Not only that, but I think it’s good to realize that if you have a history of trauma, should you be one of the unlucky few with an abscess, infection, allergy or foreign body response, how will you handle it? Will you cope? Will you be able to stay calm? I’ve met one lady was in so so so much pain. She had to endure this for six years, before she found out she had clips inside her which had migrated. And even then, she faced healthcare practitioners who had the audacity to claim it couldn’t be the clips. She had to face them down and ask them: “Can you give me in writing that you are 100% sure my pain is not caused by the clips, that are exactly at the spot where I have pain?” Only then did they relent. Would you be able to endure that?
I’m not saying that you will be the one who has a foreign body response, infection or tremendous pain, but personally I’d have liked someone to tell me this: Don’t look at the odds. Look at what will happen if you happen to be that statistic. It’s not worth it. Trust me on this, my ACE score is 6, I’ve been there and frankly I barely stayed upright… It’s frankly part of why I’m writing this post.
Yuck, what a title, right? Yes, any surgery in your belly has the small risk of damaging your bowels. During surgery, instruments are inserted in your abdomen, that can sometimes nick your bowels.. It’s rare, but if it happens and damage occurs and it is not resolved during the surgery itself, it constitutes a life threatening complication that again requires surgery to resolve.
The difficulty with any health issue is that no two persons will have the exact same symptoms. If that happens, the symptoms you may have may depend on where the damage is (e.g. Small bowel versus colon). The most clear sign is a very very tight and painful abdomen. The pain will in most cases get worse when you move.
Other symptoms you may have: fever, chills, nausea, vomiting. The symptoms may mimic appendicitis. Some symptoms may be confusing, like leg pain or shoulder pain.
Be aware that this complication can surface up to three weeks after surgery, as discussed in Delayed Presentation of a Bowel Bovie Injury After Laparoscopic Ventral Hernia Repair.
Also something to be aware of: there is one case report of a migrated stent (yes those can migrate too) causing a bowel perforation. No reports on tubal ligation devices, but I’m going out on a limb and say that the chances of a bowel perforation from any migrated device are probably not zero.
Your belly button will change due to laparoscopic surgery
You may think “What’s the big deal, woman? So what?”. But like many, I just didn’t know in advance and wish someone had mentioned it. It’s not a big deal, but in hindsight, I liked the way my belly button looked before. During keyhole surgery, they will make an incision in your belly button and later they’ll stitch it up. I used to have a very open, round, symmetrical innie, and you could see the little dot where my umbilical cord was cut at birth. Now, my belly button has erm.. collapsed? You can’t look into it anymore. I’m not bothered by it now (I can’t change it), but I was very surprised after surgery and honestly.. a little bit upset.
So, here it is for y’all out there. Be aware of this.
Easier to get them placed than to get them out
Be aware that any of the above can occur long after a device has been implanted. If you want it removed, you need to (A.) find a professional who believes that your illness stems from the implant and (B.) who is willing to remove it. There are many many stories online of women who report that their obgyn was not open to removing the clips they had placed earlier. And even if you find a health care provider willing to remove the clips, it’s never as easy as taking out an IUD, you (C.) need surgery again. And you’ll be (D.) on a waiting list. Also be aware that your insurance may not cover removal of your medical device.
Also, be aware that as a woman, you are at a higher risk of your health concerns being dismissed. It’s a well-studied and very unfortunate bias.
Not being told that you have clips inside you
I have heard stories of women who insisted they be sterilized without devices, only to find out their doctor used a device after all. Or stories of women who had a procedure to restore their fertility, only to discover years later that the doctor left migrated clips inside of them. Did you know that during gallbladder removal often surgical clips are used as well? They carry the same risk of abscess formation, infection, foreign body responses etcetera. Often patients are not told of these devices implanted in them.
I wish I could say it only happens in America. But it doesn’t. Also here in The Netherlands, there are doctors that will not inform their patients about any kind of surgical clips in the patients’ body after for example gallbladder surgery. It shouldn’t happen, but unfortunately it sometimes does. And not knowing this will make it more difficult to diagnose if you are one of the unlucky few…
I don’t want to make it sound like all of healthcare is a big mess, because there are amazing people out there who are doing brilliant work. The surgical team who removed my clips were awesome.
But if you have any doubt, any doubt whatsoever, a nagging voice in the back of your head or if you are the kind of person who often does not feel safe in the world: You don’t need anyone’s permission to ask your doctor to put in writing that they won’t leave any medical device inside your body. You don’t need anyone’s permission to ask it again on the operating table. You don’t need anyone’s permission to ask again after surgery. You don’t need anyone’s permission to push for answers. You don’t need anyone’s permission to refuse a medical procedure until you find the healthcare provider who you are sure of that they will ensure that you are not in any position you do not want to be in. You don’t need anyone’s permission to make sure that you feel safe.
Some women claim that they have what they call “Post Tubal Ligation Syndrome”. Please be aware that the person who coined this term had her medical license revoked on grounds of “incompetence, gross negligence, dishonesty, false billings and medical records, and repeated acts of clearly excessive use of diagnostic procedures in her care and treatment of six patients.”. The syndrome she coined has no scientific studies backing it.
Some people argue that closing that blood vessel that runs alongside the fallopian tube will result in menopause, because that blood vessel is a supply for the ovary. And if the ovary gets no blood, you go into menopause. There is no scientific evidence for this, because your ovary gets blood supply via a different artery. The artery that runs alongside the fallopian tubes only supplies blood to the tubes themselves, apparently.
Still, some women report early menopause as a side-effect. I can find little information on this. WebMD has an article about it, stating:
One landmark study published in 1976 in the Southern Medical Journalcompared 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.
I think the last bit of advice is very sensible.
Although the symptoms that are commonly listed may resonate with you, you may be doing yourself a huge disservice by mentioning PTLS or any such terms to your healthcare provider. Depending on the person in front of you, your very valid health concerns may be instantly dismissed as soon as you use this term. If you have any health problems that arose in the years after having a medical device implanted, stick to mentioning those health problems and insisting that the cause be found.
What to do
What if you are sick and your gut tells you (literally or figuratively speaking) that it’s a complication from your sterilization? I wished I had had concrete advice, so here is what I would have wanted to know:
- Do not touch the area. Do not massage it. Do not push or pull the area. DO. NOT. TOUCH. IT. Agitation will nearly always make things worse. In case of an infection, agitation will make it worse. An abscess may rupture if you massage/touch the area and then the infection will spread through your body. Inflammation and foreign body responses also don’t get better by moving the tissue around.
- If you have some bowel troubles, are in doubt whether you’re having infection symptoms or are just generally worried about your medical devices, I’d recommend, if you have the means, to have a private ultrasound done. (The reason being you don’t need a referral from your GP and you can circumvent waiting lists.) Ask the obgyn/ultrasound tech specifically to assure you there is no (tubo-ovarian) abscess (TOA). Ask for a report in writing. Explicitly tackling this item will either relieve you to be assured that no abscess is there, or it may make the difference between timely and late intervention.
- Make a list of the symptoms and when they started. Put them in chronological order. You can request a copy of your medical file so that you can refer to earlier doctor’s visits. Do not mention anxiety as a symptom. The confirmation bias for women is that “it’s all in your head”. Stick to the physical symptoms (even though high cortisol is definitly a physical thing.. you know what I mean)
- Make an appointment with your GP. It’s okay to ask for a referral to your own/some other gynaecologist immediately. (If you are concerned or sure you are ill from the medical device, the sooner you are in front of a specialist in this area, the better.)
- In case of severe dyspnea, a visit to the ER is warranted.
- Do not get hung up on whether your body’s symptoms can be measured in a cold, hard number. You can be very sick without having off-the-charts blood tests. (And if it’s not off-the-charts, healthcare providers may shrug and say ‘good enough’. This can especially occur if you have vague symptoms.)
There are better, much much better alternatives
Medical devices are considered safe. They hardly ever cause problems. But the point of this post is to make you aware that if you are one of the unlucky few who have any of the above, you may find yourself in a difficult position exactly because complications are so unlikely. There are alternatives that don’t have the risk of a foreign body response, abscess formation or allergic responses. Bilateral salpingectomy (removal of the fallopian tubes) is now the gold standard. No procedure is without risk, but with a ‘bisalp’ there will be no foreign body placed inside you (for the rest of your life, may I add). Also, research shows that probably ovarian cancer probably starts in the tubes and removal of the tubes apparently lowers your chances of ovarian cancer.
I am not a doctor, so this is solely my personal opinion: think twice before getting any type of medical device implanted in you if there are alternatives available to you. When it comes to birth control, I recommend the pill or an IUD over anything, if your body accepts them, because it’s very very easy to discontinue/remove. Heck, you could remove an IUD yourself, there sure are stories out there… Or your GP could do that in a 10 minute consultation. Then again, IUDs can also migrate into your body by perforating your uterus… but at least in this case there will be no doubt that it’s a complication that needs to be resolved. If your significant other is willing to get a vasectomy, it’s less invasive than female sterilisation and it’s free of hormones or medical devices so that’s a big plus. Do read up on the possible complications of that method as well, though, because unfortunately no surgery is without risk…
So, in short, if you yourself wish to be surgically sterilized, I’d recommend you find a doctor who will do this without implanting a device in you. If you have any doubts, stand up for yourself. It’s your body.