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Tubal ligation does not cause early menopause: beware the hormone “experts”

Hormones are peddled by many practitioners as well as by the Goddess of estrogen herself, Suzanne Somers, as the fountain of youth. However, if hormones were actually proven to be that wonderful/amazing/effective/risk-free via evidence based medicine, well, uh, everyone would be dishing them out like candy. While there definitely are specific instances where hormone replacement therapy can be beneficial, they are not a panacea for every symptom and like every medication the risk-benefit ratio must be balanced for each individual.

From time to time I see links and tweets from hormone “experts” and one recently caught my eye: the claim that a tubal ligation causes premature lowering of hormones. The corollary being, “If you have had a tubal ligation and feel depressed/tired/have low libido/are gaining weight/not sleeping well then do I have a cure for you!”

I have a pretty good memory and in all my years of gynaecology (22 if you count residency) I don’t think I’ve ever heard convincing evidence that a tubal ligation causes early menopause. I knew at one point people wondered if cutting/burning the Fallopian tube (which includes cutting/burning the blood vessels that run with it) might affect blood flow to the ovary, possibly affecting the development of follicles (the eggs), the source of estrogen and progesterone. However, this proposed mechanism just didn’t seem biologically plausible as blood vessels from the ovary (and the uterus) supply the Fallopian tubes, not the other way around. While the uterine artery does connect with the ovarian artery and therefore might contribute some blood flow to the ovary, the ovary gets most of its blood from the ovarian arteries, which come off the aorta (or the renal artery). Regardless, neither the ovarian nor the uterine arteries are in the surgical field for a tubal ligation.

For good measure, I took a quick hop, skip, and a jump over to PubMed. In no time at all I had three good articles on hormone levels and tubal ligation. The studies evaluated cycle length and regularity as well as hormone levels. One study, part of the Penn Study of Ovarian Aging (Nelson DB et al, Contraception 2005;71), a well-done prospective study was especially interesting as half the women had their tubal ligation 15 years or more before enrollment. This study also evaluated menopausal symptoms in addition to hormone levels over a four year period of time.

The verdict: bilateral tubal ligation has no effect on the following sex hormone levels: estrogen, progesterone, FSH, LH, testosterone, DHEAS, and Inhibin. In addition, a bilateral tubal ligation has no effect on timing or severity of menopausal symptoms.

So add, “Your tubal ligation is affecting your hormone levels” to the caravan of hormonal snake oil along with salivary hormone testing and the hCG diet. I’ve already reviewed the hCG diet (24 studies say hCG adds nothing to your weight loss efforts), but I’ll save the nonsense that is salivary hormone testing for another post.

References:

Nelson DB et al. Tubal ligation does not affect hormonal changes during the early menopausal transition. Contraception 2005;71.

Dede FS et al. Changes in menstrual pattern and ovarian function following bipolar electrocauterization of the fallopian tubes for voluntary surgical contraception. Contraception 2006;73.

Harlow BL et al. Does tubal sterilization influence the subsequent risk of menorrhagia or dysmenorrhea? Fertility and Sterility 2002;77.

 

 

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26 thoughts on “Tubal ligation does not cause early menopause: beware the hormone “experts”

  1. I wish it did cause an early menopause, I am so sick of my period and also a tiny bit paranoid that my tubal will fail and I will get pregnant again.

    Posted by Awesomemom | June 7, 2012, 7:56 am
  2. So when a hysterectomy is done, I’m assuming that the tubes removed with the uterus? And are there supposed to be any hormonal consequences? I have definitely been experiencing symptoms of menopause lately – must have been that hysterectomy I had 20 years ago….

    Posted by Theo Bromine | June 7, 2012, 11:37 am
  3. Thank you AwesomeMom, I totally agree. I don’t have children and don’t want to ever, yet was turned away from getting a tubal because of my “young” age (at that time, mid-20s) and because I had no children (if I had at least one child, they would have done it, which makes no sense, as I can afford ZERO children). I haven’t tried recently, because it’s major surgery and not to be considered lightly. That said, tubals should be more available to more women and any woman who wants one, regardless of her age, should be willing to get one. I was willing to sign 1,001 documents saying I would not sue anyone for “changing my mind” down the line because I’m never going to change my mind down the line…I don’t want children, and I’ve known this for many years, and people make me feel like less of a woman about this. However, if a man was as sure as I am that he didn’t want kids, I’m sure people wouldn’t think of him as less of a man. There are many double standards in our society surrounding reproduction.

    I think in the media there’s this kind of silence about periods, that they’re not a painful hassle that people have to schedule their lives around–at least for me and other people I know. I’m sure some women are not affected at all by them, and frankly science should be studying them (their bodies, blood, hormones, diet, etc) to find out why they don’t have bad periods and the rest of us do…to help the rest of us. But I’m afraid very little research is being done on this, which is a shame, because if men got periods, you know there’d be a “cure” or better treatment of menstrual problems than there already is. Instead, because science is male-dominated, there is much silence about women’s illnesses…silence that ruins our quality of life.

    I’m very wary of hormones (birth control) as a way to control heavy bleeding. I was put on them and they pushed me over the edge in making my gallbladder stop working, and I needed emergency surgery. I think birth control pills are a sh-tty way of regulating hormones, especially for someone who has/had PCOS, as I did at the time.

    Today, I don’t have a gallbladder, and I don’t think that’s healthy, and its removal could have been avoided had I had better doctors and better guidance. This is why I don’t think birth control pills are a good solution for menstrual issues. I still have very heavy periods today, and encounter a lot of @ss-backwards thinking about it and still get told to consider birth control pills…uh, no. So I suffer, and how I wish, too, like AwesomeMom, that tubals brought early menopause. I’d give my (left) arm for early menopause.

    Also, I would advise women to get a hemotological evaluation about their heavy periods; I have 2 blood factor deficiencies, though taking vitamin K during my period has not helped things for me personally, perhaps this information might help another woman (under her dr’s guidance, of course). I need to follow up on this, but life is getting in the way a bit, as I have even worse health issues than a heavy period, if you can imagine.

    Takeaway: Misconceptions about tubals need to be put in their places, because for a lot of women, it’s a good, permanent choice to prevent pregnancy that should be a LOT more accessible than it currently is. That would be good public policy, and we need to fight for this, and change the perceptions of chosen childlessness in the media. I would never want to subject a child to the poverty I endured growing up. And you know what? If I ever got sterilized and then miraculously changed my mind about wanting children in my life (not going to happen, but let’s say for argument’s sake), I would adopt. It’s not essential for my DNA to go on-I’m not that selfish or shortsighted, in a world of 7+ billion people, many of whom live on under $2 a day and are starving for love and literally starving.

    Posted by HappilyChildless | June 7, 2012, 2:44 pm
    • Have you considered endometrial ablation?

      The endometrium is thermally removed. Your periods will lighten.

      If you were to combine that with a copper IUD – no babies for you!

      Also, have you tried metformin for your PCOS? It can. really help with insulin resistance.

      good luck!

      Posted by boostick | June 8, 2012, 10:46 am
    • happilychildless – I say “AMEN” to you sister!!! I Love my three kids….do not get me wrong or judge me… but I never wanted kids, I was just young and stupid. My brother has multiple children by multiple women and and I seem to be the only one calling that “nastey and trampish” now, had all three my kids been from seperate men, I would be a nastey whore!!
      I agree with you on the male-driven world, men could not handle even an ounce of the crap we get put through during cycles, during child birth, menopause…you name it the list could go on!!

      Enjoy being free without children and let know one belittle you for the choice you made!!

      Posted by Connie | June 27, 2012, 3:32 pm
    • I am a mother of 5 boys, had a tubal ligation after number 4, ever since my life has been a living hell, I don’t know if its hormones or lack of blood flow but my life stopped, I have been existing not living, no quality of life at all. Please research post tubal ligation syndrome before making your decion, I know it dosent affect everyone but it does some & I am one of those, after years (13) of searching I just came upon this myself. Don’t take the symptoms lightly it ruins not only your life but your kids. It is like being imprisoned in your body and no answers or cures.

      Posted by Michelle | November 6, 2012, 7:45 pm
    • To happily childless all the other women tubals are not the answer either. If you could feel the physical struggle that I face every single day you would not go down this track, you all might read this & think I am a sook but my life did a complete 360 after my TL, I’m no sook I was in a 10 year abusive relationship survived that now this. I went from exercising everyday dropping weight off easily ( this is just a short story of my reality), to fighting myself to get out of bed, no matter how hard I try to exercise & lose weight I can not get under 100kgs, I can’t even manage 3 hours of exercise a week, I feel like I’m 80 years old & like I’m dragging around 300kgs, I’m exhausted all the time, I have to wach every piece of food I put in my mouth, is it going to make me shake, give me palpitations or an anxiety attack. Headaches, cysts on my ovaries only in my 5th pregnancy after my TL no cysts before then. Weak nerves like they are going to collapse, food allergies & or tolerances, anxiety attacks from hair color. Bad memory, eye problems, hair problems, feeling disconnected from everyone, you don’t feel a woman the list continues. It’s not something trivial.

      Posted by Michelle | November 6, 2012, 8:56 pm
  4. Pffft, if only that were the case I could have gotten this peri-menopause crap done long ago. The reluctance to give a woman a tubal ligation just blows me away. When I was in the hospital with preeclampsia before the emergency c-section the doctor (same practice, not my doctor) kept repeatedly asking me if I was sure. I had already been in the hospital for three days trying not to die and I was 46 — really? Do you not think I hadn’t considered it, or talked to my husband about it, or was mature enough to understand the implications, or that I really didn’t want to try to die again?

    And now this kind of crap?! I swear these idiots are just determined to see women die in childbirth. The hate just makes my head spin. I know this is really about making money off of fearful, ignorant people but it just adds fuel to the fire.

    Posted by lorimakesquilts | June 8, 2012, 7:40 am
  5. I am having my tubes tied at the end of August and have almost cancelled it several times because of the horrors I have read on the internet about “PTLS”. As a logical person, I am telling myself that crimping the tubes shouldn’t damage the ovaries, but at the same time I keep thinking “all these people with PTLS can’t be wrong, can they?”. I really wonder how many of the “PTLS” cases are people coming off of hormonal birth control and have forgotten what a “real” cycle is like.

    I am just thankful that you posted this. it really does give me some hope! I am only 26 and I did not want to start menopause this early.

    Posted by CC | July 31, 2012, 12:37 pm
  6. It’s been 30 years since I had a tubal that changed my life forever. I believe it does not mean everyone will be thrown into menopause but in my case it did. At that time I got no support because it wasn’t believed to be true. Finally an internalist checked my hormones and discovered my low estrogen. At that time hormones were so feared I didn’t know what to do so I didn’t get treatment for a while. It’s been hard to know what is right when it comes to treatment because there is so much disagreement in the field. I recently had a hysterectomy, it’s been hard.

    Posted by Jo | August 9, 2012, 11:20 am
  7. Then what is your explanation for/to women who *do* experience the signs and symptoms of perimenopause after a tubal ligation?

    Is it just a grand coincidence that countless women have this procedure done and then subsequently begin to experience weight gain, depression, mood swings, hot flashes, night sweats – all symptoms of hormone imbalance?

    I’ve done a little bit of “arm chair” research, and haven’t run across anything conclusive one way or the other. However, when women who have had tubal ligations complain of these symptoms, there has to be a reason.

    Posted by Magnolia Miller | August 16, 2012, 5:37 am
  8. I AM 30 YEARS OLD AND HAD A TUBAL LIGATION 4 YEARS AGO, I HAVE HAVE BEEN INVESTIGATED FOR ONGOING SYMTOMS NOT USUAL FOR ME AND HAVE BEEN TOLD I AM PRE- MENAPAUSAL. I WAS NOT ON THE PILL PRIOR TO MY PROCEDURE OR ON ANY HORMONAL TREATMENT. I HAVE BEEN TOLD THAT MY ONLY OPTIONS ARE A REVERSAL WHICH IS UNLIKELY AS MY TUBES WHERE BURNED, A HYSTERECTOMY WHICH IS UNLIKELY BECAUSE OF MY AGE OR TO GO ON THE PILL AND ANTI DEPRESEANT UNTIL I GO THROUGH NATURAL MENAPAUSE. THANKYOU MEDICAL WORLD YOU GIVE WOMAN LIKE MYSELF SO MUCH TO LOOK FORWARD TO…NOT

    Posted by s foley | August 28, 2012, 4:05 am
    • Personally I think if your having trouble now a hysterectomy would be just as bad or worse, I am fighting now to have a reversal, I’m 45 my tubes were burnt also, if there is enough tube left they can be rejoined so I’ve read, google PTLS please b4 you do anything. I would probably go with a mirena after having my tubes reversed even tho the also have hormones it still seems to be the best from ppl I know & have read about it.

      Posted by PTLS | August 29, 2012, 3:45 am
    • Hi, I did read it is still possible to have a reversal after your tubes have been burned as long as there is enough tube to reach, I am the same. My tubal is slowly killing me.

      Posted by Michelle | November 6, 2012, 7:54 pm
    • I’m having the exact same issues!!! Gonna be 31 in October. My mother in law who’s a nurse says there’s no way I can be peri menopausal but that’s what the doc told me!!!

      Posted by Not even 31 | July 19, 2013, 12:36 pm
  9. Well I am definately no doctor, but for the past 13 years after having my 5th child, (whom by the way was born after my Tubal Ligation I had in 1999), I have been back & back to my doctor for answers to why all of a sudden at the age 33 it is like my body had decided to attack itself and start to break down & even make me feel like it was dying. After numerous and many tests of which nearly all have come back clear except the same thing low iron regularly & high estrogen, all this after my TL, I CAN’T lose weight & keep it off & exercise is extremely hard fighting my body to exercise & shortness of breath, I am stiff & inflexible as total opposite to before my TL. I actually was doing karate b4 I got pregnant dropping weight easily & keeping it off, I continued whilst pregnant but struggling, but just assumed it was the pregnancy. After giving birth that’s when things started happening, when the doctor had no answers for me I just assumed because I had been pretty fit had cut out sugar, milk, bread etc I must have damaged my body or something. Everythie been through since is too much to write, buy you women who doubt I suggest you really research having your tubes done, no test tells the doc what is wrong with me but everything I have read about PTLS proves to me that is my problem, some women may not be affected but to those women who are like myself it steals your life I have lived less than half a life for the past 13 years. What has made it worse was not knowing until a few weeks ago, its like having a major disease you know there’s a problem with your body but no one can help you. Read the symptoms of PTLS its real, it takes your life & ruins your family & quality of life, I medically can’t tell you why but I am living it, & I hate it, I want to be normal be able to go for a long walk, bounce out of bed, look in the mirror & think I actually look like & feel like a woman, surely we have the right to a wholesome & healthy life with no depression or obesity or wondering if you can actually get through the day ok.

    Posted by PTLS | August 29, 2012, 3:28 am
  10. It’s so interesting to me that the medical community is so unwilling to even look at this. While it would be medically irresponsible to say that tubal ligations DO cause early menopause without further large scale studies into this area–which are desperately needed, by the way–it seems equally irresponsible to say that tubal ligations absolutely DO NOT cause early menopause, given the absence of large scale studies looking specifically into this area.

    Obviously, many women do fine after having a tubal ligation. That does not mean, however, that there is “no relationship” between tubal ligations and the myriad of symptoms that many other women experience.

    It would seem to be a big coincidence that there are a whole lot of women reporting the same symptoms in the years following their tubal ligations. They aren’t all just coming off birth control, they aren’t all nearing the age of natural menopause, and they aren’t all just coincidentally dealing with identical symptoms that they didn’t have before their tubal ligation.

    It’s commonly known and reported that tubal ligations are correlated with a reduced incidence of ovarian cancer. Why is that? Doctors seem pretty ok with saying “We don’t know why it is, but there is a correlation”.

    Huh. Seems kind of odd if there is NO connection between the tubes and ovaries.

    Other studies do show a correlation between menstrual irregularities, early menopause, and tubal ligations. Does that mean tubal ligations cause these issues? No. But obviously it means there is a relationship.

    Medicine did not get to be where it is today because everyone accepted the status quo. When confronted with something that more than a few people are reporting, that seems to be correlated with a specific issue, illness, or procedure, isn’t it the medical community’s job to say “Hey, we don’t really understand this, and it really doesn’t even make sense to us on the the surface, but it seems like something could be going on. Let’s look at it further”.

    I guess it’s easier to tell women that it’s all in their heads.

    Posted by Maryr | October 5, 2012, 11:56 am
  11. I had a tubal ligation in September or 1999 after my 5th child. Everything has been fine as far as I knew.I have been experiencing alot of perimenopausal symptoms. Irregular periods, headaches,hot flashes trouble sleeping, irritablity, heart palpatations and pounding heart (which sucks) and more. I am 36 and I have been to the doctor over the summer and I had an episode in June when I thought I was having a heart attack. Chest pain,shortness of breath, palpatations and just a feeling of impending doom. Over a series of tests, the doctor deemed it to be anxiety. But now Im thinking that it could be perimenopause. My mother had menopause in her 50′s. I thought you were suppose to be paterned from your mother when it comes to menopause but she didn’t have a tubal. I always heard that a tubal could cause early menopause. Maybe not as a rule but i think its absolutely possible. If this is what menopause is then I want to go through it when Im young and get it over with!

    Posted by Amy | November 13, 2012, 3:31 pm
  12. I am 43, have two children (had them at age 36 and 38) and had a tubal ligation at 41.5 years old. I have had no change in my cycles at all and continue to have the same problems that began at 11 years old – dysmenorhea (severe first day cramping, akin to 8/9cm dilation in labour – fortunately it’s better since childbirth though, meaning I can control it with Naproxen before it gets out of hand). So nothing had changed for me that I can see hormonally in the past 2.5 years since the TL.
    However every woman and every body is different. We can’t rule out that hormonal changes are possible after any kind of surgery/procedures with our bodies. And I say this coming from the perspective of having dysmenorrhea all of my life and being told that it is normal.
    We all have to make our own choices in the end and deal with the consequences. I had my tubal 1) to avoid further hormonal birth control, 2) my husband was not a candidate for a vasectomy due to past surgeries and complications 3) my mother’s bout with breast cancer and heart disease on both sides of my family.
    Every month though I toss around my risk factors for going back ON hormones to control my very uncomfortable, heavy periods and annoying (not debilitating) pms. I try to console myself though with the fact that I only have 7 – 10? maybe years left of periods.
    The tubal ligation, for me, gave me wonderful freedom from worrying about birth control. Even now, if things get really out of hand I can probably look into endometrial ablation – not that I’m hankering for more surgery mind you but I hate having to live my life around my periods, esp. with two active little boys.
    Good luck to all of you.

    Posted by midlifemom | December 12, 2012, 11:52 am
  13. I know I’m an oddball here in age, but I am a 22yr old with 2 children and 2 miscarriages, who decided I didn’t want to miscarry ever again. Hormonal birth control sent me to the psych ward (loestrin->switch to IUD-> prozac->hospital) when I previously had no severe issues psychologically. So, I decided a copper IUD would work. While I was debating the switch, my original IUD rejected. That’s good though, because I’m apparently allergic to all kinds of things, including the metal. Allergy testing records saved me there.
    Maybe it’s too much trouble for my age, but I brought it up and my doctor agreed he didn’t know what else to do. I am a happily married woman working on a degree in child development and family studies, so I felt strong in my choice. (Side note: both of my children were conceived via different birth control methods- condom+spermicide and the depo shot. The miscarriages were from no protection, ironically). I got a tubal ligation (bands, not clamps, no cutting) in April of 2012.
    The next six months were living hell. I had every symptom imaginable of PMDD, and every moth it got worse. It seemed to climax around my menses, with migraines during ovulation that warned me of the impending chaos. For 2 weeks of every month I was a bear, immobile unless popping midol like candy, and utterly hating my body for “trying to kill me”. I eventually broke down in front of my husband because I was uninsured and trying to hold on until his insurance kicked in, but I couldn’t wait…and he switched jobs. He didn’t know how bad it was or he would’ve waited it out. (There’s a hint in that: ladies, let your partners know what kind of struggles you’re going through, physical or otherwise.)
    My OBGYN was glad to schedule a “6 month checkup”. I called back because I literally couldn’t move for 30 minutes, and it scared me. Rushed to the front of the line, they found that I needed “preventative emergency surgery”, which is a nice way of saying my uterus was the size of a grapefruit and as dense as he’d ever seen, with the potential of becoming an emergency within the next few months. I got it taken out the next week, Halloween weekend, opting for “elective” surgery because I really didn’t care if it was the tubal or doctor’s fault or not. I just wanted the pain to stop.
    They removed my uterus and cervix at 22. I am the youngest hysterectomy in my state.
    And thank God they did! I recovered in record time and the only thing I have to deal with is a monthly migraine (like today, which is why I’m online searching for relief). If the headaches are all I have now, I’d have a hysterectomy repeatedly to avoid the pain of an attacking uterus with adenomyosis and endometriosis and God knows what else.
    I hope this helps someone. I just want to share my story. You can conclude whatever you will. But if I knew it would end like this, I’d stay away from my ovaries and fallopians and just take out the womb. That’s not conventional, but it happened anyway. The recovery from tubal ligation was worse than my LAVH.

    Posted by freefromwomb | January 21, 2013, 8:10 pm
    • P.S.
      I case anyone wants to question birth control as a cause for my mishap, my hormonal BC stopped 4 months prior to my tubal, which in most cases is considered ample time to “even out”.

      Posted by freefromwomb | January 21, 2013, 8:18 pm
  14. I am 36 I had a TL 3 years ago…and it will go down as the day my life ended!! I live in constant pain…no sex drive AT ALL…depression …anxiety…shortness if breath…heart palputations..night sweats….pain in all my joints…the list goes on and on!! My life is over…Drs think I am crazy..but I do not need xanax i do not need prozac…I have never had these issues prior to that god forsaken surgery. So to the oh so smart Dr who wrote this articel why dont you tell my family that the TOTAL change in there mother and wife was all a coincidence that it all started right after my tubal ligation!! obviously you are a man and have no clue!

    Posted by Alisoon | February 19, 2013, 1:03 pm
  15. Too many women of different ages, different backgrounds, different reproductive histories all reporting the same experiences after having a tubal ligation for the medical community to ignore.

    Maybe some women gynecologists can have their tubes tied and experience this first hand. Maybe then they will stop shrugging us off.

    I had a TL when I was 39. From the very first period afterwards, I knew something had changed. Hellish periods coming every 3 weeks, weight gain, estrogen deficiency…. I could not afford to get it reversed and now that I could, I’m too old for anyone to consider doing that. I am 47 and am on estrogen, progesterone and Wellbutrin. Did not require these things before. My mom did not go through menopause until she was 10 years older than I am now. I’ve been on replacement hormones for several years, with no end in sight that I am aware of. Am I going to end up with breast cancer or some other fatal disease as a result of trying to lead a normal life after a tubal ligation? I would advise anyone considering this surgery to change their mind. I wish I had.

    Posted by Betsy K | March 17, 2013, 9:03 pm
  16. Thank you for that information. I’m looking into permenant sterilization. I’m currently on Mirana and have read stories of woman who feel that Mirana has caused them to go into early menopause. Is this true? I do not care for any of the side effects I have experience but this one worries me quit a bit. Thank you

    Posted by Jrp | March 21, 2013, 9:51 pm
  17. If it doesn’t affect hormones then why is my period so different now and what’s with the heart palpitations ?

    Posted by Angel | June 28, 2013, 11:47 pm

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