Other Types Of Tubal Ligation Surgery
As mentioned earlier there is really no reason to have a laparotomy for tubal ligation. A laparotomy, which means cutting into the abdomen, is major surgery as compared to the laparoscopic sterilization. There are significantly more risks with the procedure itself as well as more pain, a longer recovery period and a longer hospitalization. The incision in a laparotomy is four to six inches long.
There is also the minilaparotomy where the incision is smaller, about one or two inches long. This is a big improvement on the laparotomy, but it still requires a somewhat longer recovery period with more pain and cramping. However, this may be the only type of procedure available in smaller centers, and for this reason it can be very useful, especially in regions far from a major center.
Research is under way for a much less invasive operation, using a lighted tube (hysteroscope) with a video camera attached, that is inserted through the cervix and involves no cutting. One possibility being explored is the insertion of a nylon plug with a coil at each end into the tubes. These plugs can later be removed. This operation, when available, will require a skilled and experienced surgeon.
Long-term complications of tubal ligation have not been fully studied. Some women experience heavier menstrual periods and increased menstrual pain following a tubal ligation. This can lead to repeated D-and-C's and an increased risk of hysterectomy. One study found that tubal ligation leads to a higher incidence of hysterectomy for women who were in their 20's when their tubes were tied.
The reason for menstrual complications are not understood, but they could be the result of interference with blood supply to the ovary during the operation, which then alters hormonal blood levels.
One English study showed that there was an incidence of painful periods following tubal ligation of 39 to 49 percent. Another study of 200 women two years after tubal ligation showed that 34 percent had longer periods, 32 percent had heavier periods and 20 percent had shorter or lighter periods. Of the women reporting problems, most had previously been on the pill.
For women who have been on the pill, a heavier flow can be expected because the pill normally decreases menstrual flow.
After tubal ligation scar tissue can form in the pelvic area. These bands of fibrous tissue known as "adhesions" can cause recurrent abdominal pain, which is difficult to treat.
Tubal Ligation And Premature Menopause
While practising obstetrics in the Melbourne area, Dr. John Cattanach began to notice "a disturbingly large number of young women" being admitted to hospital for hysterectomy. The usual reason given for the hysterectomy was heavy menstrual bleeding appearing several years after tubal ligation.
"Unlike abnormal uterine bleeding from other causes, the post-tubal ligation form usually failed to respond to progesterone therapy. It was also observed that many seemed to develop early estrogen deficiency [menopausal] symptoms within about four years of tubal ligation. Low grade arthritic and ligamentous symptoms and signs, particularly referable to the lumbar spine and shoulders, were observed, together with early atrophic vagina [dry vagina], skin deterioration, and complaints about loss of libido [sex drive]." (Medical Journal of Australia, March 3/84).
In 1988, Dr. John Cattanach studied the hormone levels of 112 women who had undergone tubal ligation at least two years previously. He found that women who had been sterilized by tying, burning or clipping their tubes had a 40 percent lower production of estrogen and a 20 percent lower production of progesterone than women who had been using natural methods of birth control (Medical Post, Feb 14/89).
Problems reported by women in the Australian study following tubal ligation included heavy menstrual bleeding, pain in the low back, shoulders, elbows and knees, gastritis, irritable bowel syndrome, urinary problems, excessive growth of breast tissue, heart and blood vessel problems, as well as psychological problems.
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