December 20, 2003

WHILE several birth control options are available today, tubal ligation is the contraceptive method of choice for women over the age of thirty in the United States. In Pakistan too, it is the second most popular form of contraception.

In the urban middle class sub-population of Karachi where contraceptive use is at 45 per cent, a study published in International Family Planning Perspectives found tubal ligations to be used by 27 per cent of family planners. Its popularity may be due to the seeming efficiency with which one may with a single surgery prevent future pregnancies. No pills on a daily basis, no diaphragms that need refitting: simply get the tubes tied, cauterized or blocked.

However, the human body is a complicated system with hundreds of factors in interplay with each other. Pulling one out of the show may easily disrupt the delicate balance that keeps us functioning in a state of normal health.

Unfortunately, most women who opt for tubal ligation surgery are not informed of its physical and hormonal side effects known as “post tubal syndrome”.

 

What is it?

The two Fallopian tubes of a woman reach out from the uterus to the two ovaries. When an egg is released from an ovary it travels via a Fallopian tube into the uterus in which a fertilized egg may implant itself and grow. Tubal ligation involves the physical disruption of the Fallopian tubes. This prevents an egg from coming into contact with sperm thus precluding a pregnancy.

The most common method for performing a tubal ligation involves making a loop in the Fallopian tube and tying it off. The loop is then cut off. The material used for the tie is later broken down and absorbed by the body and the two ends of the tube fall apart. Alternately, blocking the Fallopian tubes may avert the contact between sperm and egg.

 

Resulting problems

Women are often misinformed that their ovaries will continue to function normally after a tubal ligation. While this may be true for some women, for most women one or both of their ovaries will fail as a result of becoming isolated from its blood source.

This is known as ovarian isolation or female castration. Should both the ovaries fail, the sudden loss of estrogen in premenopausal woman results in a sudden premature menopause. This hormone shock to the body produces severe hot flashes, chills, vaginal dryness, painful intercourse, loss of sex drive and palpitations.

Hormone shock can unfortunately also affect the brain. Consequently, confusion, depression, rage, and memory loss may also manifest in Post Tubal Ligation syndrome. The Coalition for Post Tubal Women polled 1072 women who had undergone tubal ligations.

The census revealed that about 39 per cent of these women were suggested the use of anti-depressants in their follow up care to the tubal ligation, and 29 per cent had hormone therapy recommended to them.

Furthermore, women who lose the functioning of their ovaries as a result of their removal or from ovarian isolation, are also more at risk for coronary heart disease and osteoporosis. Specifically, these women are seven times more likely to develop heart disease than premenopausal women whose ovaries are intact and functioning.

Informed consent: Post Tubal Syndrome is known by the American College of Obstetricians and Gynecologists (ACOG) and their forty thousand plus obgyn members. However, as a matter of policy of ACOG standards this information is withheld from patients. In the poll mentioned earlier, 96.5 per cent of women stated that they had not been informed prior to the tubal ligation of the possible negative side effects of this surgery or of Post Tubal Syndrome.

Despite the possible side effects of tubal ligations, informed women consent to this surgery. The issue of ethics arises when women choosing this method of contraception are misinformed of the consequences of their choice. It is the withholding of such information that should be considered fraudulent consent.

The good news is that tubal ligation reversal surgeries are available. Under optimal conditions the success rate for a reversal is 70-80 per cent. Short remaining tubes or damage to the tubes as a result of the original ligation lowers the success rate of a reversal. The chance of ectopic pregnancies also increases significantly with rejoined tubes.

At any rate, though a remedy may be available for a misinformed decision, whether the issue is choosing tubal ligation as a method of contraception or any other life choice, it is in the psychological, physical and financial interest of a woman to take upon herself the responsibility of making an informed decision.

The writer is a molecular biologist from Yale University, Connecticut, USA. She writes independently on issues of contemporary interest

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