In principle, sterilization by removing/occluding/blocking/cutting the tubes won't impact the ovaries, and thus won't impact hormone levels. The ovaries will remain intact. They have their own blood...
What are the side effects of sterilization? How does it affect hormones and periods?
[...] sterilization by removing/occluding/blocking/cutting the tubes won’t impact the ovaries, and thus won’t impact hormone levels. The ovaries will remain intact. They have their own blood supply, so blood flow to the ovaries won’t be interrupted...
Many individuals seeking sterilization are concerned about risks and possible complications of laparoscopic sterilization surgery, especially given that it is elective (i.e. medically unnecessary)....
What are the risks of sterilization? Isn't it a medically unnecessary surgery?
Complications are very rare, but they can occur. It is important to weigh the risks of sterilization surgery against the risks of long-term hormonal birth control use...
Bilateral salpingectomy is now considered the standard of care over tubal ligation. The standard procedure for a bilateral salpingectomy is to remove the entire visible tubes, leaving behind only the...
Essure banned from sale in most countries
Essure is a non-surgical sterilization method performed hysteroscopically by inserting coils into the fallopian tubes. However, Essure will no longer be sold in the US after the end of 2018 and has been banned from sale in most other countries around the world...
Concerned about PTLS? What are the side effects of sterilization? How does it affect hormones and periods?
In principle, sterilization by removing or occluding/blocking/cutting the tubes won't impact the ovaries, and thus won't impact hormone levels. The ovaries will remain intact. They have their own blood supply, so blood flow to the ovaries won't be interrupted.
An Analogy: A tubal ligation or bilateral salpingectomy is like unplugging a video cable that runs between your computer and your monitor. Your computer and your monitor will still retain their individual power supplies, just as your ovaries and your uterus will still retain their own blood supplies. But the image will no longer be able to get from your computer to your monitor, just like your eggs can no longer get from your ovaries to your uterus. Unplugging a video cable will not cause your system to shut down, just like removing or severing the tubes will not cause your ovaries to shut down.
Article from gynecologist Dr. Jen Gunter about the myth of "Post Tubal Ligation Syndrome"
Here are some references showing hormone levels, blood flow to the ovaries, and menstruation are not affected by sterilization.
Hormone levels and blood flow to the ovaries are not affected by sterilization:
"5-year follow-up study suggests that there is neither an accelerated decline of ovarian follicular reserve nor ovarian dysfunction after tubal sterilization" (2003)
"Tubal ligation does not affect hormonal changes during the early menopausal transition." (2005) - "134 women reporting a BTL were compared throughout the course of a 4-year follow-up study to 172 women without a BTL."
"There were no significant hormonal changes in sterilized women over a period of 2 years when compared with their baseline levels or when compared with unsterilized age-matched controls." (2006)
"There was no significant difference in AMH, AFC or FSH in women with a history of salpingectomy compared to women without surgery." "Neither salpingectomy nor cystectomy for cysts other than endometrioma has appreciable effects on ovarian reserve." (2016) - Subjects in this study underwent a variety of procedures; not all were for sterilization
"Even when the surgical excision includes the removal of the mesosalpinx, salpingectomy does not damage the ovarian reserve." (2015)
"Use of a hormonal contraceptive method prior to TL was significantly associated with a postoperative increase in AMH. [...] This study suggests that ovarian reserve is not altered by TL." (2013)
"non-significant change in the current ovarian reserve markers, especially in the AMH levels." (2013)
no decrease in ovarian blood supply at 12 months post-sterilization (2006)
"Ovarian function and vascular resistance do not seem to be affected by laparoscopic bipolar tubal coagulation" at one year post-sterilization (2004)
"6-month postoperative follow-up of groups that had undergone different TS methods showed no difference in uterine or ovarian artery blood flow rates or ovarian hormone secretion" (2004)
"no statistically significant difference in the serum FSH, LH and estradiol levels in preoperative and postoperative assessments" (2006)
"There were no statistically significant changes in serum levels of ovarian hormones after laparoscopic tubal ligation" (2001)
"Doppler flow studies of the ovarian stromal arteries showed that there were no significant differences before and after tubal ligation" (2004)
"Sterilization by salpingectomy appears to be as safe as tubal ligation regarding operative complications and subsequent ovarian reserve." (2017) - the purpose of this study is only to "compare short-term ovarian reserve and operative complications in cases of salpingectomy and tubal ligation"
Menstrual abnormalities are no different after sterilization:
"Women who have undergone tubal sterilization are no more likely than other women to have menstrual abnormalities." (2000) - 9514 subjects with TL
"Menstrual abnormalities were not significantly different between the case and control groups" (2005)
"The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding." (2012)
The effect of tubal sterilization on ovarian function (1994) This study from Germany had the following conclusions:
1) Menstrual disturbances, climacteric symptoms after tubal sterilisation during perimenopause do not occur more frequently than in a comparative group of the same age.
2) In comparison with a group of women with no surgical history, neither did cycle anomalies and ovarian deficiency symptoms in terms of climacteric complaints occur earlier, nor did early onset of menopause take place more often in this examined group of sterilised women.
Cycle anomalies, ovarian deficiency symptoms, and early menopause were just as likely as in non-sterilized subjects.
3) Hormone analysis could not establish any significant differences between both groups in respect of endocrinological parameters in the perimenopause.
In perimenopause, hormones are the same between sterilized and non-sterilized subjects.
So, why do some people experience symptoms?
They had complications during surgery (very rare, but not impossible) and are experiencing symptoms related to that
They stopped hormonal birth control for the first time in years (or even decades) and are reacclimating to their normal cycle
In the case of postpartum sterilizations, they just gave birth and are experiencing effects/impacts related to that
In other words, the symptoms are real, but the cause is misattributed.
A note on the scientific method:
The studies referenced above confirm the null hypothesis. However, fundamentally, it is not up to medical researchers to prove that PTLS doesn't exist. The onus is on people who claim PTLS exists to provide scientific evidence for their claims.
Do not assume the alternate hypothesis - that PTLS exists, hormone levels change after sterilization, sterilization limits blood flow to the ovaries, sterilization leads to increased menstrual abnormalities, etc.; and expect the null hypothesis - that these effects are not observed - to be proven by experiment. This is the opposite of how the scientific method works.
I understand some of the studies here are old, sample sizes tend to be small, and usually patients are not followed for years afterward (it's very expensive to conduct cohort studies of that nature; the CREST studies are the last major cohort study for sterilization AFAIK). But there is a lack of studies showing that sterilization negatively impacts hormone levels, blood flow to the ovaries, periods, cycles, etc. As old and small as these studies are, it's better than the utter lack of evidence showing PTLS exists.
Ten years post-tubal: no side effects, no regrets, and definitely no babies!
This is a personal contribution from a mod of this website. Want to share your story? Please contact us!
I've now been sterile longer than I was fertile.
No "side effects" and no "clock" - just two tiny scars
First things first, I have no remaining signs of the procedure except for two tiny scars - one near my belly button and one near my pubic hairline. I have to look very closely to see them; I wouldn't be able to find them if I didn't already know. I believe some use vitamin E oil to reduce the appearance of scars, but I actually wish they were more visible and didn't want them to fade to begin with!
Everything feels absolutely identical before and after the surgery - I've had no changes in hormone levels, energy levels, menstrual patterns, sex drive, etc. and I have not experienced post-op pain beyond the initial recovery period. Scientifically speaking, there are no hormonal changes or menstrual changes associated with tubal sterilization!
After surgery, I was back at work 4 days later and I will never look back.
(And as expected, no biological clock has "gone off". Nor is it "ticking".)
Relationships
I met my SO about a year after my surgery and we've never looked back. We are marriagefree and in a stable relationship, which was "supposed" to make me want kids, but of course, it hasn't. My SO is a fencesitter - he could take or leave parenthood...at least that's how he felt when we met 9 years ago. Now, he's come off the fence and is even pursuing a vasectomy.
Together, we've lived in 3 different cities in 2 states (US), held several jobs between the two of us, bought and sold a house, and we're well on our way to early retirement. None of this has made us want kids.
In online childfree communities, we often hear from members who date fencesitters, only to find, years later, that the fencesitter either secretly wanted kids all along or finally came off the fence on the side of having children. Being sterilized has brought clarity to our relationship from the start: my SO has always known not only that I am childfree, but that I'm very sure about it. There is no "wiggle room"!
Family
Several years ago, my brother married his wife and a few years after that, they had their first child, a daughter. Her sister followed a couple years later. When I was younger, everyone told me, "When you hold your niece/nephew for the first time, you will want kids." When my sister-in-law was pregnant, my family told me, The first time you hold [niece] in your arms, you'll want your own. You'll crave children. I never wanted kids until my sibling had one. Your body will beg you for a child when it sees one related to you. and so on.
For a moment, I let them get to my head. I'd never had experience with a baby who was related to me. As a teen, I'd babysat unrelated children and never enjoyed it. I don't like spending time with kids, especially babies and young kids. I don't even find them cute. But my niece would be the first related baby I'd meet.
My niece was the first baby I ever held as an adult, of my own volition. And I felt...nothing, just absolute indifference. I didn't seriously think she'd make me want my own, but I did expect to feel something. And it was the same with her sister. I love them, in the most abstract of ways.
Friends & "Society"
I'm getting to an age (I'm 33) where my peers generally either have kids or want them soon. It is difficult to maintain friendships with friends who have young children. Some like to pretend nothing changes after baby. But at the least, new parents are busy, and sometimes, by the time the child is a bit older, friends have grown apart. Other times, new parents push away childfree or childless friends; I've been told by many former friends that they "can no longer relate to [their] childless friends" after having kids. Online, some childfree people admit to pushing away friends who have become parents.
Fortunately, I have always cultivated friendships with people decades older than me. I have many friends in their 60s and 70s, and most of my friends are 50+. They come from various walks of life: some never had children (by choice or circumstance) and others have children who are my age, so they're not new parents.
With acquaintences and at work, I keep my childfree status and sterilization procedure completely private. I just don't discuss these topics at work or with anyone other than my SO and closest friends.
"Never forget this day. Never forget how lucky you are."
Ten years ago, I lived next door to a retired woman in her 70s, who drove me to and from the surgery. She had one child, a daughter, who is also childfree. I still talk to both of them sometimes. She told me she wished she had my options and said, "Never forget this day. Never forget how lucky you are." I haven't, and I don't. She helped make my dream come true.
