Post Tubal, Pre Tubal Women, please have the following blood tests performed. You have the knowledge that tubal ligations are KNOWN to cause hormone imbalances. You have a right to know if you are experiencing an imbalance or not, and you have a right to have it treated if you do.
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If you request these tests of your doctor, and he/she refuses to order the testing for you REGARDLESS if you are experiencing PTS symptoms or not, please let us know.
MEDICAL PROTOCAL FOR POST TUBAL AND PRE-TUBAL WOMEN
as designed by Dr. Vicki Hufnagel, M.D., written by Susan J. Bucher c 1999
There are medical tests and procedures that can be done in order to track your health and general overall well being. This information can be useful and beneficial not just for post tubal women but for all women.
Regarding the issue of these tests for post tubal women who are experiencing negative health changes, and in the words of Dr. Hufnagel:
"This (protocol) is a first step if you are experiencing problems after your tubal ligation (TL). I have been gathering clinical data for over 20 years and nothing is chance, or in your mind. The problems women have are based on anatomical and physical changes that occur from the TL. The gynecological community has with intent denied these problems in order not to expose themselves to the intentional fraud and misrepresentations they have imposed on hundreds of thousands of women. From a legal point of view I believe these negatively impacted women are victims of assault and battery. You need to demand and get a proper work up."
It has been noted that the medical community has met the suggestion of hormone testing for post tubal women with health problems and possible hormone problems with disallowance. The following blood tests and non invasive procedures are routinely ordered and done for women all the time. If you have a condition that merits the testing and merits the procedure you shouldn't be denied the following tests if you request them.
Explain your condition. List your symptoms. Explain your concerns. We suggest that you FAX a letter with your symptoms and concerns to your doctor prior to your visit. You may even want to request that the tests be ran before your office visit.
If the doctor doesn't suggest or order hormone testing be done for you on his/her own, request the doctor to order these tests for you. If the doctor suggests or proposes that you forgo hormone testing or any of the tests that you request ask the doctor to explain his/her reasoning for forgoing the tests. If the doctor suggests starting hormones (or the pill - not for birth control but to regulate your periods) with out first testing then you should DEMAND that these tests be done first.
The following medical protocol(s) have been formatted and designed for all post tubal and all pre tubal women (women about to have a tubal ligation). These protocols are to ensure for their overall health and well being.
STEP ONE- BLOOD TESTS AND HORMONE LEVELS
These blood tests should be done for post tubal women experiencing negative health changes following a tubal.
It's possible that some post tubal women may be experiencing a hormone imbalance (estrogen deficiency) with out even realizing it. For that reason ALL post tubal women should be able to request and have ordered the following blood work and base line bone scans.
Lastly, the informed consent to a tubal ligation should include that women be allowed to record their base line hormone levels and have a base line bone scan done. With this in mind the protocol also applies to women who have not yet had a tubal but are in the process of making that decision.
The following blood tests will help to determine if you have a thyroid condition, if your ovaries are functioning and at what level, or if you need further testing to check for an auto autoimmune disorder . If you are not experiencing problems, or are pre tubal these levels will then give you a base line to work with.
Estrogen or Estradiol - test (E2) recommend to be done for any abnormal menstrual periods
inhibin-a and inhibin-b.
LH luteinizing hormone
SHBG-Sex hormone-binding globulin. High SHBG levels plays a possible role in the the development of endometriosis. See here for more information.
DHEA-sulfate dehydroepiandrosterone sulfate
Cortisol Cortisol level
TSH - thyrotropin; thyroid stimulating hormone
The above is the protocol for the hormone Blood tests- (NOT 'saliva')
You could also request your doctor to run these following tests.
iron levels for anima or too much iron
also request a Total Cholesterol. (HDL, LDL, and VLDL)
If called for a CA-125 blood test (cancer test- if symptoms merit the test)
Other tests that are non invasive and can give further information include...
A pelvic ultrasound
Pelvic MRI or MRA
Base Line Bone Scan
Mammogram - If you have a family history of breast cancer, you should begin getting regular mammograms in your 30s or earlier, based on your doctor's advice. Standard is to start regular mammograms at age 40. If you are post tubal, on HRT (or the pill), or have been suggested HRT (or the pill) you may want to have your 1st mammogram at this time.
Lastly, and only as a last option and only if called for should a doctor suggest surgical intervention. (This would include D&C) Surgical intervention should never be done before other non-invasive tests have been ran and all things ruled out.
National Post Tubal Study
and about these blood tests.
Q. I am 31 years old and had a tubal 3 1/2 years ago after the birth of my 3rd child. I don't think that I'm suffering PTS, but have noticed that I am experiencing more intense PMS, itching vagina (with out a yeast infection), and have noticed a slight change in my periods. Should I follow the Post Tubal Woman's Medical Protocol?
A. Yes. All Post Tubal Women should follow this protocol regaurdless if you have having symptoms or not and regaurdless if you want to be included in the national study or not. Tubal ligations are known to cause hormonal imbalances. You may be experiencing a minor estrogen deficiency and experiencing slow bone loss with out even realizing that this is happening.
Q. I had a tubal ligation in 1988. I belive that I was spared from PTS. Can I still be included in the study?
A. Yes, anyone who had a tubal may particapate in this national study. It does not matter if you are suffering PTS, and it does not matter how long ago you had your tubal. This information is being collect directly from post tubal women and will be compared to other studies. If you are post tubal then your voice counts!
Q. I am considering a tubal ligation. My doctor hasn't told me very much about the procedure and I just found this site. Should I have a bone scan and have my hormone levels checked before my tubal?
A. Yes. If you are pregnant you may want to wait until some time after the birth to undergo the TL to let your body heal from the pregnancy. Wait until your periods return and everything is O.K.. and normal, then have the hormone testing, bone scan and the tubal. If you (or you doctor) are dead set that you are going to have a tubal in the hospital before returning home then have the bone scan as soon as it is safe to do so. You can have hormone levels tests done anytime after the birth. O.K. to have hormone levels checked while breast feeding, but you will want to have them checked again when you stop and then 6 months afterwards.
Q. Why are we asked to have our hormones checked before we fill out the study application.
A. If you are post tubal you need to have these levels checked regardless. This is very important and very serious. Please have this done first chance you get. Part of the study application asks you questions about the tests, what tests were ran, what were not, etc... If you fill out the application before having this information then you'll have to follow up later. It easier to have this information from the start.
Q. My doctor refuses to order the tests for me. Can I still be in the study.
A. Yes. Of course it's better if you're able to have the tests ran. We ask that you request the tests by "FAX". If you didn't do this to start we reguest that you ask for the tests again via "FAX", cc a copy to us. If the doctor refuses after this then you'll be able to fill out the study application.
Q. I had some blood tests and my doctor said my levels were fine. Why then am I having hot flashes?
A. It possible that your doctor didn't check all your levels. For example, if s/he checked your TSH, and it came back normal that doesn't mean your FSH, LH, and other levels are not. Reguest a copy of the blood work that was done and check and see what levels were checked and see for your self where they fall within the ranges. You have a right to see the information yourself. REQUEST A COPY OF THE RESULTS! It might be possible you are one or two points from being in a high/low range. Techinally you may be within "normal range", but on an "alert" status. You need to know this information. The doctor isn't going to be keeping track of your health, only you are. If your levels are indeed within normal range then you should have the tests repeated in one year.
Q. Where can I get more information about hormones and their function?
A. Try searching the internet. Use the search terms, Pituitary Hormones, hormones, menopause, TSH - thyrotropin; thyroid stimulating hormone, Estrogen or Estradiol - test (E2), FSH. LH (lutinizing hormone ) , Progesterone (serum), SHBG -Sex hormone binding globulin, Hormone Binding , Testosterone, DHEA-sulfate (dehydroepiandrosterone sulfate), Cortisol (Cortisol level), Prolactin (PRL), Insulin
...here is an example of some information you will find.
Follow this link for more information about Hormone Binding. This site has some good information about "Hormone Loops" and "Feedback and Regulation".
...Hormones act on their target cells by way of receptors: specific sites on or inside the cell bond with the incoming hormone and initiate the cell's response to the hormone. Feedback loops often involve changes in the receptor content of target cells; an increased or decreased receptor content results in increased or decreased responsiveness of the cell to any given level of incoming hormone.
"Target Cells" are found everywhere, including the "Fallopian Tube". With tubal ligations it's the nature of the surgery to destroy and remove portions of the fallopian tube. "Target Cells" are often removed causing hormonal imbalances.