CAN HORMONE PROBLEMS AFTER TUBAL LIGATION BE TREATED?
The Story of Virginia
Virginia was a prolific writer of children's stories and was finding it more and more difficult to use her word processor because of pain in her neck, forearms and wrists. The shopping and picking up her two young children were also proving stressful as she had lower back pain which restricted her bending over. She felt rather cheated and angry by these symptoms as she was only 39 and was suffering with symptoms that both she and her doctor thought were typical of a woman much older. She was not used to this as she had previously been very sportive and fit.
It had all started three years after her tubal ligation which had been performed immediately after the caesarean section required for the birth of her last child. She became increasingly exhausted which was due to undiagnosed anaemia due to her heavy painful periods that had developed in the last six months. Her beautiful athletic physique had also changed and she had developed lumpy cellulite around her buttocks and thighs although she was following a very healthy low fat diet. She found that her skin looked thinner and dry and started to age more rapidly.
Virginia's creativity also seemed to be flagging and the magical stories did not flow from her brain with the same ease and colour. She could not understand why she felt so down as she was trying to do all the right things and even her supplements of evening primrose oil, vitamins and minerals did not give her a lift.
Fortunately, Virginia's doctor had the foresight to refer her to a specialist as he remembered how different she had been four years ago and he suspected she had a hormonal problem. The specialist ordered blood and urine tests and discovered that Virginia had subnormal levels of oestrogen and progesterone, as well as a severe iron deficiency anaemia. She was started on iron supplements, given an oestrogen implant and natural oestrogen tablets to take along with progesterone. The progesterone tablets were to be taken for twelve days of every calendar month.
Within six weeks Virginia felt her aches and pains disappear and her mental and emotional state improved. Once again, she was churning out her children's stories and felt like playing with her children. She was delighted to find the lumpy cellulite reducing without having to starve herself to death and she now had the energy to resume her aerobics classes at the gym.
Virginia still felt a little cheated as her gynaecologist had not warned her that tubal ligation can result in hormonal problems and she felt that she was rather young to start Hormone Replacement Therapy. Had she known, she would never have had her tubes tied.
At least her symptoms had been recognised for what they were, or else she feared that she may have continued to age rapidly and needed antiinflammatory drugs. Virginia was amazed that the hormone oestrogen exerted such a powerful influence in her body as she had never before been a victim of her hormones.
Can Hormone Problems After Tubal Ligation Be Treated?
In many women with hormonal problems after tubal ligation, a hormonal state similar to the pre-menopause is found. This means that the hormonal output from the ovaries is reduced to a similar level that we find typically in a woman in her late 40s who is approaching the menopause.
Tb assess the level of oestrogen and progesterone production by your ovaries you can ask your doctor to measure the amount of these hormones and their metabolites (breakdown products) in both blood and urine tests. If your doctor does not want to do this, ask for a referral to a specialist who is called a gynaecological endocrinologist. You have a right to know as it is vitally important because long-term consequences of oestrogen and progesterone deficiency could be an increased risk of cardiovascular disease, osteoporosis, premature ageing or cancer.
Oestrogen and progesterone production is best assessed in 24-hour urine tests the day before, during and after ovulation. Blood tests for levels of oestrogen, progesterone and Follicle Stimulating Hormone are also helpful, but because the daily production of oestrogen from the ovary fluctuates markedly, this may make one or two blood samples unreliable as true indications of your overall oestrogen state. This is best assessed in three separate 24-hour urine collections which integrate these fluctuations.
Once your doctor has proven that you have a hormonal deficiency or imbalance, this can be treated with natural Hormone Replacement Therapy.
It is possible to supplement your own inadequate oestrogen levels with natural oestrogen in the form of tablets which can be taken every day. Make sure your doctor uses the natural form of oestrogen as synthetic forms do not work.
Some women will also need oestrogen replacement in the form of an oestrogen implant. The implants consist of small pellets of pure crystalline oes-tradiol and resemble a tiny piece of spaghetti. They come in various strengths to suit individual needs and are somewhat expensive, although the cost can be claimed from some private health funds. They can be painlessly implanted into the fatty layer of your abdomen or buttocks under a local anaesthetic and many doctors use a small hollow tube with a sharp cutting edge to slide the pellet neatly into your fat.Depending upon the strength of the implant chosen by your doctor, an implant will continue to release oestrogen directly into your blood stream for between four to twelve months which is ideal for those who cannot remember to take tablets.
Of all the types of HRT, an implant comes closest to copying the function of your own ovaries as in both cases oestrogen is released directly into the bloodstream and carried to the various oestrogen-dependent tissues of your body. Thus, your hungry cells get their supply of precious oestrogen before the liver enzymes can break it down. Unfortunately, this is not so with oestrogen tablets which are first broken down by passage through the liver after their absorption from the gut. Thus, the liver could be said to weaken the effect of oestrogen tablets upon your cells, whereas the oestrogen implant is able to deliver an unweakened supply of oestrogen.
Oestrogen can be given via your vagina and indeed this is a very popular form of HRT. It is easily inserted with a vaginal applicator which enables you to place the cream high into the vagina. It is best done last thing at night on retiring, after sex, and after emptying your bladder. Oestrogen will be rapidly absorbed through the vaginal lining into the bloodstream and reasonable levels of blood oestrogens can be achieved.
Oestrogen replacement can also be given in the form of an oestrogen patch which is a sticky transparent membrane impregnated with natural oestrogen. It is applied to the skin of the buttock, abdomen or trunk (excluding the breast) and releases oestrogen to the skin which absorbs it into your bloodstream. The patch is changed every third day.
Thus, oestrogen replacement is very versatile and different combinations of the oestrogen tablets, patches, implants and creams can be tried with your own doctor until you find the programme that suits your individual mental, physical and sexual requirements.
No matter what type of oestrogen replacement you receive, it is necessary that you also receive replacement with the other ovarian hormone progesterone. This is usually given in tablet form and must be given for twelve to fourteen days of every calendar month to balance the oestrogen and regulate your cycle to bring on a regular menstrual bleed.
If your periods are very heavy and/or painful you may need to take both progesterone tablets and oestrogen tablets for twenty-five days of every calendar month, which is a similar programme to the oral contraceptive pill. However, the oral contraceptive pill should not be used routinely to treat women with hormonal problems after tubal ligation, as contraception is no longer required and it contains synthetic hormones which do not have the same beneficial effect in your body as natural oestrogen.
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