Perimenopause via Tubal Ligation

Most women don't get the memo they will go into perimenopause if they get a tubal ligation. Over the last nearly 16 years working in the field of Hormone Medicine, I’ve been talking to women (and men) about hormones and hormone replacement therapies. Patients typically schedule a consultation with me before considering hormone therapy and I give them the run –down on what they can expect, what their responsibilities are, and what it might look like for them overall so they can make an informed decision as to whether hormone therapy is right for them and what kind. In this initial consultation, I listen to every patient as they give me their history of illness, symptoms, treatments, and medications. With hundreds of patients in a hormone specialty clinic, both men and women are quite frank about how they feel and what other providers have said to them. As with any field of specialty, complaints from patients tend to be the same and consistent from patient to patient and our patients are no exception.

Recently my cousin Claire reached out via text and asked if she could ask me a few questions regarding her health and Hormone Medicine. After reading her text messages out loud to a colleague, we looked at each other and smiled. We hear the same things from woman after woman no matter what her age is saying the exact same things. We chuckle because it’s almost verbatim as if they were all reading off the same script. Below is 38-year-old Cousin Claire’s random text messages indicating how miserable she is and what she tried to do about it. It’s not uncommon for women who’re low in estrogen to lose the ability to fluidly articulate the magnitude of how crappy they feel but this is a perfect example...

“On 1/4/16 I woke up very sick with a bad cold. Must have been some sort of infection because it wouldn’t go away so by February I went to the Nurse Practitioner. I was given a Z-Pak and told it was some type of bronchitis. After the round of antibiotics I still felt like crap but a bit better in March.  

In April I noticed my front teeth felt funny. It wasn't until I felt some pain that I took note my front gums and lip were actually swollen. My regular dentist looked and took pictures and said maybe it’s an autoimmune problem. Another dentist a week later looked and said go to oral surgeon. Oral surgeon looked and said autoimmune.

Now I had awful headaches and couldn't hardly function a full day at work. Exhausted and ended up with several panic attacks. Very unusual for me. Went to cardiologist and I have a very healthy heart, no concerns. I was tested for leukemia but that came back negative. Phew....    

I went to women's health specialist who said they had no clue, but didn't think it was hormonal in nature. I asked because I had my tubes tied two years ago and had missed a period. That also is weird.  

I had several blood tests all of which I could scan and email to you. Some thyroid stuff off but rheumatologist said no lupus (I had positive Ana test and symptoms that matched) and no thyroid disorder.

Finally got a new primary and she sent me to an Ear Nose & Throat specialist. They said I had an enlarged thyroid and needed to see an endocrinologist.   My symptoms are odd and off the wall. Just had another abnormal period. That is the short version of it...  

My symptoms: 

  • Swollen red gums
  • Severe headaches
  • Muscle soreness/pain not from exercising
  • Exhaustion
  • Foggy brain
  • Frequent nausea
  • No appetite
  • Depression
  • Anxiety attacks
  • Odd periods
  • Cramping to the point of feeling awful even when I didn't have my period
  • Extremely dry, itchy skin

It feels like all the "specialists" I have seen think I'm crazy, except the dentist who believes me but can't help me. I've been pushed from one person to another. My old primary told me this pain might be my new normal. I won't accept it. This is not normal.

I think the exercise I do is the only thing keeping me from really getting too low. There are days and weeks that exercise is too hard and I can't do it. But if I skip for too long my depression comes back too strongly. I'm obsessed with running and will at least do a mile if I can tie my sneakers. That is my happy place (that is when my chest pain - apparently fake - isn't bothering me).”

It frustrates me how women have to deal with this like being on the exercise wheel of conventional medicine. The truth is doctors are purposely left in the dark with regards to what causes all these symptoms and what to do about it. The reality is every symptom, including her angioneurotic edema, is a result of estrogen deficiency.  When estrogen is right, none of these symptoms exist in our patients. As estrogen becomes healthy, each issue diminishes for most to nothing. Our modern medical model ships women from specialist to specialist as if we are all parts. There isn’t one function in the female body that estrogen does not affect so piece-mealing medicine doesn’t make sense. Every cell in a woman’s body depends on healthy levels of estrogen so when it gets too low, our body will fall apart all over the place, mentally, physically, and physiologically. If physicians were properly educated as to the true benefits of our main-sex hormones, it would be first-line therapy to check levels up front. Doing this would save time, money, medications, and mental and physical misery.

Tubal ligation will cause a woman to go into premature perimenopause within 1 to 3 years post surgery due to lack of blood flow to the ovaries.  Doctors will tell you this isn't the case however if they followed up with blood labs over this period of time, they would see for themselves what transpires in the clinic.  Though tubal ligation does not directly affect estrogen production, reducing the blood supply to the ovaries will cause them to malfunction and not produce supercritical estrogen in health amounts.  Dysfunctioning ovaries under produce estrogen, if at all, leaving women estrogen deficient and in a state of hypoestrogenism.   Women who are hormonally sound don’t feel the way Claire does. I tend to get a little giddy when I hear women tell me their stories because I know the impact their new hormone therapy will have on them over the next few months. They have no idea how much their lives are going to change. Their symptoms will go away and will feel alive again if done correctly. The greatest impact of intelligently administered hormones like Panacea|HRT is what it does to the brain of a woman. I can always tell by the look in a female patient’s eyes when she has plenty of estrogen running through her blood. It’s like the light goes back on.

If you've had your tubes tied and have never been the same or you’re having a hard time getting to your personal "Hormone Sweet Spot", click on the "Programs" link in the menu above and choose a program that's right for you.


Alvarez-sanchez F, Segal SJ, Brache V, Adejuwon CA, Leon P, Faundes A. Pituitary-ovarian function after tubal ligation. Fertil Steril. 1981;36(5):606-9.

Cattanach J. Oestrogen deficiency after tubal ligation. Lancet (London, England). 1985; 1(8433):847-9. 

Lethbridge DJ. Post-tubal sterilization syndrome. Image J Nurs Sch. 1992;24(1):15-8.


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