Expert: Brenda - 7/19/2008

Question
Hello, My name is Maria & I have a question. I have had my tubes tied for 7 yrs now & in the past few months my period has been weird. Last month I only had it a one day & then it was completely gone. The month before that it was 2 days long. The past year it has been like that on & off. I have gone to my doctor & she can not explain what it is. She thinks they are ovarian cyst I have had sonograms & tons of test & nothing can explain it. This month I feel anxious & have cravings I can not explain. I have not had my period yet this month. My husband thinks I am pregnant I told him he is crazy can you help me with this.

Answer
Dear Maria,

Although rare, tubal ligations can fail. Occasionally a woman can still get pregnant, despite having had her tubes tied properly. The tubes can evolve in such a way as to try to heal themselves, and sometimes a tract develops that allows egg and sperm to meet. However, tubal ligation, regardless of whether the tubes are cut, burned, clipped, banded, or tied, is about 99% effective, meaning that about 1% of women will conceive an unplanned pregnancy after tubal ligation. This failure occurs slightly more frequently in younger women.

Symptoms which are typically associated with early pregnancy (breast tenderness/swelling, headache, nausea, fatigue, backache, etc,...) are basically hormonally related and can also be related to hormone fluctuations within our cycles. That is why it is so difficult to "diagnose" a pregnancy based on symptoms alone.

Also, you did not note your age, but if you had your tubal ligation seven years ago, I would guess you are at least late 30s, nearing 40 -- unless you had the tubal VERY young. It is not uncommon for cycle variations related to perimenopause to begin in our late 30s/early 40s. I would suspect that your unusual periods are likely due to a bit of a hormonal imbalance - as most cycle irregularities are. This happens occasionally for all women - even those who are usually like "clockwork", and especially as we get closer to perimenopause. There are many various potential causes for irregularities in our cycles. They are:
-Significant weight gain or loss
-Excessive or strenuous exercise
-Poor nutrition (or a diet too high in carbohydrates)
-Smoking
-Drug use
-Excessive caffeine intake
-Excessive alcohol use (interfering with how the liver metabolizes estrogen and
progesterone)
-Eating disorders
-Increased stress
-Polycystic ovarian syndrome/estrogen dominance
-Uterine abnormalities (fibroids/cysts/polyps/endometriosis)
-Hormonal imbalance related to perimenopause
-Medications
-Chemotherapy
-Thyroid dysfunction
-Recent childbirth, miscarriage, or D&C
-Breastfeeding

Your cycles may return to a fairly normal pattern, but keep in mind that as we age we cannot count on them being so much like clockwork as we did in our youth. We really don't get concerned until a woman misses three consecutive periods and pregnancy is not the reason OR if periods become very heavy with or without clotting on a rather continual basis. At that point, you should see your doctor so that a cause can be determined.

I hope this has helped you and answered your question. I wish you well.

Brenda