Tubal.org Blogs
Women's March on Washington - WMW 2017
Category: Member Blogs
Tags: Womens March on Washington WMW

We march for women's health rights, reproductive rights, equality, and justice for all women on all matters.
"Education is Key"

Womens March on Washington - WMW 2017

Why Post Sterilized Women should have their anti-Mullerian hormone (AMH) levels checked
Category: Tubal.org News
Tags: Tubal ligation post tubal ligation syndrome PTLS sterilization Essure labs hormones lab testing

Why "Post Sterilized Women" should have their anti Mullerian hormone (AMH) levels checked.

CPTwomen www.Tubal.org menopause hormone testingAnti-mullerian hormone (AMH) is useful in evaluating ovarian function because levels decline as ovarian function declines. AMH levels are low to undetectable in female infancy and after menopause. Low levels of AMH in a woman of reproductive age (under the age of 40) indicate ovarian hypofunction or “early menopause”. AMH levels do not vary greatly throughout the menstrual cycle so they can be measured on any day of the cycle. AMH is not altered or influenced by birth control pills or pregnancy. A decrease in AMH can be caused by increasing age, obesity, chemotherapy/radiation, hysterectomy and by "tubal sterilization".

Women can self order their own hormone testing: Current costs to do so at  www.ultalabtests.com is $12.95 for an FSH test, $62 for a basic menopause panel, $77 for an Anti-Mullerian Hormone AssessR™ , and $248 for a Comprehensive Menopause Panel (which includes Anti-Mullerian Hormone).

For more information see: http://tubal.org/hormonetesting.htm

Coalition for Post Tubal Ligation Women (CPTwomen)



Lab Protocol for Post Sterilized Women
Category: Tubal.org News
Tags: Tubal ligation post tubal ligation syndrome PTLS sterilization Essure labs hormones lab testing

Laboratory Protocal for Post Sterilized Women
by Susan Bucher, BSN


          This laboratory protocol for post sterilized women is the first and only of it’s kind. Created in the 80’s by Dr. VG Hufnagel, MD, it is specifically for post sterilized women after tubal ligation, clip or essure placement, and all forms of sterilization. This laboratory protocol is just one key element in the care plan for post sterilized women which she defined. Other elements to the full plan of care and protocol concentrate on education, sexual function/libido, pain, breast health, bone health, and more.

          This information is presented here so post sterilized women can become better informed and educated and so they may become an empowered proactive partner in their health and health care The proactive patient/physician goal of Hufnagel’s Laboratory Protocol is to monitor the health of women who have known risk factors for disease and syndrome. This protocol promotes education and timely diagnosis in order that women may be presented with treatment and options.

Read more about Dr. Hufnagel and learn more about the presentation of this information below:

All forms of sterilization (tubal ligation, clips, Essure, etc…) can cause ovarian isolation, catastrophic hormonal imbalances, castrative menopause, and hormone shock. The symptoms of menopause, hormone shock or that of a depleted hormonal state often manifest as sleep disturbances/insomnia, chronic fatigue, hot flashes, depression, mood swings, memory loss, urinary infections/incontinence, and loss of sex drive and libido. These symptoms and the condition of a depleted hormonal state can greatly affect a woman's well being, her social/work life, and family life.

Long term, a depleted hormonal state if left untreated in a young woman can lead to accelerated bone loss, earlier and more severe cases of osteoporosis, increased risk of colon cancer and earlier onset of heart disease.

Because of this risk for hormonal imbalance after sterilization regular hormone and other lab testing is necessary to monitor overall health and well being. For women who have the Essure or clip products testing for toxic elements are included. The clinical significance of these tests are explained below. 

For post sterilized women who have not had a health change:  These laboratory tests are suggested in order to obtain a baseline.

For post sterilized women who have had a health change: These laboratory tests can help rule out if your symptoms are hormone related or due to some other condition. As female sterilization carries the risk of creating a hormonal imbalance it make sense to start with the most obvious which is determining ovarian function. If ovarian function is diminished then proper treatment(s) can be offered by your treating physician(s). 

Self order Hormone and Lab Testing  
 Self order (direct to the customer) Lab Testing

Hufnagel’s Laboratory Protocol for
Post Tubal & Post Sterilized Women

The avenues to obtain lab testing are to ask your private physician to order tests for you (in which case your insurance may pay for some or all of the cost), or to self-order labs on your own.

Click here for information about direct to the customer (DTC) lab tests and pricing. We promote Ulta Labs Tests who offers the best value. click here for more information or to self order lab testing.

To order a Toxic Element Exposure Profile (heavy metal profile test kit) click here

When to Test:  For the best results and most optimum levels, blood draw for the estrogen, progesterone, and SHBG-Sex hormone-binding globulin levels should occur sometime in-between day 17 through day 20 of your cycle (day 1 being the first day of your last period). On these four days all of the female hormones are at high levels.

If you are no longer having periods, or if you are having irregular cycles and are not able to determine when you had your last real/full cycle then it will have to be a guess.

FSH levels, when checking to see if they are elevated, can be tested anytime expect for mid-cycle.  If FSH levels are evaluated or high in range, standard of practice is to re-check 7 days later to confirm if FSH levels remain elevated.

Some of the above listed blood work requires that you fast (no eating for at least twelve hours) prior to the blood draw.  Water and black coffee is o.k. to consume when fasting. 


The findings of hypothyroidism, diabetes, or anemia does not rule out that a hormone imbalance or menopause is not also occurring.

The findings of normal thyroid, insulin, and iron levels does not rule out that a hormone imbalance or menopause is not occurring.

The findings of a hormonal imbalance does not rule out that other conditions (ie, autoimmune, cancer, etc) is not also occurring/present.


Hufnagel’s Baseline Hormone Profile Protocol

Since the 80’s Dr. Hufnagel has lobbied and advocated for baseline hormone testing not only for post tubal ligation and sterilized women but for ALL women as a standard of care to promote hormone health. 

Hufnagel’s protocol directs baseline hormone testing for ALL women starting at age twenty-five as a standard screening test in the same way that mammograms are for women at age forty.

Loss of hormones or hormone production can affect both your physical and mental health (examples include bone health, memory, and libido). In the U.S., your odds are more then one in four of one day having a tubal ligation or hysterectomy. Your chance of one day having a surgery that could affect your hormone production or possibly castrate you is much higher (1 in 4) then getting breast cancer (1 in 8), yet women are not routinely offered hormone testing as they are with mammograms.

Having information about what your levels are when you are in the prime of your life and feeling your best is good information to have in your medical files if you ever need HRT or wish to match your baseline levels.

Hufnagel’s Baseline Hormone Profile Protocol directs the following plan of care:

All women (including women younger then age 25) should be hormone tested before all surgical procedures or medical treatments which could affect her hormone levels short term or long term: This would include being tested before a hysterectomy, tubal ligation/female sterilization, uterine fibroid embolization, prior to donating eggs, Lupron shots, etc…

Women who are experiencing irregular periods or cycles (regardless of age). This would include missing cycles (in absent of pregnancy), experiencing long periods (longer then 10 days of bleeding) long or short cycles (having two periods in a month, going 45 days between cycles).

All women who have undergone any form of female sterilization/tubal ligation, tubal reversal, essure removal, hysterectomy, uterine fibroid embolization, one or both ovaries removed, one or both fallopian tubes removed, or any type of surgical or medical treatment that could have affected her hormone production (regardless of age).

Women who are suffering hormonal or menopausal symptoms such as: hot flashes, chills, night sweats, bouts of rapid heart beat, irritability, mood swings, trouble sleeping, loss of libido/sexual drive, crashing or chronic fatigue (CFS), anxiety, difficulty concentrating, fuzzy logic, memory lapses, sore joints/muscles, increase in headaches/migraines, depression, allergies developing or increasing, irritable bowel syndrome (IBS), sudden weight gain or loss, hair loss or thinning, episodes of dizziness or light-headedness, and loss of balance (regardless of age).

Women who have had labs drawn for them in the past are urged to obtain copies of their reports and review first hand which labs were ordered. 


Clinical significance of these tests: 

Anti-mullerian hormone (AMH) is useful in evaluating ovarian function because levels decline as ovarian function declines. AMH levels are low to undetectable in female  infancy and after menopause. Low levels of AMH in a woman of reproductive age (under the age of 40) indicate Premature Ovarian Failure (POF) also known as Ovarian Hypofunction or early menopause. AMH levels do not vary greatly throughout the menstrual cycle so they can be measured on any day of the cycle.  AMH is not altered or influenced by birth control pills or pregnancy. A decrease in AMH can be caused by increasing age, obesity, chemotherapy/radiation, hysterectomy and by tubal ligation. [1]


Women with decreased ovarian function (ie…women in menopause) have high levels of FSH which range from 25.8 - 134.8 mIU/ml.  These levels remain elevated through out the month.  Women of reproductive age with normal ovarian function have FSH levels which wax and wane throughout the menstrual cycle in a range from 4.7 - 21.5 mIU/ml (normal value ranges may vary between laboratories).  The fall of inhibin B and the increase in FSH constitute markers of ovarian aging.


Elevated levels of LH are found in women who are not ovulating, women with polysystic ovarian syndrome (POS), women in menopause, and “when the ovaries produce little or no hormones” (ovarian hypofunction). This test may be effected by taking birth control pills or hormone therapy.


To evaluate the function of the ovaries and (to) detect ovarian failure. Postmenopausal women in the lowest quartile of E2 levels are at higher risk of osteoporotic fractures.


Inhibin B levels are low to undetectable in women with diminished ovarian reserve and in menopause. Some cancers produce Inhibin (regardless of menopause) so the test also functions as a screening test for post-menopausal women.

A recent study found that  postoperative levels of AMH and inhibin B were significantly higher in women who had had their tubal ligation at the time of a c-section compared to women who had tubal ligations via minilaparotomy. The researchers stated “CSTL (cesarean section tubal ligation) results in less disturbance to ovarian function than interval (laparoscopy) TL”. [2]


Filshie clip: Femcare-Nikomed states that the titanium in the clip does not contain nickel but that the silicone used to manufacture the clip "does contain trace levels".  CooperSurgical states, “The silicone and titanium used in the manufacture of the Filshie Clip are generally regarded as safe materials for human implantation. Although no adverse toxic or tumorigenic effects due to the device or its materials have been reported, the effects of long term implantation are unknown.

The MELISA Foundation states that titanium can be polluted with nickel.

Hulka clips:  Hulka clips contain metal with gold covering which some women are senitive to. In 2014 there was a Hulka clip recall reported as failed biocompatibility testing on a component used.

Essure:  The Essure micro-insert is made from a nickel-titanium alloy. The manufacturer states that this metal is “generally considered safe” but goes on to explain that, "in vitro testing has demonstrated that nickel is released from this device. Patients who are allergic to nickel may have an allergic reaction to this device, especially those with a history of metal allergies. In addition, some patients may develop an allergy to nickel if this device is implanted. Typical allergy symptoms reported for this device include rash, pruritus, and hives.”

Click here for more information on nickel allergy.  

... the clinical significance on the balance of the listed tests will be posted here soon.


Notice: To all Women who Underwent Sterilization: 

          You have been empowered and you now have the knowledge that female sterilization and tubal ligations (TL) are KNOWN to cause hormone imbalances.

          You have a right to know if you are experiencing a hormonal imbalance or not. Hormonal imbalances, ovarian hypo function, ovarian failure and menopause can cause loss of sex drive, memory loss, loss of balance, depression, confusion, rage, hot flashes, and bone loss.  Hormonal imbalances of this nature are treatable and you have a right to treatment if you are experiencing a hormonal imbalance.

          The Laboratory Protocol for Post Sterilized Women and the Baseline Hormone Profile Protocol which is detailed above was designed by Dr. Vicki Hufnagel, MD. Dr. Hufnagel is a whistle blower who exposed in the 80’s that hysterectomies were being unnecessarily done as a standard of practice.

          Dr. Hufnagel is the first to come forth and fully expose and document the massive female surgical abuses in the United States. (Hysterectomies in the United States, 1965-1984, Vital & Health Statistics; U.S. Department of Health and Human Services, December 1987). She provided testimony before the U.S. Congress and the National Institute of Health on gender issues in medicine and wrote the best selling book, "No More Hysterectomies".

          In the 80’s, she defined and reported on post tubal ligation syndrome (PTLS) to peer review medical associations and wrote the first papers describing a need to change the informed consent laws not only for hysterectomies but also for tubal ligation and female sterilizations. In seeking peer support on these issues she was denied (see acog letter). Statistical data was censored from her presentations that detailed the role tubal ligation played (and still does) in the number of hysterectomies performed each year and she was blacklisted.

          Not only did she blow the whistle on her obgyn peers for performing unnecessary hysterectomies and for not informing women of PTLS, she also blew the whistle and reported to the FDA on harmful products and devices such as ova bloc, uterine artery embolization (aka uterine fibroid embolization) and Essure. 

          The ivory towers (her peers and medical/pharmaceutical companies) utilizing insider contacts and major crisis management firm(s) retaliated hard with backlash, smear campaigns (to the point of her being slandered in books and magazines), and other acts of terror such as arson, home raids, and false charges. Their goal was to strip her of her medical license in order to entirely discredit her. She was made to face a kangaroo court and has paid the price for speaking out. Currently she is not licensed n the US.   

“Reverence for life requires action. One must stand up alone against all odds and speak out as to the issues and events that are corrupted and cause human suffering. Knowing at all times that the fact they are seeking change is the very reason they will face attack. The more vocal, the more vicious the attack”.  - Vikki Hufnagel  1985  

          To get a perspective of how Dr. Hufnagel was attacked for her radical theories that the uterus plays an important function in women health and for promoting informed consent laws see how Dr. Leana Wen as been attacked. The attacks on Dr. Hufnagel make the attacks on Dr. Wen look like a walk in the park. The attacks upon Dr. Hufnagel are real and ongoing.

          Dr. Hufnagel is to be vindicated. Without her ethics to work to expose the truth about post sterilization syndrome and the injustices that has been occurring this information and medical protocol would not be made public. We pay homage to her and her life work in promoting women’s health care and health care rights on all fronts and offer support for her restitution.

          Today we all see the devastation and destruction of tens of thousands of women in the wake of the FDA Essure scandal that Dr. Hufnagel specifically warned of and spoke out about. Just ask any woman today what they were informed of before their sterilization (essure or otherwise) and they will attest that they were not informed of post tubal ligation syndrome (PTLS) or post sterilization syndrome (PPS). This was a denial of their rights to information prior to consent. In truth, these are the injustices and batteries against women in the medical setting that Hufnagel spoke out about and was attacked by her peers for doing so.  

          Not only are women still not being informed today about the risks of sterilization, they are not properly monitored or cared for after their sterilization. Women are told when symptoms manifest after sterilization that post sterilization syndrome is not real, told they are crazy (put on antidepressants), and denied information and proper laboratory work ups and testing to help diagnose their condition or syndrome.

          The scandal and cover-up is further exposed as women learn after the fact that tubal ligations have side effects. Medical professionals who do not practice directly in women’s health care or and who do not perform and profit from tubal ligation are more forth coming but those who perform and profit from sterilizations hold fast that here are no side effects.   

Regarding the The Laboratory Protocol for Post Sterilized Women Dr. Hufnagel states:

          "This (protocol) is a first step if you are experiencing problems after your tubal ligation. I have been gathering clinical data for over 35  years and nothing is chance, or in your mind. The problems women have are based on anatomical and physical changes that occur from the tubal ligation and sterilization products. 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."   Dr. Vicki Hufnagel, MD, 1999. 


Recommendations from the CPTwomen:

          It has been noted that the obgyn medical community has met the suggestion of hormone testing for post sterilized and post tubal ligation women with health problems and possible hormone problems with disallowance. Blood tests are routinely ordered and done for women all the time. If you have a risk factor or symptoms that merits the testing you should not be denied the following tests if you request them.

          When speaking with your physician explain your condition. List your symptoms and voice your concerns. We suggest that you put your request(s), symptoms and concerns in writing and fax or email this information to your doctor prior to your visit. You may even want to request that the tests be ran before your office visit. See email/fax example below:

          If your 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 (such as the birth control pill, the mirna product - not for birth control but to “regulate” your periods) with out first hormone testing then you should DEMAND that these tests be done first

Q. When requesting to be hormone tested, should I email or FAX my doctor?

A. YES!  In this case it's a good idea to put your request in writing and FAX or email your physician a short letter about your health concerns. It's possible that s/he will order the tests for you before your office visit. This can save you time and money.

The CPTwomen has outline the following examples on how your letter might read. Your letter, once faxed/sent to your doctor, will become part of your medical file/history. It will always be on record that you requested that these tests be ran for you.

Faxing or emailing your request is very easy. Call your doctors office and ask the receptionist the office fax number or email address. Also find out were you would need to go to have blood drawn (at their office or someplace else?)

You could tell them at that time on the phone that you want blood work ordered and that you will be sending over your request via email (or fax).

If your physician asks that you come in person to talk with them before hand, tell them that you rather come in and talk AFTER the blood work comes back. Then email or FAX your request!

Your letter might read something like this...

***** EXAMPLE email/FAX #1 *****

Dear Dr. ___________,

I believe that I might have a hormone imbalance. My symptoms are… (list your symptoms, voice your concern…)

I would like to have the following blood tests ordered for me. (list tests)

I will be in the area on ______ and would like to stop in and have the blood drawn on that day.

I will call on ______ to confirm that these tests were ordered for me....

Please file a copy of this fax/letter with my medical file.

Sincerely, Jane Doe


If the doctor says that s/he MUST see you in his office before ordering any tests you might write your fax the following way....Send a 2nd email or FAX if required. 

***** EXAMPLE email/FAX #2 *****

Dear Dr. ___________,

(As I stated in my first email/fax to you) or (As I stated on the phone to your nurse)  I believe that I have a hormone imbalance.  My symptoms are… (list your symptoms and concerns).

I would like to have the following blood tests ordered for me. (list tests)

I understand that you would like to see me in your office before you order any tests. I believe my symptoms and risk factors merit ordering these tests, and would prefer to have them ordered now and be done before my office visit with you so we can at that time discuss the results.

I'm a very busy mom and having my labs done now before my office visit with you would be saving me time and would also be saving me/my insurance company money because I'll be charged for one visit instead of two.

If you will not order these tests with out first seeing me, then I'm requesting that my follow-up visit with you after these tests are ran to be waived so I'm charged for only one office visit.

I understand that if I do have a hormonal imbalance that hormone replacement therapy may be prescribed. I will not consider any type of treatment (including the "pill") until after I have my hormone levels checked.

As it stands right now, since I was told that I must see you first, I made an appointment to see you in your office on ________.

I will however be in the area on ________ and would like to have my blood drawn at that time. That way when I see you on ________ we can  discuss the results.

I believe that the cost of these tests maybe covered by my insurance company if ordered by you. I will call to find out. Regardless, if these tests are not covered by my insurance company then I will pay for them myself. I have a right to this information and will not consider any type of treatment without it.

I prefer that the tests be ordered for me before my office visit with you.

Please file a copy of this fax/letter with my medical file.

I'll be looking forward to your reply.

Sincerely, Jane Doe



The CPTwomen advocates for hormone testing for all post sterilized women and all pre sterilized women (women about to undergo sterilization) to help protect overall health and well being.

It is possible that some post sterilized women may be experiencing a hormone imbalance (estrogen,  progesterone, or testosterone deficiency) without even realizing it. For that reason ALL post sterilized women should be able to request and have ordered the following blood work and base line bone scans.

Lastly, the CTPwomen advocates that informed consent to a sterilization include provisions that women be allowed to record their base line hormone levels and have a base line bone scan done.  For that reason this plan of care would apply to women who have not yet had a tubal but are in the process of making that decision. All women considering a TL should be offered and allowed to have these tests. 

The listed blood tests in the protocal will help your physician 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 autoimmune disorder, cancer, and other conditions.  If you are not experiencing problems or all the tests come back in the normal range  then these levels will then give you a base line for future reference.  

The following tests can also give much further information about your health and health condition:

A pelvic ultrasound

Pelvic MRI or scans

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, ablation, hysterectomy, etc..). Surgical intervention should never be done before non-invasive tests have been ran and all things ruled out.




1.  Grant, M.A. et al.  Evaluation of ovarian reserve following tubal sterilization using anti-müllerian hormone. 2011. Fertility and Sterility, Volume 95 , Issue 4 , S7

2. Ozyer S, Moraloglu O, Gulerman C, Engin-Ustun Y, Uzunlar O, Karayalcin R, and Ugur M. 2012. Tubal sterilization during cesarean section or as an elective procedure? Effect on the ovarian reserve.Contraception. Article in press.



Disclaimer: Diagnosis of health/medical conditions are not made at this web site, by the Coalition for Post Tubal Ligation Women (CPTwomen), tubal.org, or by any of its associates. The "Campaign to Inform" is a grass roots informational movement. No treatment is provided. Information contained on this web site or any website is not a substitute for a consultation and physical examination by a physician. Only discussion of your individual needs with a qualified physician will determine the best method of treatment for you. You are advised to obtain the services of a physician or health care professional if the need for medical treatment is indicated. 

1 2 3 4 5