(My writing style is somewhat assertive and I have a fair bit of gynaecological knowledge. Please feel free to set the tone and content of your letter to whatever you are comfortable with. All objections to these RCOG guidelines will help to undermine their validity)

The address to send your letter to is:

                     Clinical Governance and Standards Department
                     Royal College of Obstetricians and Gynaecologists
                     27 Sussex Place
                     Regent’s Park
                     London
                     NW1 4RG

Dear Sir/Madam

GUIDELINES FOR TUBAL OCCLUSION

I am writing to you to ask you to consider the possibility, that tubal occlusion causes severe adverse long-term side effects in many women (myself included), and to ask you to alter RCOG guidelines to take this into consideration.

In the patient leaflet the following guidelines cause me considerable concern:

1.      “There is no evidence that having a tubal occlusion causes problems that would mean you need a hysterectomy.”

Don’t you think there is evidence [1] [2] that tubal occlusion increases hysterectomy risk? Isn’t this statement merely a play on words designed to disguise the fact that you recognise this increased risk, (in Section 6.7 recommendation 33 in your “Guideline Summary” January 2004) but wish to conceal this from the general public in direct contravention of GMC recommendations on withholding information [3] for informed consent?                                          (Had I been aware of the increased risk of hysterectomy prior to my tubal occlusion I would not have considered it as a contraceptive option.)

2.      “There is no evidence that having a tubal occlusion affects your sex drive. “

Are you not aware of these studies[4] [5], which clearly show that it results in decreased libido in 6.6 - 8% of women?

3.      “Research shows that if you are over 30 years old when you have a tubal occlusion, it is not linked to getting heavier or irregular periods. There is little evidence about how having a tubal occlusion affects your periods if you have the operation when you are under 30.”

To what research, specifically, are you referring? Why would women over 30 be less likely to experience heavier or irregular periods following sterilisation? What physiological change occurs at age 30 to explain this statement? Haven’t you read any of the evidence[6] [7] [8] that tubal occlusion does indeed cause menstrual problems?

I notice in your vasectomy guidelines that you warn men of the risk of chronic testicular pain. Vasectomy is a minor operation compared to tubal occlusion yet despite evidence that tubal occlusion causes pelvic pain[9] and dyspareunia[10] you appear to deny the existence of this chronic pain within the higher risk operation.

I am also concerned that you do not warn women of the possibility of early menopause. 14% of the sterilised women I have spoken to, personally, (these figures are not inclusive of the 1000’s of women with similar symptoms on the internet) so far, have experienced onset of menopausal symptoms before the age of 40, most within a year of their sterilisation. (Many over 40 at the time of sterilisation also experienced menopause within a year of sterilisation). All the women under 30 (3%) at time of sterilisation also experienced onset of climacteric symptoms. Why do you not mention this risk? Is it not the case that any pelvic surgery carries a risk of premature menopause?

Can you begin to understand how angry and abused the many women who have been misled by your myth that sterilisation is the “safe” contraceptive option feel? The dissemination of accurate information on this issue could save women who have been sterilised from the bewilderment and anguish that result when they are not believed if they tell their doctors they think their problems are caused by the sterilisation. It will also stop women, like me, who would never have considered this option had they had awareness of the full picture prior to their operation, from experiencing the total lack of confidence that I now have in the medical profession. (Two of your members have said that progesterone levels of 19.9nmol/L on day 21 of my cycle are normal. Do you share their opinion?). What will it take before you will consider the validity of the experiences of those that you operate on?

I look forward to your reply

Yours sincerely