Hi, Tubal ligation is a surgical procedure that blocks the fallopian tubes to prevent pregnancy. Although it is considered a permanent form of birth control, it is important to note that it does not affect menstrual cycles or hormonal changes in the body. Therefore, unpredictable menstrual cycles after tubal ligation may be caused by other factors. One possible cause of irregular menstrual cycles is hormonal imbalances. Hormonal imbalances can occur due to various factors such as stress, weight changes, medication, or underlying medical conditions. These imbalances can cause changes in the menstrual cycle, including missed periods, spotting, or heavier-than-usual periods. Another possible cause of irregular menstrual cycles is a condition called polycystic ovary syndrome (PCOS). PCOS is a common hormonal disorder that affects the ovaries and can cause irregular menstrual cycles, along with other symptoms such as acne, weight gain, and excessive hair growth. It is also important to consider other potential causes of stomach pain, such as digestive issues or urinary tract infections, as these can also affect menstrual cycles. If you are experiencing irregular menstrual cycles or stomach pain, it is recommended to consult with your healthcare provider for a proper evaluation and diagnosis. They may perform a physical exam, blood tests, or imaging tests to determine the underlying cause of your symptoms. Depending on their findings, they may recommend treatment options such as medication, lifestyle changes, or further testing. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Priyanka, General & Family Physician