The main points
- Female sterilisation is a permanent method of contraception.
- The two main sterilisation procedures are tubal ligation, where clips are put on the fallopian tubes, and tubal occlusion, where a tiny, flexible device is put into each tube.
- Sterilisation does not give protection from sexually transmissible infections (STIs). The best way to lessen the risk of STIs is to use barrier methods such as condoms with all new sexual partners.
Tubal Ligation, also known as sterilisation is a permanent method of contraception that a woman can choose if she is sure that she does not want children in the future. The two main sterilisation procedures are tubal ligation, where clips are put on the fallopian tubes, and tubal occlusion, where a tiny, flexible device called a micro-insert (EssureTM) is put into each tube. Tubal occlusion does not involve having surgery.
How sterilisation prevents pregnancy
When a woman ovulates, an ovum (egg) is released from the ovary and moves down the fallopian tube. If the ovum meets a sperm, conception happens. Sterilisation blocks the path of the sperm through the tube. Eggs are still released by the ovaries, but are broken down and safely absorbed by the body.
As the ovaries are not affected by sterilisation, periods will keep happening as normal, with the ovaries continuing to release the same hormones. Sterilisation does not cause menopause or affect a woman’s sex drive or enjoyment of sex.
Even though tubal ligation can often be reversed, it is considered to be a permanent method of contraception. Tubal occlusion, however, is not reversible.
Sterilisation issues for women
If you are thinking about sterilisation, issues to talk about with your doctor include the following:
- Other methods – there are a number of long-term, reversible methods of contraception available that offer added benefits, such as light or no periods, without carrying the risk of a surgical procedure.
- Your age – doctors are usually hesitant to carry out sterilisation procedures for women who are aged under 30, do not have children or may feel pressured into the decision by their partners.
- Your family situation – if you have completed your family, you may prefer to be surgically sterilised rather than continue to use a reversible method of contraception.
- Medical conditions – you may choose to have the procedure because you have a medical condition that would be affected by pregnancy.
- The procedure – it is important to find out about the procedure, including any possible side effects, risks and complications.
Tubal ligation is an operation that is usually done under general anaesthetic using a procedure called laparoscopy. Between one and three small cuts are made around the navel (belly button). A telescopic device called a laparoscope is put in through one of the cuts. A small camera at the tip of the laparoscope sends an image to a screen for the surgeon to see the internal organs. The surgeon works through these small holes to put clips on the tubes.
After tubal ligation
After having the operation, you can expect:
- to have some pain and nausea in the first four to eight hours (you may need pain medication for a short time)
- to have some abdominal pain and cramps for 24 to 36 hours
- to go home the same day
- to have no changes to your periods
- to have the stitches taken out by your surgeon after seven to 10 days
- to see your surgeon for a check-up in six weeks.
Risks and complications of tubal ligation
Possible risks and complications from tubal ligation include:
- an allergic reaction to the anaesthetic
- damage to nearby organs, such as the bowel or ureters
- infection, inflammation and pain, which is rare, but can be caused by a clip used in the procedure
- haemorrhage (very heavy bleeding)
- infection of the wound or one of the fallopian tubes
- pregnancy (the method is more than 99 per cent effective, but there is a very small chance of the tubes getting unblocked, which would mean a pregnancy could happen)
- ectopic pregnancy, where a pregnancy develops in the fallopian tubes rather than in the uterus (womb).
Caring for yourself after tubal ligation
It is important to follow the advice of your doctor or surgeon. Suggestions for caring for yourself after having surgery include:
- You should avoid intense exercise for seven days
- You can take pain medication to manage the pain, but should see your doctor if the pain is very strong.
- You can usually go back to work within a few days.
- You can start having sex again as soon as you feel ready. This is because the procedure starts working straight away.
Reversing tubal ligation
A woman usually chooses sterilisation if she is sure that she does not want children in the future, but circumstances can change. For example, a woman may start a new relationship, which may cause her to want a reversal.
Tubal ligation can be reversed, but this is not always successful. Success rates depend on the woman’s age, the length of the tubes when repaired and the type of sterilisation procedure used.
To reverse the procedure, the fallopian tubes are reached through a cut in the abdomen and the surgeon rejoins the cut tubes using very small stitches. Generally, the chance of getting pregnant after reversal of a tubal occlusion is about 60 per cent, with about 50 per cent of women having a baby after a reversal procedure.
The risk of ectopic pregnancy after a successful reversal is quite high. This is because scar tissue can stop the fertilised ovum from moving down the fallopian tube.
The tubal occlusion procedure involves putting a tiny, flexible device called a micro-insert (EssureTM) into each fallopian tube. These micro-inserts are shaped like coils and are made of titanium. After having the procedure, the body grows scar tissue around the inserts, which blocks the fallopian tubes.
Facts about this procedure include:
- Only a gynaecologist who has had further specialised training can perform the procedure.
- General anaesthetic is not needed, but can be used.
- A flexible device called a hysteroscope enters through the cervix (entrance to the uterus) and is threaded along a fallopian tube. Once the hysteroscope is in place, the micro-insert is released. This is then repeated for the other fallopian tube.
- The procedure usually takes less than 30 minutes.
- Tubal occlusion is more than 99 per cent effective in preventing pregnancy.
Issues to consider with tubal occlusion
Issues to consider include:
- Tubal occlusion is permanent and cannot be reversed, but it is possible to then get pregnant through in-vitro fertilisation (IVF).
- About one in 10 women cannot have the micro-inserts successfully put into both fallopian tubes because their tubes are slightly different to normal. There is no way of knowing which women this will apply to before the procedure starts. Some surgeons can perform a tubal ligation using laparoscopy on the same day if they are not able to perform a tubal occlusion.
- Possible complications include tearing the fallopian tube during the procedure and the micro-insert moving out of place.
- It can take three months before the fallopian tubes are blocked. Another method of contraception will be needed during this time.
- After having a tubal occlusion, an x-ray is needed to check if the tubes are blocked. Some women will also need a procedure called a hysterosalpingogram, which involves putting dye into the uterus and fallopian tubes and taking x-rays.
Other methods of contraception
Alternatives to tubal occlusion include:
- hormonal injections, rings and implants
- hormonal and copper intrauterine devices (IUDs)
- oral contraceptive pills, such as the combined pill and the mini pill
- barrier methods, such as male and female condoms
- vasectomy, which is a relatively simple method of permanent contraception for men.
Protection from sexually transmissible infections
Female sterilisation does not give protection from sexually transmissible infections (STIs). It is important to practise safer sex, as well as to prevent an unintended pregnancy. The best way to lessen the risk of STIs is to use barrier methods such as condoms with all new sexual partners. Condoms can be used for oral, vaginal and anal sex to help stop infections from spreading.
Where to get more information, support or advice
- Contact your local doctor (GP)
- Contact Family Planning Victoria's clinics
- Visit Better Health Channel