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Female sterilisation

Introduction

Female sterilisation is an effective form of contraception that permanently prevents a woman from being able to get pregnant.

The operation usually involves cutting or blocking the fallopian tubes, which carry eggs from the ovaries to the womb. This prevents the eggs from reaching the sperm and becoming fertilised. It can be a fairly minor operation, with many women returning home the same day.

In most cases, female sterilisation is more than 99% effective, and only one in 200 women will become pregnant after the operation.

Who is female sterilisation for?

Almost any woman can be sterilised. However, sterilisation should only be considered by women who do not want any more children, or do not want children at all. Once you are sterilised, it is very difficult to reverse the process (see Female sterilisation - risks), so it is important to consider the other options available (see below). Sterilisation reversal is not usually available on the NHS.

Surgeons are more willing to perform sterilisation when women are over 30 years old and have had children, although some younger women who have never had a baby choose it.

How common is female sterilisation?

Every year, thousands of UK couples choose sterilisation as their method of contraception. It has become increasingly popular since the late 1960s. In 2009-2010, more than 10,000 female sterilisation operations were carried out in hospitals in Wales and England.

Types of female sterilisation

There are two main types of female sterilisation: 

  • when your fallopian tubes are blocked, for example with clips or rings (tubal occlusion)  
  • when implants are used to block your fallopian tubes (hysteroscopic sterilisation)

See Female sterilisation - how it is performed for more information about these two procedures.

What are the alternatives?

  • Vasectomy: this method of sterilisation for men is simpler, less invasive and has a better chance of a successful reversal if you change your mind in the future.
  • Long-acting reversible methods of contraception, such as contraceptive implants and injections or the intrauterine device (IUD): these may be suitable if you do not want to get pregnant in the next few years, but may want to eventually.
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Getting Ready

Your GP will strongly recommend counselling before referring you for sterilisation. Counselling will give you a chance to talk about the operation in detail, and talk about any doubts, worries or questions that you might have.

If you decide to be sterilised, your GP will refer you to a specialist for treatment. This will usually be a gynaecologist at your nearest NHS hospital. A gynaecologist is a specialist in treating conditions of the female reproductive system.

Pregnancy test

Before you have the operation, you will be given a pregnancy test to make sure that you are not pregnant. It is vital to know this, because once the surgeon blocks your fallopian tubes, there is a high risk that any pregnancy will become ectopic (when the fertilised egg grows outside the womb, usually in the fallopian tubes). An ectopic pregnancy can be life-threatening because it can cause severe internal bleeding.

Contraception

You will be asked to use contraception until the day of the operation, and to continue using it:

  • until your next period if you are having your fallopian tubes blocked (tubal occlusion) 
  • for around three months if you are having fallopian implants (hysteroscopic sterilisation)

Sterilisation can be performed at any stage in your menstrual cycle. Your menstrual cycle lasts from the first day of your period up to, but not including, the first day of your next period.

Do I need my partner's permission?

You do not need your partner's permission to be sterilised, but some doctors prefer it if both partners agree to the operation.

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How is it performed?

Sterilisation is usually carried out using a technique called tubal occlusion (blocking the fallopian tubes). A cut is made in your abdominal wall to access your fallopian tubes.

An alternative method called hysteroscopic sterilisation involves inserting implants into your fallopian tubes. It does not require any cuts to be made into your body. The National Institute for Health and Clinical Excellence (NICE) has published guidance about hysteroscopic sterilisation. However, the technique is not yet widely available.

Both procedures are described below.

Tubal occlusion

First, your surgeon will need to access and examine your fallopian tubes, using either laparoscopy or mini-laparotomy.

Laparoscopy

This is the most common method of accessing the fallopian tubes. The surgeon makes a small cut in your abdominal wall near your belly button and inserts a laparoscope. A laparoscope is a small flexible tube that contains a light source and a camera. The camera relays images of the inside of your body to a television monitor. This allows the surgeon to clearly see your fallopian tubes.

Additional cuts can be made in your abdominal wall if other instruments, such as surgical scissors, need to be inserted.

See the topic about Laparoscopy for more information.

Mini-laparotomy

This involves a small incision, usually less than 5cm (2 inches), just above the pubic hairline. Your surgeon can then reach into your pelvis and access your fallopian tubes through this incision.

A laparoscopy is usually the preferred option because it is faster. However, a mini-laparotomy may be recommended for women who:

Blocking the tubes

The fallopian tubes can be blocked using one of the following methods:

  • applying clips: plastic or titanium clamps are closed over the fallopian tubes
  • applying rings: a small loop of the fallopian tube is pulled through a silicone ring, then clamped shut
  • tying and cutting the tube: this destroys 3-4cm (1.2-1.6 inches) of the tube

Hysteroscopic sterilisation (fallopian implants)

The implants are usually inserted under local anaesthetic (painkilling medication to numb the area). You may also be given a sedative to relax you.

A narrow tube with a telescope at the end called a hysteroscope is passed through your vagina and cervix. A guidewire is used to insert a tiny piece of titanium metal called a microinsert into the hysteroscope, then into each of your fallopian tubes. This means that the surgeon does not need to cut into your body.

The implant causes the fallopian tube to form scar tissue around it, which eventually blocks the tube.

You should carry on using contraception until an imaging test has confirmed that your fallopian tubes are blocked. This can be done with one or more of the following: 

  • an X-ray – when radiation is used to examine the inside of your body 
  • an ultrasound scan – when high-frequency sound waves are used to create an image of part of the inside of your body 
  • a hysterosalpingogram (HSG) – a type of X-ray that is taken after a special dye has been injected to show up any blockages in your fallopian tubes 

Removing the tubes (salpingectomy)

If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.

How long does tubal occlusion take?

Tubal occlusion is usually performed under general anaesthetic and takes around 30 minutes. Many women return home the same day.

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Advantages

Female sterilisation is more than 99% effective at preventing pregnancy.

Tubal occlusion (blocking the fallopian tubes) and removal of the tubes (salpingectomy) should be effective immediately. However, doctors strongly recommend that you continue to use contraception until your next period.

Hysteroscopic sterilisation (when implants are used to block the fallopian tubes) is usually effective after around three months. This will need to be confirmed with an imaging scan (see Female sterilisation - how it is performed). Research collected by the National Institute for Health and Clinical Excellence found that the fallopian tubes were blocked after three months in 96% of sterilised women.

Other advantages of female sterilisation include:

  • there are rarely any long-term effects on your health
  • it will not affect your sex drive,
  • it will not affect spontaneity of sexual intercourse or interfere with intercourse (as other forms of contraception can)
  • it will not affect your hormone levels
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Risks

Your GP will discuss with you the potential risks associated with sterilisation, and the things you need to consider. These are outlined below.

Sexual Health

Female Steriliasation does not protect you against sexually transmitted infections.  You should still use barrier methods of contraception, such as condoms, if you are unsure of your partner’s sexual health.

Tubal occlusion

Tubal occlusion is a more complicated operation than a vasectomy, which is the surgical procedure used for male sterilisation. A vasectomy does not require access to the abdomen.

There is a very small risk of complications - these include internal bleeding and infection or damage to other organs.

It is possible for sterilisation to fail.  The fallopian tubes can rejoin and make you fertile again, although this is rare (about one in 200 become pregnant again). If you do get pregnant after the operation, there is an increased risk that it will be an ectopic pregnancy (when the fertilised egg grows outside the womb, usually in the fallopian tubes). 

If you miss a period, take a pregnancy test immediately. If the pregnancy test is positive, you must see your GP so that you can be referred for a scan to check if the pregnancy is inside or outside your womb.

It is very difficult to reverse a tubal occlusion.  This involves removing the blocked part of the fallopian tube and re-joining the ends. Reversal operations are rarely provided by the NHS.

Hysteroscopic sterilisation (fallopian implants)

The National Institute for Health and Clinical Excellence (NICE) has found that fallopian implants are a safe and effective method for female sterilisation and can be routinely offered to women. However, you must use another form of contraception until an imaging scan has confirmed that your tubes are blocked. Also be aware that there is a small risk of pregnancy even after your tubes have been blocked.

Research collected by NICE showed that possible complications after fallopian implants can include:

  • pain after the operation – in one study, nearly 8 out of 10 women reported pain afterwards 
  • the implants being inserted incorrectly – this affected 2 out of 100 women 
  • bleeding after the operation – many women had light bleeding after the operation, and nearly a third had bleeding for three days

Periods

After female sterilisation, you will continue to have periods. If you previously used the combined contraceptive pill, you may notice that your periods are now heavier. This is not due to the operation, but because you have now stopped taking the pill, which can make your periods lighter.

Regretting the operation

Some women who have been sterilised regret having it done, especially if they were under 30 years old, had no children or were not in a relationship at the time.

It is difficult to reverse the operation, so it is essential that you are sure before you have it done.

Never get sterilised if you are under stress, especially if you have just given birth or had a miscarriage or an abortion.

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Recovery

Once you have recovered from the anaesthetic, passed urine and had something to eat, you will be allowed home. If you leave hospital within hours of the operation, ask a relative or friend to pick you up, or take a taxi.

The healthcare professionals treating you in hospital will tell you what to expect and how to care for yourself after surgery. They may give you a contact number to call if you have any problems or any questions.

If you have had a general anaesthetic, you should not drive a car for 48 hours afterwards.  This is because even if you feel fine, your reaction times and judgement may not be back to normal.

How you will feel

It is normal to feel unwell and a little uncomfortable for a few days if you have had a general anaesthetic.

You may have to rest for a couple of days. Depending on your general health and your job, you can normally return to work five days after tubal occlusion. However, you should avoid heavy lifting for about a week.

You may have some slight vaginal bleeding. Use a sanitary towel rather than a tampon until this has gone. You may also feel some pain, similar to period pain. You may be prescribed painkillers for this. If the pain or bleeding gets worse, seek medical attention.

Caring for your wound

If you had tubal occlusion to block your fallopian tubes, you will have a wound with stitches where the surgeon made an incision (cut) into your body. Some stitches are dissolvable and disappear on their own, and some will need to be removed. If your stitches need removing you will be given a follow-up appointment for this.

If there is a dressing over your wound, you can normally remove this the day after your operation. After this, you will be able to bath or shower as normal

Having sex

Your sex drive and enjoyment of sex will not be affected. You can have sex as soon as it is comfortable to do so after the operation,

If you had tubal occlusion, you will need to use contraception until your first period to protect yourself from pregnancy.  If you had hysteroscopic sterilisation (fallopian implants), you will need to use another form of contraception for around three months after surgery. After scans have confirmed that the implants are in the correct position, you will no longer need contraception.

Remember, sterilisation will not protect you from sexual transmitted infections (STIs), so continue to use barrier contraception, such as condoms, if you are unsure of your partner’s sexual health.

Seek medical attention

You should seek medical attention if:

  • your wound continues bleeding
  • there is pus or discharge from your wound
  • you have severe stomach pain that painkillers cannot help 
  • you are still vomiting after 24 hours (sometimes general anaesthetic will make you feel sick when you wake up, but this should pass) 
  • you have a high temperature (fever) of 38ºC (100.4ºF) or over 
  • you have difficulty passing urine
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