Contraception - female sterilisation

Sterilisation is a permanent form of contraception. Sterilisation is a method of contraception a woman may choose when she is certain she doesn’t want children in the future. The most common method of sterilisation is tubal occlusion, which is the surgical blocking of the fallopian tubes. Female sterilisation is also called tubal ligation (tying) or more commonly, ‘getting the tubes tied’. A less invasive procedure involves placing a tiny, flexible device (micro-insert) into each fallopian tube; this is called the Essure method.

How sterilisation prevents conception
During ovulation, an egg is released from the ovary and swept down the fallopian tube. If the egg meets up with a sperm, conception takes place. Sterilisation blocks the path of the sperm through the tube. Eggs are still released by the ovaries, but they are broken down and safely reabsorbed by the body.

As the ovaries are not affected by this procedure, periods will continue as normal, because the ovaries will continue to release the same hormones. Tubal occlusion does not cause menopause or affect sexual desire or pleasure.

Although tubal occlusion can often be reversed, it is considered a permanent form of contraception. Essure is not reversible.

Issues to discuss
Issues to discuss with your doctor, if you are thinking about sterilisation include:

• Your age – doctors are generally hesitant to perform sterilisation procedures for women who are younger than 30 years, have no children or who 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 use contraceptives for the rest of your reproductive years.
• Medical issues – you may choose to undergo the procedure because you have a medical condition that would be made worse by pregnancy.
• Operation procedure – you should find out about the procedure, including side effects, risks and complications.

• Some pain and nausea in the first four to eight hours. You may need painkillers for a short time
• Some abdominal discomfort for 24–36 hours from the gas used during laparoscopy
• To go home the same day
• Your surgeon will remove non-dissolvable stitches seven to 10 days after surgery
• You will need to see your surgeon for a check-up about six weeks after surgery.

• Allergic reaction to the anaesthetic
• Damage to nearby structures, such as the bowel or ureters
• Occasionally, a clip or ring used in the tubal ligation procedure may cause infection, inflammation and pain
• Haemorrhage
• Infection of the wound or a fallopian tube
• Pregnancy (the method is more than 99 per cent effective but, sometimes, the tubes can become unblocked)
• A risk of ectopic pregnancy in women who fall pregnant after tubal occlusion. An ectopic pregnancy is one that develops in the fallopian tubes rather than in the uterus (womb).

• Exercise – avoid strenuous exercise for several days.
• Pain – painkillers are usually enough to manage the pain. See your doctor if you experience severe pain.
• Work – most women can return to work within a few days.
• Sex – sexual intercourse can be resumed as soon as you feel ready.
• Menstruation – should return to normal quickly
• Contraceptive cover – tubal occlusion is effective straight away.

• A gynaecologist who has undergone specific extra training can perform the procedure.
• General anaesthesia isn’t needed, although it is available if the patient prefers.
• A flexible device called a hysteroscope is inserted through the cervix and threaded along a fallopian tube. Once the hysteroscope is in place, the micro-insert is released. This is repeated for the other fallopian tube.
• The procedure takes about 30 minutes.
• Essure’s effectiveness rate is more than 99 per cent.

• About one in 10 patients cannot have the micro-inserts successfully placed into both fallopian tubes because their tubes may be slightly different than normal. There is no way to determine which women this will apply to before the procedure starts. Some surgeons are set up to enable you to have a tubal occlusion using laparoscopy on the same day if they are not successful in placing both the Essure inserts in the fallopian tubes.
• Possible complications include tearing the fallopian tube during the procedure, and the micro-insert moving out of place.
• There are no known life-threatening complications.
• It can take three months before the fallopian tubes are effectively blocked. Other contraception will be needed during this time.
• An x-ray is needed to check if the tubes are blocked. Some woman will need another procedure (hysterosalpingogram) to determine whether their tubes are blocked. This involves putting dye into the uterus and fallopian tubes and taking x-rays.

• Barrier methods of contraception, such as male and female condoms
• Oral contraceptive pills
• Hormonal injections, rings and implants
• Intrauterine device (IUD)
• Vasectomy, which is a relatively simple form of permanent contraception for men.

• Your doctor
• Family Planning Victoria Tel. (03) 9257 0100
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
• Community health centre
• Reproductive specialist
• Pharmacist

• Tubal occlusion is the surgical tying or blocking of the fallopian tubes.
• The tubes may be clipped, removed or have small sections taken out.
• Sterilisation does not provide protection against sexually transmissible infections (STIs).
• Successfully reversing a tubal occlusion depends on the woman’s age, the type of sterilisation procedure used and the length of the tubes when repaired.

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