Surgery Overview

Tubal ligation, often referred to as
“having your tubes tied,” is a surgical procedure in which a woman’s
fallopian tubes are blocked, tied, or cut.
Tubal implants, such as Essure, are small metal springs that are placed in each fallopian tube
in a nonsurgical procedure (no cutting is involved). Over time, scar tissue
grows around each implant and permanently blocks the tubes. Either procedure
stops eggs from traveling from the ovaries into the fallopian tubes, where the
egg is normally fertilized by a sperm.

Tubal ligation and tubal
implants are considered to be permanent methods of birth control for women.
They are usually done by a
gynecologist. They may also be done by a
family medicine doctor or a
general surgeon.

Tubal ligation method

There are several different
ways of closing the
fallopian tubes, including clipping or banding them
shut or cutting and stitching or burning them closed. Your surgeon will
probably prefer one of these tubal ligation methods.

A tubal ligation can be done using a:

An open tubal ligation (laparotomy) is done through a
larger incision in the abdomen. It may be recommended if you need abdominal
surgery for other reasons (such as a
cesarean section) or have had
pelvic inflammatory disease (PID),
endometriosis, or previous abdominal or pelvic
surgery. These conditions often cause scarring or sticking together (adhesion) of tissue and organs in the abdomen.
Scarring or adhesions can make one of the other types of tubal ligation more
difficult and risky.

Laparoscopy is usually done with a
general anesthetic. Laparotomy or mini-laparotomy can
be done using general anesthesia or a
regional anesthetic, also known as an epidural.

Reversing a tubal ligation is possible, but it isn’t
highly successful. This is why tubal ligation is considered a permanent method
of birth control.

Tubal implant method

Implants, such as Essure, are inserted in
the fallopian tubes without surgery or general anesthesia. The procedure is
done in a doctor’s office, an outpatient surgery center, or a hospital, and it doesn’t require an overnight stay. The implant procedure itself takes about 10
minutes.

  • Before the procedure, your
    cervix is first opened (dilated) to reduce the risk of
    injury to the cervix. Your doctor will use a
    speculum and a dilating instrument to gradually open
    the cervix just before the procedure.
  • For the procedure, you are
    positioned as you would be for a pelvic exam. Your doctor passes a
    thin tube (catheter) through your vagina and cervix, into the uterus, and then
    into a fallopian tube. The catheter is used to place an implant into a
    fallopian tube. An implant is then placed in the other fallopian tube the same
    way. You may have some menstrual-like cramps afterwards.

After the procedure, an
X-ray is taken to make sure the implants are in place
and the tubes are closed.

In some cases, a tubal implant can be
difficult to insert. Should this happen, a second procedure is needed to
completely block both tubes.

For the first 3 months after
insertion, you must use another method of birth control. At 3 months, dye is
injected into your uterus and an X-ray is taken (hysterosalpingography) to make sure that the implants
are in place and the tubes are fully blocked by scar tissue. If they are, you
will no longer have to use another method of birth control.

Advantages

Tubal ligation and tubal implants are
permanent methods of birth control and allow you to be sexually active without
worrying about becoming pregnant.

Although tubal ligation and
tubal implants are expensive, it is a one-time cost. These procedures are
usually covered by medical insurance, and there are no costs after the surgery
is done. The cost of other birth control methods, such as pills or condoms and
spermicide, may be greater over time.

Disadvantages

Tubal ligation and tubal implants do
not protect against
sexually transmitted infections (STIs), including
infection with the
human immunodeficiency virus (HIV). To help protect
yourself and your partner from possible STIs, use a condom every time
you have sex.

You must use another form of birth control for 3
months after receiving tubal implants.

What To Expect After Surgery

Tubal ligation

After a tubal ligation, you will
most likely go home the same day. Your surgeon will give you instructions on
what to expect and when to call after the surgery.

  • You may have some slight vaginal bleeding
    caused by the movement of your uterus during the surgery.
  • If you
    had a laparoscopy, your stomach may be swollen (distended) from the gas that
    was used to lift your skin and muscles away from your abdominal organs so the
    surgeon could see them better. This should go away within a day or so but may
    last longer. You may also have some back or shoulder pain from the gas in your
    abdomen. This will go away as your body absorbs the gas.
  • You can
    shower 24 hours after the surgery, but avoid rubbing or pulling on your
    incision for at least a week.
  • You can have sexual intercourse as
    soon as you feel like it and it does not cause pain, which is usually 1 week
    after surgery.
  • Be sure to rest for a few days (or at least 24
    hours) before beginning to resume your normal activities. You should be able to
    resume all activities within a week.
  • No backup method of birth
    control is needed after the surgery.

A follow-up exam in 2 weeks is usually scheduled.

Tubal implants

  • Most women can return to normal activities
    the same day as the procedure. You may have cramps, vaginal bleeding, or discomfort in your pelvis or back.
  • Be sure to use another method of
    birth control for 3 months, until an X-ray confirms that the fallopian tubes
    are blocked.

Why It Is Done

A tubal ligation or tubal implant
placement is a permanent method of birth control. Only
consider this method when you are sure that you will not want to become
pregnant in the future.

How Well It Works

Tubal ligation and tubal implants are
not 100% effective at preventing pregnancy.

Tubal ligation

  • There is a slight risk of becoming pregnant
    after tubal ligation. This happens to about 5 out of 1,000 women after 1 year.
    After a total of 5 years following tubal ligation, about 13 out of 1,000 women
    will have become pregnant.footnote 1
  • Pregnancy
    may occur if:

    • The tubes grow back together or a new
      passage forms (recanalization) that allows an egg to be fertilized by sperm.
      Your doctor can discuss which method of ligation is more effective
      for preventing tubes from growing back together.
    • The surgery was not done correctly.
    • You were
      pregnant at the time of surgery.

Tubal implants

  • Studies show
    that over 2 years, fewer than 1 out of 100 women with
    implants got pregnant.footnote 1
  • A tubal implant can be
    difficult to insert. Some women have to have a repeat procedure before both
    tubal implants are properly placed.

Call your doctor immediately if you have had tubal ligation or tubal implants and you
have:

  • Symptoms of pregnancy, such as a missed
    menstrual period, breast tenderness, and nausea.
  • Pain on one side
    of your lower abdomen and you feel faint or dizzy.

Risks

Tubal ligation. Major
complications of tubal ligation aren’t common.

  • Minor complications include infection and wound
    separation.
  • Major
    complications include heavy blood loss,
    general anesthesia problems, organ injury during
    surgery, and need for a larger laparotomy incision during surgery.

Although fewer complications occur with laparoscopy than
with other kinds of tubal ligation surgery, these complications can be more
serious. For example, in rare cases, the bowel or bladder is injured when
the laparoscope is inserted.

The general risks of surgery are
greater if you have
diabetes, are overweight, smoke, or have a heart
condition.

Tubal implants. Most women who have tubal implants don’t have problems. Some women do have problems, such as:

  • Pelvic pain.
  • Rash or itching, if she is allergic to nickel.
  • Movement of the implant through a fallopian tube into her belly or pelvis.
  • A break in the wall of her uterus or fallopian tube.

About 2 to 3 out of 100 women who have Essure will need another operation within 1 year.footnote 2

Before you receive implants, you may be tested to make sure
that you don’t have a vaginal infection or a
sexually transmitted infection (STI).

Ectopic pregnancy risk

If a tubal ligation or
implant fails and you become pregnant, you have an increased risk of having an
ectopic pregnancy. Ectopic pregnancies can occur years
after the tubal ligation and are most likely 3 or more years after the
procedure.footnote 3To learn more, see the topic
Ectopic Pregnancy.

What To Think About

Tubal ligation and tubal implants
do not change your monthly
menstrual cycle. You will still release an egg each
month (ovulate) and have menstrual periods. You will go through
menopause at the same time that you would have if you
hadn’t had the surgery. Your sexual desires won’t change, although you may
feel more relaxed about having sex because you don’t have to worry about
becoming pregnant.

Other things to think about

Reversing tubal ligation
or removing tubal implants requires major surgery, and success rates are very low. If you are considering tubal ligation or tubal implants, be absolutely certain that you
will never want to have a biological child in the future.

  • Health insurance coverage may require a
    waiting period from 48 hours to 30 days under most
    circumstances.
  • Some doctors advise a waiting period
    between the time a woman requests a tubal ligation or tubal implants and the time the procedure is
    performed. This waiting period allows you to be certain about your decision.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Roncari D, Jou MY (2011). Female and male sterilization. In RA Hatcher, et al., eds., Contraceptive Technology, 20th rev. ed., pp. 435-482. New York: Ardent Media.
  2. Mao J, et al. (2015) Safety and efficacy of hysteroscopic sterilization compared
    with laparoscopic sterilization: An observational cohort study. BMJ. DOI: 10.1136/bmj.h5162. Accessed November 12, 2015.
  3. Speroff L, Darney PD (2011). Sterilization. In A Clinical Guide for Contraception, 5th ed., pp. 381-404. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

  • U.S. Food and Drug Administration (2015). Essure benefits and risks. U.S. Food and Drug Administration. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452250.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery. Accessed July 9, 2015.

Credits

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Rebecca Sue Uranga, MD – Obstetrics and Gynecology

Current as ofMarch 16, 2017