Tubal ligation

Definition

Tubal ligation (or "tying the tubes") is surgery to close a woman's fallopian tubes. These tubes connect the ovaries to the uterus. A woman who has this surgery can no longer get pregnant. This means she is "sterile."

Alternative Names

Sterilization surgery - female; Tubal sterilization; Tube tying; Tying the tubes; Hysteroscopic tubal occlusion procedure

Description

Tubal ligation is done in a hospital or outpatient clinic.

  • You may receive general anesthesia. You will be asleep and unable to feel pain.
  • Or, you will be awake and given local or spinal anesthesia. You will likely also receive medicine to make you sleepy.

The procedure takes about 30 minutes.

  • Your surgeon will make one or two small surgical cuts in your belly, usually around the belly button. Gas may be pumped into your belly to expand it. This helps your surgeon see your uterus and fallopian tubes.
  • Your surgeon will insert a narrow tube with a tiny camera on the end (laparoscope) into your belly. Instruments to block off your tubes will be inserted through the laparoscope or through a separate, very small cut.
  • The tubes are either burned shut (cauterized) or clamped off with a small clip or ring (band).

Tubal ligation can also be done right after you have a baby through a small cut in the navel or during a cesarean section.

Another sterilization method involves going through the cervix and placing coils or plugs in the tubes where they connect with the uterus (hysteroscopic tubal occlusion procedure). This technique does not involve cuts in the abdomen.

Why the Procedure Is Performed

Tubal ligation may be recommended for adult women who know for sure they do not want to get pregnant in the future.

Even though many women choose to have tubal ligation, some are sorry later that they did. The younger the woman is, the more likely she will regret having her tubes tied as she gets older.

Tubal ligation is considered a permanent form of birth control. It is NOT recommended as a short-term method or one that can be reversed. However, major surgery can sometimes restore your ability to have a baby. This is called a reversal. More than half of women who have their tubal ligation reversed are able to become pregnant.

A hysteroscopic tubal occlusion procedure is very hard to reverse.

Risks

Risks for any surgery are:

  • Bleeding
  • Damage to other organs (bowel or urinary systems) needing more surgery for repair
  • Infection

Risks for any anesthesia are:

Risks for tubal ligation are:

  • Incomplete closing of the tubes, which could make pregnancy still possible. About 1 out of 200 women who have had tubal ligation get pregnant later.
  • Increased risk of a tubal (ectopic) pregnancy if pregnancy occurs after a tubal ligation
  • Injury to nearby organs or tissues from surgical instruments

Before the Procedure

Always tell your doctor or nurse:

  • If you are or could be pregnant
  • What drugs you are taking, even drugs, herbs, or supplements you bought without a prescription

During the days before your surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop. Ask your doctor or nurse for help quitting.
  • If you are having the tubal occlusion procedure, you will be asked to take a hormone for at least 2 weeks before the procedure.

On the day of your surgery:

  • You will usually be asked not to drink or eat anything after midnight the night before your surgery, or 8 hours before the time of your surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital or clinic.

After the Procedure

You will probably go home the same day you have the procedure. Some women may need to stay in the hospital overnight. You will need a ride home.

You will have some tenderness and pain. Your doctor will give you a prescription for pain medicine or tell you what over-the-counter pain medicine you can take.

After laparoscopy, many women will have shoulder pain for a few days. This is caused by the gas used in the abdomen to help the surgeon see better during the procedure. You can relieve the gas by lying down.

You should avoid heavy lifting for 3 weeks, but you can return to most normal activities within a few days.

If you have the hysteroscopic tubal occlusion procedure, you will need to keep using a birth control method until you have a test 3 months after the procedure to make sure it worked.

For more information, see: Taking care of yourself after a tubal ligation

Outlook (Prognosis)

Most women will have no problems. Tubal ligation is an effective form of birth control for women. You will NOT need to have any tests to make sure you cannot get pregnant in the future if the procedure is done with laparoscopy or after delivering a baby.

Some women may need to have a test called hysterosalpingogram about 3 months after the procedure to make sure your tubes are blocked.

Your periods should return to whatever pattern is normal for you. If you used hormonal birth control or the Mirena IUD before, then your periods will change to whatever is normal for you after you stop using these methods.

Women who have a tubal ligation have a decreased risk of developing ovarian cancer.

References

Mishell DR Jr. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 14.

Review Date:2/26/2012

Reviewed by:Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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