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Patient education: Permanent birth control for women (Beyond the Basics)

Patient education: Permanent birth control for women (Beyond the Basics)
Literature review current through: Jan 2024.
This topic last updated: Mar 07, 2023.

INTRODUCTION — The most common form of permanent birth control (contraception) for women is called a tubal ligation or having the "tubes tied." This is a safe and highly effective option for women who wish to prevent pregnancy permanently.

During ovulation, an egg is released from the ovary. The fallopian tubes are the passageway for the egg to travel from the ovary to the uterus (figure 1), and where the egg can be fertilized by sperm. During a tubal ligation, the fallopian tubes are both cut, separated and tied, or sealed shut. Another approach, called a bilateral salpingectomy, involves removing both of the fallopian tubes completely. These procedures prevent the egg and sperm from meeting, thus preventing pregnancy. Both of these methods may also reduce your risk of developing ovarian cancer in the future.

Either procedure may be done in one of several ways, depending on when it is done (immediately after childbirth or at another time).

Laparoscopy is done in the operating room any time other than after childbirth. It requires general anesthesia. (See 'Laparoscopy' below.)

Minilaparotomy is performed in an operating room, using general or regional anesthesia, often within one to two days after giving birth. (See 'Minilaparotomy' below.)

Permanent birth control procedures can also be performed at the time of a cesarean birth ("C-section"). No additional incisions are required.

Other (nonpermanent) methods of birth control are discussed separately. (See "Patient education: Birth control; which method is right for me? (Beyond the Basics)" and "Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)" and "Patient education: Hormonal methods of birth control (Beyond the Basics)" and "Patient education: Long-acting methods of birth control (Beyond the Basics)".)

DECIDING ON PERMANENT BIRTH CONTROL — Having a permanent birth control procedure is a major decision; it means deciding that you never want to get pregnant in the future. This choice must be your own and not forced onto you by anyone else, including your family, partner, or health care provider.

In the United States, it is not necessary to obtain the consent of your partner before having the procedure; however, it is a good idea for both you and your partner to fully understand the procedure as well as the benefits, potential risks, and alternatives. Some couples choose male permanent birth control (vasectomy) as an alternative. (See "Patient education: Vasectomy (Beyond the Basics)".)

Your clinician should provide an explanation of the details of the procedure, including the options for anesthesia (general, spinal, or local), and the risk of pregnancy following the procedure (see 'What to expect after a permanent birth control procedure' below), including the chance of ectopic pregnancy (when a pregnancy begins to grow outside of the uterus, usually in the fallopian tube). You can change your mind at any time before the procedure.

Permanent birth control procedures should be considered a permanent and final decision to prevent future pregnancy. Reversing a tubal ligation procedure involves major surgery, is not always successful, and is rarely covered by insurance plans. A complete salpingectomy procedure (where the tubes are removed completely) is not reversible. If you think there is a possibility that you may change your mind about wanting to get pregnant in the future, you should choose a different form of birth control. There are options that are long-acting and effective but not permanent. (See 'Alternatives' below.)

Alternatives — Alternatives to permanent birth control procedures for women include permanent male birth control (vasectomy); long-acting reversible methods, including intrauterine devices (IUD) and contraceptive implants (in the skin of the arm); and short-acting reversible types of contraception (birth control pills/patch/vaginal ring, condoms, diaphragm, cervical cap, or the contraceptive injection). IUDs and implants prevent pregnancy just as well as permanent birth control procedures.

All of these methods are discussed in detail separately. (See "Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)" and "Patient education: Hormonal methods of birth control (Beyond the Basics)" and "Patient education: Long-acting methods of birth control (Beyond the Basics)" and "Patient education: Vasectomy (Beyond the Basics)".)

Regret after permanent birth control — While most people are happy with their decision following a permanent birth control procedure, some do have regrets later. This is sometimes known as "tubal regret." The factor most strongly associated with regret is being younger than 30 years old at the time of the procedure. The younger a woman is, the more likely they are to regret the decision later [1]. Other factors that might lead to regret include relationship problems at the time of the procedure, stress due to recent pregnancy complications, pregnancy loss, death of an infant or child, and being in a new relationship after having the procedure.

For these reasons, if you are younger than 30, have recently given birth and had significant complications (eg, premature birth, death of an infant), or are having problems with your relationship, you may want to consider other birth control options. Your health care provider may recommend delaying permanent birth control until you are certain of your decision. While the decision is yours alone, if you are unsure at all, you may want to choose a long-acting but reversible method of birth control (eg, an IUD or implant) instead. These are as effective as permanent birth control at preventing pregnancy but can be removed in the future if you wish to become pregnant.

Timing of procedure — Permanent birth control procedures can be performed at any time during the menstrual cycle, although having the procedure just after your period lowers the risk that you could be pregnant (even without knowing it) at the time of the surgery.

The procedure can also be performed after childbirth (postpartum), after an abortion, or in conjunction with another surgical procedure (eg, gallbladder removal). Ideally, postpartum procedures are performed immediately after childbirth or within 24 hours, although the procedure may be done up to seven days later. Delaying the procedure for more than seven days increases the difficulty of the procedure and the risk of infection.

Preventing pregnancy before a permanent birth control procedure — Before your procedure, you should use another method of birth control (such as condoms, a diaphragm, birth control pills, injections, or the IUD) to decrease the risk of pregnancy. It is possible to get pregnant if fertilization occurs just prior to the procedure. Performing the procedure immediately postpartum, at the time of an abortion, or during (or immediately following) your menstrual period reduces the chance of this happening.

Although permanent birth control is very effective, it does not prevent sexually transmitted infections. Condoms are the only birth control method that is known to reduce the risk of sexually transmitted infections and are recommended for anyone who might be at risk, such as people with more than one sex partner or those whose partner has other partners. (See "Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)".)

SURGICAL APPROACHES

Laparoscopy — This is a surgical procedure that is done in an operating room at a time other than after childbirth. It requires general anesthesia, meaning you will be "put to sleep" so you are unaware of what is happening during the procedure. During the procedure, a small incision is made near the belly button and in the lower abdomen, and a thin camera device (a laparoscope) is used to view the fallopian tubes. The doctor either uses heat to seal the tubes shut or uses rings or clips to close the fallopian tubes.

Another method clinicians may offer for laparoscopic permanent birth control is a bilateral salpingectomy, in which both tubes are removed entirely. All of these methods are very effective at preventing pregnancy, and your doctor may talk to you about risks, benefits, and reasons for choosing one of these methods over another.

Minilaparotomy — A minilaparotomy is a surgical procedure done one to two days after childbirth. It is done in an operating room using either general or regional (eg, spinal) anesthesia. The doctor makes a small incision (one to three inches) in the abdomen, and then removes a section of the fallopian tubes on each side. When this procedure is done during the postpartum period, it does not lengthen the hospital stay.

One advantage of minilaparotomy is that a portion of the tube is completely removed, which ensures that the fallopian tubes have been completely cut. Disadvantages of minilaparotomy include a greater need for pain medication, a slightly longer recovery time, and a larger surgical incision than with a laparoscopic procedure.

WHAT TO EXPECT AFTER A PERMANENT BIRTH CONTROL PROCEDURE

Immediately following the procedure — Most people are able to go home a few hours after having a permanent birth control procedure when performed separately from childbirth. Someone should be available to drive and help you as needed. You can expect some discomfort at the incision site and menstrual-type cramping. This can be treated with pain medication such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). Some people will have a sore throat (from a tube placed to help with breathing during general anesthesia), neck or shoulder pain, vaginal discharge, or light bleeding.

You will most likely be able to return to your normal routine within a couple of days. Your doctor will likely instruct you not to place anything in your vagina (eg, tampons, douches) and to avoid sexual intercourse for approximately two weeks. (See "Patient education: Care after gynecologic surgery (Beyond the Basics)".)

Complications — Complications of laparoscopic and minilaparotomy procedures occur in approximately 1 of every 1000 procedures. The most common complications include infection, injury to other organs, internal bleeding, and problems related to anesthesia.

Effect on monthly periods — There is no evidence that bleeding or uterine cramping increases after a permanent birth control procedure. In fact, people who have the procedure are more likely to have fewer days of bleeding during menstruation, a lower amount of blood loss, and less menstrual pain. However, some people who have had a permanent birth control procedure have described more irregularity in their menstrual cycle. You may also notice changes in your menstrual cycle if you stop taking a hormonal method of birth control (such as the pill) after having a permanent birth control procedure.

Sexual desire — Permanent birth control procedures do not affect sexual desire or performance.

Pregnancy — It is uncommon to become pregnant after a permanent birth control procedure, though no method of birth control can prevent pregnancy 100 percent of the time. The long-term pregnancy rate for women who have had a permanent birth control procedure is less than 1 percent [2]. When pregnancy does occur after the procedure, the risk of ectopic pregnancy is increased compared with people who have not had a permanent birth control procedure. An ectopic pregnancy is a pregnancy that grows outside of the uterus, usually in the fallopian tube, which can be life-threatening if not promptly treated. (See "Patient education: Ectopic (tubal) pregnancy (Beyond the Basics)".)

Although it is rare to get pregnant after a permanent birth control procedure, because of the risk of ectopic pregnancy, it is important to contact your health care provider as soon as possible if you think you might be pregnant. (See "Patient education: Ectopic (tubal) pregnancy (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Permanent birth control for women (The Basics)
Patient education: Choosing birth control (The Basics)
Patient education: Vasectomy (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)
Patient education: Birth control; which method is right for me? (Beyond the Basics)
Patient education: Hormonal methods of birth control (Beyond the Basics)
Patient education: Long-acting methods of birth control (Beyond the Basics)
Patient education: Vasectomy (Beyond the Basics)
Patient education: Ectopic (tubal) pregnancy (Beyond the Basics)
Patient education: Care after gynecologic surgery (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Intrauterine contraception: Candidates and device selection
Contraception: Issues specific to adolescents
Depot medroxyprogesterone acetate (DMPA): Formulations, patient selection and drug administration
Emergency contraception
Internal (formerly female) condoms
Fertility awareness-based methods of pregnancy prevention
Hormonal contraception for menstrual suppression
Pericoital (on demand) contraception: Diaphragm, cervical cap, spermicides, and sponge
External (formerly male) condoms
Contraception: Counseling and selection
Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use
Vasectomy
Contraception: Progestin-only pills (POPs)
Combined estrogen-progestin contraception: Side effects and health concerns
Female interval permanent contraception: Procedures

The following organizations also provide reliable health information.

National Library of Medicine

(https://medlineplus.gov/healthtopics.html)

Planned Parenthood

(www.plannedparenthood.org)

Society of Obstetricians and Gynaecologists of Canada (SOGC)

(https://sogc.org/)

Managing Contraception

(https://managingcontraception.com/)

Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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