October 26, 2022

Tubal ligation: weighing the pros and cons

by

The term “getting your tubes tied” is misleading. Here’s what to know about this permanent birth control method.


Sometimes tubal ligation is casually referred to as “getting your tubes tied,” but that’s not really an accurate term. Here’s how the birth control method, which is considered sterilization and is non-reversible, works.

During the “tube tie surgery,” the fallopian tubes are cut, not tied in a knot. Tubal ligation interrupts the path a human egg takes when it’s released from the ovary to travel to the uterus, where if the egg is fertilized it would implant and grow into a fetus. Without intact fallopian tubes, egg and sperm cannot meet.

How is the tubal ligation procedure done?

Tubal ligation can be done in two ways: through a small incision below the navel (a mini-laparotomy), or laparoscopically, which is a kind of minimally invasive surgery. Which way it’s done depends on when it’s done, said Dr. Elise Boos, an OB-GYN with Vanderbilt Women’s Health.

Usually a doctor does a tubal ligation laparoscopically. A camera is threaded through a small incision in the navel and incisions made in the lower abdomen to reach the fallopian tubes. Most people have the tubes removed completely, Boos said, because this can reduce risk of ovarian cancer in the future.

This is an outpatient procedure, meaning you do not need to spend a night in the hospital. It’s done with general anesthesia, so afterward the patient needs someone to drive home. 

Recovery depends on the person. “The incisions themselves may be sore, but probably the thing that causes the most discomfort is the air that’s used to inflate the abdomen” during the surgery, Boos said. Residual air takes time to expel, so it’s common to feel bloated for a few days. Typically the discomfort after surgery should only last a few days and within a week or two you are back to your normal daily activities. 

Sterilization at the time of childbirth

This procedure can be done while you’re in the hospital after giving birth. After a vaginal delivery, the doctor makes a small incision below the belly button and removes a piece of each fallopian tube. This is done in the operating room and typically patients will use an epidural or spinal for pain control. If they had an epidural from labor the doctors will make sure it provides enough anesthesia. Patients who did not have epidurals during labor can still have the surgery, either by getting a epidural before surgery or talking with the anesthesiologist about alternatives.  

If a tubal ligation is done at the time of a C-section (surgical) delivery, the surgeon removes a piece of each fallopian tube. The procedure does not make a hospital stay any longer after childbirth, Boos said. Recovery coincides with recovery from the birth and doesn’t add any additional discomfort. 

Who is a good candidate for the tubal ligation procedure? Who is not?

There are few restrictions on who can have tubal ligation done, though different insurance plans may have various requirements for coverage. Ask your health insurer what your plan covers and requires.

“Outside of that, there is no restriction on how old someone must be, whether they’ve had children, how many children they have or what their relationship status is or their sexual orientation,” Boos said. She sometimes hears from patients who say that health-care providers have discouraged them from sterilization, especially if they are young and/or do not already have children.

“In my practice, I listen to patients and discuss with them how they came to this decision, and why they are choosing this method of contraception when there are alternatives of nearly similar efficacy available in our market,” Boos said. Long-acting reversible contraceptives (such as implants and IUDs) are reliable options.

“But if ultimately a patient feels that this is the right method for them, I certainly do not pretend to know better than them, and take a lot of pride in respecting their decision to proceed with this. I recognize that this is a decision that they’ve probably put a lot of thought and deliberation into.”

It’s important to have detailed discussions with your health-care provider about tubal ligation, including your medical history. For some people, the risks of sterilization can outweigh the benefits. “For instance, a patient with a complex abdominal surgical history may have increased risk of adhesive disease, which could complicate their surgery,” Boos said. Similarly, patients with cardiac or pulmonary disease may be at increased risk of complication from general anesthesia. They may want to explore options such as contraceptive implants and IUDs,” which work very well but don’t require surgery.

Does tubal ligation stop periods and ovulation?

Tubal ligation does not prevent ovulation (the process where an ovary releases an egg). Many patients report that this procedure changed their menstrual cycle, Boos said, but what’s more likely happening is that the patient relied on hormonal birth control methods (such as the pill, the contraceptive ring or an IUD) until the sterilization. After the procedure, they gave up the hormonal methods, and their cycles reverted to whatever pattern it would have followed naturally. Thus, after tubal ligation you might experience changes in the frequency of your cycles, how heavy your periods are, etc. It’s due not to the surgery but to the lack of hormonal contraception.

If after sterilization a patient is bothered by their menstruation, providers often recommend hormonal contraception to regulate bleeding. However, some patient have medical conditions that will make certain forms of birth control unsafe, so you’ll want to discuss this with your doctor.

Will this affect hormones or menopause?

Generally, “tubal ligation does not affect the health or function of the ovaries,” Boos said, “which are the organs of the female reproductive system that produce hormones.” You can expect to have not only your natural menstrual cycle but to enter menopause at the same time you would have otherwise, with the same menopausal symptoms, she said. 

However, patients should be aware that because tubal ligation is a surgery, there are small, rare risks of injury to an ovary, which could in turn affect hormonal activity. 

Does tubal ligation affect the risk of cancer?

Tubal ligation lowers the risk of developing ovarian cancer, Boos said. Recent evidence suggests that some ovarian cancers actually begin in the fallopian tubes, so removing those tubes can help reduce the chances of a future ovarian cancer.

Some hormone-based birth control methods also reduce the risk of certain cancers of the female reproductive system, Boos said. Some patients at high risk for ovarian or endometrial cancer may keep using hormone-based contraception after tubal ligation to help prevent those cancers. It’s best to discuss your medical history with your OB-GYN to decide if you should use hormone-based birth control even after tubal ligation. 

Beware claims of reversing tubal ligation

Tubal ligation is considered permanent sterilization. But Boos is aware of health-care providers who say they can reverse this procedure to allow someone to conceive naturally. Boos cautioned that those surgeries are usually not covered by insurance. Even after surgery to reverse sterilization, many patients will not be able to become pregnant naturally and their best path to pregnancy is with in vitro fertilization (IVF), Boos said. IVF is notoriously expensive and time-consuming. It is rare for insurance to cover the cost of IVF. 

Care for all stages of life

Vanderbilt Women’s Health provides the best in women’s health care at locations across Middle Tennessee.

Find Locations