Tubal ligation, or “having one’s tubes tied,” is a procedure intended for permanent sterilization in women. Roughly 33% of women who are married use tubal ligation as a method of contraception. The Centers for Disease Control and Prevention (CDC) name tubal ligation as the second most common form of birth control after oral contraceptives.
A tubal ligation involves closing off the fallopian tubes so that eggs cannot travel to the uterus and be fertilized by sperm. Having one’s tubes tied refers to cutting and stitching, burning and sealing, or clipping and banding the fallopian tubes shut.
Several methods of tubal ligation exist. If the patient is in good health, the preferred method is laparoscopic tubal ligation, which uses a lighted lens tube and leaves little scaring. Another type is mini-laparotomy tubal ligation (or mini-lap), which pulls part of the fallopian tubes out of the incision, ties them, and replaces them. This method leaves even smaller scars. A similar method is postpartum tubal ligation, which is a “mini-lap” performed soon after childbirth. A less common form of tubal ligation called the Essure procedure was approved in 2002. This method involves a catheter placing micro-inserts into the fallopian tubes. Scar tissue eventually grows over these inserts, blocking the tubes. A woman should ask her doctor about which method is best for her, since a patient’s medical history often determines the type of tubal ligation performed.
Post-op procedure involves a 2-4 hour monitored hospital stay and a list of home care directions to follow. A tubal ligation can affect a woman’s menstrual cycle, libido, and hormone production.
Pregnancy after Tubal Ligation
Although getting one’s tubes tied is considered a permanent form of birth control, it is not always 100% effective. A study by Comprehensive Gynecology, 4th edition, reported 5 in 1,000 women after 1 year and 18 in 1,000 women after 10 years experiencing pregnancy after their tubal ligations.
Several factors can cause this. A patient’s fallopian tubes may grow back together or grow a new path to the uterus, the patient can be unknowingly pregnant at the time of the surgery, or the surgery can be performed improperly. A patient should contact her doctor if she experiences any of the following, as these are symptoms of a tubal pregnancy:
- Breast tenderness
- Missed menstrual periods
- Pain on one side of the lower abdomen
Tubal Ligation Reversal
Every year in the US, approximately 650,000 women receive a tubal ligation. Within five years, roughly six percent of patients desire a reversal. Women who are under the age of 30 are advised against getting their tubes tied because of the difficulty involved in tubal ligation reversal. The procedure reconnects the fallopian tubes, allowing eggs to pass through to the uterus and potentially become fertilized by sperm. However, not every patient is considered an ideal candidate for tubal ligation. True successful tube reconnections are rare and depend on the length of the remaining fallopian tubes and other factors. Typically, the diameters of each end of the fallopian tubes must be identical for the procedure to be a success.
Many women opt for a tubal ligation reversal in hopes to stop the effects of post tubal ligation syndrome (PTLS). The Department of Obstetrics and Gynecology lists symptoms of PTLS as lower back pain, intercourse pain, hemorrhaging, no menstruation or difficulty menstruating, or premenstrual tension syndrome. It also contributes the syndrome to various problems with circulation. The cause and cure for this syndrome is still being explored and is hotly debated. Women considering a tubal ligation should carefully consider the benefits and risks involved and discuss these with their doctors.
[page updated December 2008]