Dear Alice,

What is the difference between getting your tubes tied vs. tubal ligation? Which is the best? What are the side effects? Could getting one of these surgeries cause hormonal imbalances?

Dear Reader,

"Getting your tubes tied" (the popular expression) and "tubal ligation" (the medical term) refer to the same form of sterilization and a permanent form of pregnancy prevention for women. To understand what it means for a woman to have her tubes tied, knowing a little bit about female anatomy will help. As a part of the female reproductive system, the ovaries produce eggs. These eggs travel through the fallopian tubes. If an egg and a sperm meet in the fallopian tube, fertilization occurs. A fertilized egg then travels to the uterus, where it imbeds itself on the uterine wall and may develop as a pregnancy. Tubal ligation is a procedure that cuts or blocks the fallopian tube in order to prevent an egg and sperm from meeting, thus preventing pregnancy. There are a few different tubal ligation procedures, each with their own pros and cons. To your question about hormonal imbalance as a result of the procedure, recent research suggests that tubal ligations do not have a significant impact on reproductive hormones (more on that later).

During a tubal ligation, anesthesia is typically used (the specific type depends on the procedure) and a small incision is made near the navel. Once the fallopian tubes are located, implements are used to severe, cauterize, or seal them. In a laparoscopic procedure, a tube with a viewing lens at the end of it is used to find the tubes. The benefits of this specific procedure are that it’s short (taking about 20 to 30 minutes on an outpatient basis), minimally invasive, and typically results in very little scarring. The mini-laparotomy procedure is also considered minimally invasive and typically performed in conjunction with a caesarean section or just after childbirth. The recovery period for both the laparoscopic and mini-laparotomy procedures is about one to two days, though it’s recommended to steer clear of heavy lifting for about a week. Used more rarely, the laparotomy procedure is considered major surgery that takes longer and results in a longer recovery period. The common denominator with all of these procedures is that the results are considered permanent. While surgery can be performed to attempt a reversal, they tend to be quite complicated and there’s no assurance that it will be successful.

As with any type of medical procedure, there are potential risks involved. For tubal ligation procedures, risks include adverse reactions to anesthesia or medications, infection, bleeding, and (in rare cases) accidental damage to nearby organs and tissues. Tubal ligations also do not protect against sexually transmitted infections (STIs), so condoms may be used to reduce the risk. Though most tubal ligations are successful and are effective immediately, about 5 in 1000 women will become pregnant after the procedure. If pregnancy does occur after a tubal ligation, there is a greater risk of having an ectopic pregnancy. This type of pregnancy occurs when a fertilized egg grows and develops in the fallopian tube. It’s considered to be life-threatening and requires immediate medical attention.

Previously, it was thought that the procedure resulted in a hormonal imbalance for some women, due to reports of symptoms including menstrual irregularities, pain, and cramping (referred to as "post-tubal ligation syndrome"). More recently, researchers have found that minor fluctuations in reproductive hormones can occur following the procedure, but they are usually temporary and when measured, were not found to be statistically significant. It’s also been found that reproductive hormones fluctuate naturally over time, especially in young and fertile women. One other research observation of note was that, in one study, women who’d used hormonal birth control prior to tubal ligation experienced a notable, but temporary change in hormone levels after the procedure (presumably due to the absence of hormones from the birth control when they stopped using it). Overall though, the procedure does not appear to have any sort of significant impact on the menstrual cycle, nor does it induce premature menopause.

All this to say, Reader, tubal ligation is a safe and reliable form of permanent birth control. For those who do not wish to have children, who’d like to limit the size of their family, who’ve not been satisfied with other birth control methods, or who’d like to avoid passing on a hereditary condition, this might be an attractive contraceptive option. It may also interest you to know that many women who undergo tubal ligation after careful consideration often find that they are better able to relax and enjoy sex even more because they aren’t worried about becoming pregnant. To learn more about this birth control option or weigh the pros and cons for yourself, it’s best to make an appointment to speak with your health care provider.


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