Tubal ligation

Originally Published: March 28, 2003
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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 surgical procedure of sterilization, a permanent form of pregnancy prevention. Sterilization is the most popular form of contraception among married couples.

To understand what it means for a woman to have her tubes tied, knowing a little bit about female anatomy will help. The ovaries produce eggs. These eggs travel through the fallopian tubes. If an egg and a sperm "hook up" in the fallopian tube, fertilization occurs. The fertilized egg travels to the uterus, where it imbeds itself and may develop as a pregnancy. If no fertilization occurs, the egg passes into the uterus, only to be shed along with the menstrual flow during a monthly period.

Tubal ligation is usually performed on an outpatient basis. Most practitioners use general anesthesia, so the patient will be unconscious throughout the procedure. Sometimes spinal or epidural anesthesia is used, in which case the woman will be awake but numb from about the waist down. Tiny "keyhole" incisions near the navel are made, using a scope and tiny instruments. It can also be done during or after a caesarean section or just after childbirth. During the procedure, the fallopian tubes may be surgically cut, cauterized, or sealed with heat or a clip. As a result, neither the egg nor the sperm can travel through the tubes to reach each other.

As with any surgery, there are risks, including those associated with undergoing general anesthesia, infection, bleeding, reactions to medications, and accidental damage to nearby organs and tissues.

Although most tubal ligations are successful, there is still a small 1:200 risk of surgical failure resulting in pregnancy. When pregnancy occurs after a tubal ligation, there is a great risk of having a tubal or ectopic pregnancy. Tubal or ectopic pregnancy is a life-threatening condition in which a fertilized egg grows and develops in the fallopian tube. This condition often requires emergency surgery.

Tubal ligation is a permanent method of contraception. While surgery can be performed successfully to reverse a tubal ligation, reversals are extremely expensive and many women are still unable to get pregnant.

While having this surgery prevents pregnancy, it does not protect a woman from getting sexually transmitted infections (STIs).

The question you bring up about hormonal imbalance after tubal ligation is interesting and controversial. Most researchers and health care providers say no, there are no hormonal imbalances that occur after tubal ligation.

However, a small number of women report symptoms that seem to suggest hormonal imbalances. This has been termed "post-tubal ligation syndrome." Some researchers suggest that these are normal symptoms that the women haven't noticed before, perhaps because they were on birth control pills that masked the symptoms. Because women typically discontinue birth control pills after having had a tubal ligation, women may notice new symptoms that they accidentally attribute to the tubal ligation. Some researchers and health care providers recommend that women stop using birth control pills well in advance of a tubal ligation, so that they are aware of what kinds of menstrual and pre-menstrual symptoms they will experience after the procedure.

Tubal ligation is a reliable form of permanent birth control. Women who undergo tubal ligation after careful consideration often find that they are better able to relax and enjoy intercourse, secure in their form of contraception.

Alice