What Is Tubal Ligation?

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Tubal ligation, also known as having your tubes tied, is a kind of surgery that will stop you from ever being able to get pregnant. If you’re thinking about having it done, it's important to understand the procedure and its advantages and disadvantages before making a decision.

“Tubal” refers to your fallopian tubes, and “ligation” means to tie off. Fallopian tubes are thin tubes that connect each of your ovaries to your uterus (womb). They are also called ovarian tubes. They’re passageways for unfertilized eggs. In a tubal ligation, you’ll have surgery to cut or block your fallopian tubes. That way, the eggs released by your ovary each cycle can't meet up and be fertilized by sperm.

illustration of tubal ligation

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Tubal ligation is a permanent method of birth control that involves surgery to cut or block your fallopian tubes. (Photo Credit: Science Picture Co/Science Source)

Tubal ligation is a surgery that blocks the tubes with a small cut, tie, clamp, or band. That way, eggs released from your ovaries can’t get through to your uterus to implant. They also can’t meet up with sperm and become fertilized. Tubal ligation is also called sterilization because it makes it impossible to get pregnant from sexual activity. Tubal ligation lasts forever.

Tubal ligation vs. bilateral salpingectomy

A similar surgery that also makes it impossible to get pregnant is called bilateral salpingectomy. During a salpingectomy, your surgeon will take out all or part of your tube. Bilateral is a way of saying “both sides.” In a bilateral salpingectomy, a surgeon removes both tubes. This is important because people can still get pregnant with just one tube. When both tubes are taken out, your eggs can’t get to your uterus or meet up with sperm, and you won’t be able to get pregnant.

The processes for bilateral salpingectomy and tubal ligation are similar, and their risks too are about the same. After either surgery, it’s rare to have a fertilized egg implant itself outside your uterus (also called an ectopic pregnancy). However, some scientists think the chance of having an ectopic pregnancy is lower if you have a bilateral salpingectomy compared to a tubal ligation.

The main reason that some people pick a bilateral salpingectomy over a tubal ligation is that a bilateral salpingectomy might make you less likely to get ovarian cancer.

The tops of your fallopian tubes have small “fingers” on them, called fimbriae. When you ovulate, the fimbriae wave around to “catch” the egg and guide it into the tube. Scientists now think that some ovarian cancers start out as tiny tumors floating in the fallopian tubes. When the fimbriae “wave,” these cells get passed on to the ovary, where they start to grow into cancer. Taking out your tubes stops them from passing cancer cells onto your ovaries.

Scientists think that tubal ligation also cuts down your risk of getting ovarian cancer, but it’s not as helpful as bilateral salpingectomy. Taking out the ovaries prevents ovarian cancer, but it can have a lot of side effects because your ovaries make hormones that affect many aspects of your health. Bilateral salpingectomy doesn’t usually have many side effects.

Both tubal ligation and bilateral salpingectomy are permanent, and people who get these surgeries need to be sure that they don’t ever want to get pregnant again. Sometimes, doctors can try to undo a tubal ligation by sewing the tube back together, but there is no way to try to undo a bilateral salpingectomy.

Whether to have a tubal ligation or a bilateral salpingectomy is a personal decision. What you choose might depend on your insurance and what it covers, the cost, side effects, as well as your medical situation and goals. Your health care provider can help you think through which surgery is right for you.

It’s permanent. This is a big plus if you don’t want to have children or you don’t wish to have any more.

It works. Only about 1 in 200 of those who’ve had a tubal ligation get pregnant. That’s less than 1%.

It doesn’t affect your hormones. It won’t change your periods or bring on menopause. And it doesn't cause the side effects that birth control pills can, such as mood swings, weight gain, or headaches, or the ones sometimes caused by IUDs, such as cramps, heavier periods, or spotting.

You don't need to remember to do anything. You don’t have to put in a diaphragm, take a pill, use a condom, or count days on the calendar to avoid pregnancy. That may make you feel more relaxed about sex.

It may lower your chances of ovarian cancer. Scientists aren't sure exactly why this happens, but research has shown that tubal ligation can greatly lower the odds of this type of cancer.

If pregnancy would be a health risk for you, or if you or your partner has a genetic disorder that would be risky to pass on to a child, tubal ligation may be right for you.

It’s permanent. While it can sometimes be reversed with surgery, that's not always possible. Only around half of those who have a reversal are able to get pregnant. Unless you're certain that you'll never want to get pregnant, tubal ligation isn’t right for you.

In some cases, it’s possible to reverse tubal ligation. But it’s a major surgery that requires a couple of days in a hospital.

There is a good chance that you might not be able to get it reversed. It depends on the method used for tubal ligation, how long ago it was done, and whether your tubes are too damaged to undo it.

Reversing a tubal ligation raises your chances of an ectopic pregnancy.

It doesn’t protect against STDs. You’ll need to use condoms to prevent sexually transmitted diseases, including HIV.

Pregnancy. It’s rare, but tubal ligation can fail. If your tubes aren’t completely closed, you can get pregnant.

It may lead to an ectopic pregnancy. If you do get pregnant, you’re more likely to have this type of pregnancy, which occurs someplace other than the uterus, usually in one of your fallopian tubes. Ectopic pregnancy may cause the tube to burst. This can lead to severe bleeding. You’ll need surgery right away to fix it.

There are risks to surgery. Problems are very rare, but this type of surgery can cause bleeding or damage your bowel, bladder, or major blood vessels.

After tubal ligation, you might have a rapid decline in the hormones estrogen and progesterone. Whether this may occur is often debated, but it is referred to as post-tubal ligation syndrome(PTLS). Symptoms are a lot like menopause: hot flashes, night sweats, vaginal dryness, mood swings, trouble sleeping, a lower sex drive, and irregular periods. Or you could have heavy, painful periods.

Getting tubal ligation is a big decision because it means that you’ll never be able to get pregnant from sexual activity ever again. First, your doctor, nurse, or counselor will talk to you to make sure you understand how the procedure will impact you, now as well as in the future. Often, they’ll ask you some questions to make sure that no one is forcing you to get your tubes tied. They’ll also explain the process, its risks, and recovery, and answer any questions you may have.

You can choose to have tubal ligation at any time. Some people decide to have tubal ligation during a Cesarean birth or an abortion procedure, or when they are having another surgery in the same area of their body. You can also get tubal ligation right after having a miscarriage or giving birth. If you decide to get the procedure after giving birth, you should have it in the first week after your baby is born. After that, it's best to give yourself a little while to heal from birth before getting your tubes tied.

Depending on whether you’re having just tubal ligation, getting another surgery at the same time, or giving birth, the procedure might happen at a hospital or an outpatient surgical clinic. There are a few different kinds of tubal ligation procedures:

Laparoscopic tubal ligation

This type of surgery uses very small cuts to shorten recovery time and reduce your risk of getting an infection. It can happen at a hospital or an outpatient clinic.

First, you’ll get an IV with medicine to make you relaxed. You’ll either get a medicine that puts you to “sleep” (anesthesia) or a shot of numbing medication in your back or belly. Once you can’t feel anything, your doctor will make a small cut near your belly button. Then, they will fill your belly up with gas to make it easier to see, and pass a tiny camera, called a laparoscope, through the cut. 

Next, your doctor will make another small cut near your pubic bone, around where your hair starts, to get to your fallopian tubes. They will either put a small band or clip around each tube to close them or use an electric current to seal them shut. You’ll get a few stitches to close your cuts. The entire laparoscopic tubal ligation takes about half an hour.

After your surgery, they will watch you for a few hours to make sure you're okay. People can usually go home about 4 hours after a laparoscopic tubal ligation. This kind of procedure takes less time to heal because the cuts are so small.

Rarely, something may happen during a laparoscopic tubal ligation, making the doctors change over to a laparotomy, where they make bigger cuts. This happens to less than 1 in 100 people who have laparoscopic tubal ligations.

Laparotomy

A laparotomy is a more intensive kind of tubal ligation than a laparoscopic tubal ligation. It’s usually done when someone is having their tubes tied at the same time as they give birth by Cesarean section (C-section).

With this procedure, your doctor will make a bigger cut in your belly, usually about 2-5 inches long. Then, they’ll pick your uterus and tubes up through this cut, and use a ring or clamp to tie your tubes closed. During a C-section birth, your doctor has already made a cut into your belly and picked up your uterus to deliver your baby. They’ll use the same cut to get to your fallopian tubes for the tubal ligation.

Once your tubes are closed, the doctor will sew the cuts closed. Most people have to stay in the hospital for a night or two after having a laparotomy. If you just had a baby with a C-section, you’ll probably already be staying in the hospital for a few nights. Because a laparotomy procedure is a bigger surgery than a laparoscopic tubal ligation, it will take longer to heal, usually a few weeks.

Mini-laparotomy tubal ligation

This kind of tubal ligation surgery is also called a mini-lap. It’s most often done if you decide to have tubal ligation right after you give birth. If you have a C-section, your doctor is more likely to recommend a laparotomy procedure during your birth, as they will already be cutting into your belly to deliver your baby. But if you give birth vaginally, you can have a mini-lap surgery after your baby is born.

For this surgery, you’ll get an epidural or spinal -- this is when the doctor puts numbing medication directly into your spine so you can’t feel anything from your belly down. Some people get an epidural during labor to help with the pain of childbirth. If you had an epidural during your birth, they will probably leave it in and do your tubal ligation while you’re still numb.

Because of how much your uterus grows when you’re pregnant, your uterus and tubes are near your belly button right after you give birth. The doctor will make a cut near your belly button and take your tubes out through the cut. Then, they will sew your tubes closed, put your tubes back in, and sew up the cut.

If you have a mini-lap tubal ligation surgery when you haven’t been pregnant recently, you’ll still get an epidural or spinal so you can’t feel anything. In this case, the doctor will make the cut on your lower belly near your pubic bone, around where your hair starts. They might tie your tubes closed with stitching, a ring, or a clamp.

Hysteroscopic sterilization

In the past, hysteroscopic sterilization was another option for getting your tubes tied. It was also called Essure or Adiana. For hysteroscopic sterilization, a health care provider would put a small, specially designed metal coil inside each tube. Over time, the metal would irritate the inside of the tube and cause scar tissue to build up. After about 3 months, there would be so much scar tissue that the tube would be completely blocked.

The biggest pro of hysteroscopic sterilization was that it could seal your tubes shut without surgery. The health care provider would put the metal coil right into your tube by going through your vagina. The process could be done right in the doctor’s office or clinic. There were no cuts to your body and you didn’t need to be put to sleep.

Unfortunately, there were more side effects from hysteroscopic sterilization than doctors thought there would be. Some people had too much bleeding with their period, and other people needed to get a regular tubal ligation because their hysteroscopic sterilization didn’t work. For these reasons, hysteroscopic sterilization hasn't been available in the U.S. since 2019 and in Europe since 2017.

In the U.S., the cost of tubal ligation surgery typically ranges from $0 to $5,000 or higher. One key benefit of this procedure is that you won’t have to pay for other types of contraception.

The Affordable Care Act requires that most insurance plans cover some or all the cost of birth control, including tubal ligation. But what you’ll have to pay depends on factors such as where you live, which kind of surgery you have, your doctor, and your insurance coverage.

If you’re pregnant, you may choose to have your tubes tied during the delivery process. But you might have extra fees on top of what you’ll already pay for childbirth.

The procedure is free for most people with Medicaid. But if you have this state-run health insurance for people with low income, you should check with them ahead of time to find out if you’ll need to pay anything. 

Your local health department (or Department of Health Services) can help you find out if you qualify for Medicaid or other low-cost or free family planning services in your area. Other resources include:

  • National Women’s Law Center website
  • Local Planned Parenthood clinics 
  • Local sexual and reproductive health clinics

    •  

    Your recovery time after getting your tubes tied will depend on which kind of procedure you had. Because laparoscopic tubal ligation is not a major surgery, it takes less time to recover and most people can go home a few hours afterward. Most people go back to their usual routine a few days after a laparoscopic tubal ligation. 

    If you have a laparotomy or mini-lap procedure, your body will need more time to heal from these surgeries, usually a few weeks. You might need to stay in the hospital for a night or two after a laparotomy or mini-lap, especially if you also just gave birth. If you get your tubes tied at the same time as a Cesarean birth, it could take up to 8 weeks to get better. 

    Right after your tubal ligation, you might have pain or cramps in your belly and mild vaginal bleeding, or feel very tired, nauseous, or dizzy.

    Your incision sites (where you got the cuts) might get uncomfortable or irritated, and blood or pus might come out. Tell your doctor or nurse right away if your cuts are bleeding enough to soak through their bandage, or smell bad. If you had general anesthesia (meaning you were put all the way to sleep) and the surgical team used a breathing tube while you were out, you might have a sore throat. Your doctor or nurse will make sure you know how to manage any pain before you go home.

    If you have laparoscopic surgery, your doctor will fill your belly with gas to make it easier to see what they are doing. This gas might make you feel bloated, or cause pain in your belly, shoulder, neck, or chest. This should go away within the first 1-3 days, and it might help to walk, use a heating pad, or take a hot shower.

    Ask your doctor how long after your tubal ligation you should wait to shower. Wait at least 2 weeks to take a bath or go swimming so that your cuts can heal all the way. Don’t rub or scrub your cuts for at least a week, and carefully pat your skin dry after you take a shower. You should wait at least a day after the surgery to drive or drink alcohol.

    If you had a laparoscopic tubal ligation, you shouldn’t lift anything heavy for at least 1-2 weeks. If you had a laparotomy or mini-lap procedure, you might need to wait at least 4 weeks to lift anything heavier than a baby.

    Make sure to ask your doctor any questions you have about what to expect during recovery and how long it might take.

    How soon can I have sex after a tubal ligation?

    You should be able to have sex a week after your tubal ligation. Your doctor will confirm when you can start having sex again, and if there are any kinds of sexual activity you should avoid at first.

    This will depend on what kind of surgery you had and if you just gave birth. You don’t need to use a backup form of birth control after the procedure, but it won’t protect you from sexually transmitted diseases (STDs). Using a condom during sex will help prevent STDs.

    As with any procedure, tubal ligation can have some risks. They include:

  • Bleeding
  • Infection
  • Damage to other organs or major blood vessels
  • Side effects caused by anesthesia
  • A fertilized egg that implants outside the uterus (ectopic pregnancy)

    • Call your doctor if you notice any of these problems after your procedure:

  • A temperature over 100.4 F
  • Fainting
  • Vomiting or nausea
  • Redness or swelling around the wound
  • Severe pain that doesn’t go away
  • Bleeding through your bandage
  • Bad-smelling discharge from the wound

    • Right after your tubal ligation, you might have some surgery-related side effects, such as:

  • Pain or cramps in your belly or pelvis
  • Bleeding from your vagina
  • Feeling very tired, weak, dizzy, or faint
  • Discomfort, irritation, or swelling where the cut was made (your incision site)
  • Infection to your cuts, stitches, tubes, or the tissue around them

    • There can also be long-term side effects of tubal ligation. These include:

  • Heavier, less regular or more painful periods, though it’s more common for your period to get lighter, with less cramping
  • Post-tubal ligation syndrome (PTLS)

    • You will also have scars from tubal ligation. If you had a laparoscopic procedure, your scars would be very small. If you had a laparotomy or mini-lap, your scars from tubal ligation would be larger. Your doctor will tell you how to take care of your cuts (incision site) so that your scars heal well.

    Post-tubal ligation syndrome

    After tubal ligation, some people experience a rapid decline in the hormones estrogen and progesterone. This condition is called post-tubal ligation syndrome (PTLS). These problems include heavier or more painful periods than before, bleeding from the uterus or vagina when you don’t have your period, irregular periods, PMS, pain in your back or pelvis, pain during sex, and headaches.

    If you have PTLS, you might also have symptoms that are like those of menopause: hot flashes, night sweats, less wetness in your vagina, mood swings, trouble sleeping, or changes to your sex drive. Some scientists think this has to do with a drop in your levels of the hormones estrogen and progesterone after a tubal ligation.

    So far, scientists haven’t seen these issues happen more often to people who have had their tubes tied, compared with people who haven’t. Talk with your health care provider if you have any of these problems after you get your tubes tied. They can do tests to figure out your situation and treat your symptoms.

    Tubal ligation is generally safe, but it’s important to know about the risks and complications; less than 2 people out of 100 have complications. Your chances of having complications depend on many things including the kind of procedure you have; whether you have the surgery as part of giving birth; if you have diabetes, endometriosis, or pelvic inflammatory disease; and if you’ve had other surgeries in the same area before. Possible complications after getting your tubes tied include:

    Infection. You can get an infection in the place where the doctor cut into your skin, your stitches, or your tubes. Call your doctor right away if you have any signs of infection. These include having a fever, swelling, redness, or a rash near your cuts from the surgery, blood from your vagina that smells different from your period, discharge that smells bad, chills, or feeling like you’re going to faint.

    Reaction to anesthesia. Any time you have surgery, it’s possible to have a bad reaction to the medicine they use to put you to sleep.

    Damage to other organs. It’s rare, but you could end up with an injury to the tissue or organs around your tubes, including your uterus (womb), bladder, or bowels (intestines). If your doctor uses an electric current to seal your tubes closed, you could get burns on the skin, organs, or tissue nearby.

    Pain in your belly or pelvis. This pain might continue even after you heal from your tubal ligation.

    Regret. Getting your tubes tied is a permanent decision. Some people might get their tubes tied and then decide later that they want to get pregnant after all. In one study, a little more than 1 in 10 people who got their tubes tied wished that they hadn’t later on. People who felt pressured into the surgery were more likely to regret it. If you change your mind later on, it’s sometimes possible to have surgery to try to unblock or reattach your tubes, or you can try to have a baby with in vitro fertilization (IVF). These options only work about half the time, though, and they can be very expensive.

    It’s rare, but sometimes the surgery doesn’t block your tubes completely. Even more rarely, the tubes can grow back together. If this happens, it's possible to get pregnant, because an egg might still make it through and meet up with sperm.

    If you become pregnant after you’ve had a tubal ligation, you’re more likely to have an ectopic pregnancy, when a fertilized egg implants itself somewhere other than inside your uterus (womb). The egg can hurt your body as it grows, and if it’s in your tube, the tube can burst open. This is a medical emergency.

    If you’ve had your tubes tied and you’re sexually active with people who make sperm, you should go to the emergency room right away if you have any signs of ectopic pregnancy. These include pregnancy symptoms such as morning sickness (nausea), bleeding from your vagina when you don’t have your period, and intense pain in one side of your belly or in one shoulder.

    You have more than one possibility when it comes to contraception, so it’s important to weigh the pros and cons of all your birth control choices. Up to 20% of those who have tubal ligation eventually wish they hadn’t, particularly people younger than 30. 

    There are many ways to prevent pregnancy, including tracking ovulation and not having unprotected sex when you know sperm can fertilize an egg. But this fertility-awareness method isn’t as reliable as other forms of birth control. 

     Barrier methods can prevent pregnancy, and some can lessen your chances of getting STDs. They include: 

  • Condoms
  • Diaphragm
  • Cervical cap
  • Spermicide

    • Hormonal options (with estrogen and progestin or progestin-only) are more effective than barrier methods and include:

  • Pills you take at the same time every day
  • Patch you replace weekly
  • Vaginal ring you replace once a month
  • Shot you get every 3 months

    • If you’re not sure if you want something permanent but you still want an effective choice you can’t mess up, consider these long-term options for birth control:

    IUD. An intrauterine device is a type of long-acting reversible contraception (LARC). Your doctor puts this small, T-shaped plastic device into your uterus. It can stay in place for 3-10 years, depending on which kind you get. IUDs are more than 99% effective in preventing pregnancy and are the most effective form of birth control outside of surgical methods like tubal ligation.

    Hormonal IUD options available in the U.S. and how long they last are:

  • Mirena: up to 8 years
  • Liletta: up to 8 years
  • Kyleena: up to 5 years
  • Skyla: up to 3 years

    • The copper IUD (ParaGard) doesn’t have hormones. It prevents pregnancy because copper triggers an immune response that makes the uterus unsafe for sperm and eggs. You can use it to prevent pregnancy for up to 10 years.

    A health professional must put in and take out your IUD, but you can ask to have it removed at any time. You don’t have to wait for the end date.

    Implant. This is another type of LARC. Your doctor puts a plastic rod about the size of a matchstick under the skin of your upper arm. It releases a steady dose of the hormone progestin and can stay in place for up to 3 years, but you can get it removed whenever you want.

    Vasectomy. This is a type of birth control for men and people assigned male at birth. During the procedure, the doctor cuts and seals tubes that carry sperm to semen. A vasectomy is a minimally invasive surgery, which makes it a safer procedure than tubal ligation. If your partner decides to get one, they can get it while they’re awake.

     

     

     

    Tubal ligation surgery is also called getting your tubes tied, and it’s a generally safe way to make sure you never get pregnant. There are different kinds of tubal ligations that you can pick, but they all block the tubes that take eggs from your ovaries to your uterus (womb) so that eggs can’t meet up with sperm and become fertilized. If you are sure you don’t want to ever be pregnant, getting your tubes tied may be a safe and reliable birth control option for you.

    Do you still get periods after tubal ligation?

    Yes, you will still get your period after your tubal ligation. Your ovaries will still release an egg (ovulate) and your uterus will still build up a lining and shed it out when you have your period. The egg just won’t be able to get to your uterus or meet up with sperm.

    Many people spot or bleed from their vagina for about a month after their surgery. It might take 4-6 weeks for your period to come back. Your first period after you get your tubes tied might be heavier or more painful than usual.

    If you had your tubal ligation surgery at the same time as having a baby, miscarriage, or abortion, it might take longer for your periods to be regular again. Especially if you're breastfeeding, your period might not come back right away. This is related to how your hormones change after a pregnancy and probably isn’t affected by your tubal ligation.

    How painful is a tubal ligation?

    You should not feel any pain at all during the tubal ligation surgery itself. You will either be totally “asleep” from general anesthesia, or you will get numbing medication. If you have a mini-lap procedure, you will probably have an epidural or spinal -- this is when numbing medication is put directly into your spine so that you can’t feel anything. 

    When the numbing medication wears off, you might feel some discomfort or pain. This will depend on which kind of tubal ligation surgery you had, your body, and whether you are also healing from giving birth. If you had a laparoscopic tubal ligation, you might have some bloating from the gas they put in to make your organs easier to see. You might also have some pain in your belly or shoulder as the gas breaks up. Your cuts (incisions) may feel painful or irritated, or you might have pain or cramping in your belly. Some people say this pain feels like period cramps.

    Your doctor or nurse will talk to you before you go home about how to manage any pain during recovery. Make sure to tell your doctor if you are still having pain a few days after your surgery. Call your doctor right away if you have severe pain in your belly that doesn’t go away after 12 hours or gets worse.

    Posted : 2024-08-26 09:03

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