Sterilisation

Sterilisation involves blocking or sealing the fallopian tubes, which link the ovaries to the womb (uterus). Sterilisation is meant to be permanent - though there are reversal operations, they are not always successful.

How common is it?

In recent years, many more couples in their 30s and 40s are opting for efficient and long lasting contraceptives instead of sterilisation, as more couples are choosing to have families later in life.

You can be sterilised at any age. However, if you are under 30, particularly if you do not have children, you will be offered the opportunity to discuss your choices before you commit to having the procedure.

You should only be sterilised if you are certain that you do not want to have any, or any more, children. If you have any doubts, consider another method of contraception until you are completely sure.

Clinicians do have the right to refuse to refer you for the procedure if they do not believe that it is in your best interests. In some areas, waiting lists for sterilisation on the NHS can be quite long. You can pay to have the operation done privately.

What is involved?

Female sterilisation works by preventing eggs from travelling down the fallopian tubes. This means a woman's eggs cannot meet sperm, and fertilisation cannot happen.

Sterilisation is a fairly minor operation, with many women returning home the same day.

You may feel unwell for a couple of days and need to take a bit of time off work.

There are two types of operation, one which blocks the fallopian tubes, using clamps or rings, and the other using an implant to create scar tissue which eventually blocks the tubes. Read more about the options in our Questions section.

You may experience slight vaginal bleeding and/or cramps afterwards. Your periods will continue to be as regular as they were before sterilisation. Occasionally, some women find that their periods become heavier. This is usually because they have stopped using hormonal contraception, which may have lightened their periods previously.

Questions?

Who should I talk to if I am considering getting sterilised?
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You should talk to your GP or sexual health clinic.

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Is sterilisation available on the NHS?
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Yes, sterilisation is available on the NHS

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Is sterilisation reversible?
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It is very difficult to reverse female sterilisation and is not always possible. Reversal is not usually available on the NHS.

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Does sterilisation affect emotions, hormones or sex drive?
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No, you should still go through normal menstrual cycles. Sterilisation does not change your hormones.

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Am I protected against pregnancy straight away after sterilisation?
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No. After tubal sterilisation, you will need to use contraception for one month afterwards.

After Hysteroscopic sterilisation, you will need to use contraception for three months afterwards.

Do also ensure you use contraception up till the time of your operation.

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How does the operation work?
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There are two types of sterilisation operation:

Tubal – using clips or rings

First, your surgeon will need to access and examine your fallopian tubes. Laparoscopy is the most common method: the surgeon makes a small cut in your abdominal wall near your belly button and inserts a laparoscope (a small flexible tube that contains a tiny light and camera). The camera allows the surgeon to see your fallopian tubes clearly by relaying images to a monitor.

Blocking the tubes can be done in three ways:

  • Applying clips – plastic or titanium clamps are closed over the fallopian tubes
  • Applying rings – a small loop of the fallopian tube is pulled through a silicone ring, then clamped shut
  • Tying and cutting the tube – this destroys 3-4cm (1-1.5 inches) of the tube.

You will need to use contraception until your operation and for four weeks afterwards.

Hysteroscopic sterilisation (fallopian implants)

The National Institute for Health and Care Excellence (NICE) has published guidance about hysteroscopic sterilisation. In the UK, the brand name of the hysteroscopic sterilisation technique is Essure.

The implants are usually inserted under local anaesthetic.

A narrow tube with a telescope at the end, called a hysteroscope, is passed through your vagina and cervix. A guidewire is used to insert a tiny piece of titanium metal (called a microinsert) into the hysteroscope, then into each of your fallopian tubes. This means that the surgeon does not need to cut into your body.

The implant causes the fallopian tube to form scar tissue around it, which eventually blocks the tube.

You should carry on using contraception until an imaging test has confirmed that your fallopian tubes are blocked. This can be done with one or more of the following:

  • A hysterosalpingogram (HSG) – a type of X-ray that is taken after a special dye has been injected to show up any blockages in your fallopian tubes
  • A hysterosalpingo-contrast-sonography (HyCoSy) – a type of ultrasound scan involving injecting dye into your fallopian tubes.

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What will the recovery after the sterilisation be like?
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  • Once you have recovered from the anaesthetic, passed urine and had something to eat, you will be allowed home. If you leave hospital within hours of the operation, ask a relative or friend to pick you up, or take a taxi
  • If you have had a general anaesthetic, do not drive a car for 48 hours afterwards as your reaction times and judgement may not be back to normal
  • You may be prescribed painkillers. If the pain or bleeding gets worse, seek medical attention.

Caring for your wound

If you had tubal occlusion to block your fallopian tubes, you will have a wound with stitches where the surgeon made an incision (cut) into your stomach. Some stitches are dissolvable and disappear on their own, and some will need to be removed. If your stitches need removing, you will be given a follow-up appointment for this.

If there is a dressing over your wound, you can normally remove this the day after your operation. After this, you will be able to have a bath or shower as normal.

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How will I know which method of sterilisation is best for me, Tubal or Hysteroscopic?
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There are advantages and disadvantages of both procedures, your gynaecologist will discuss these with you.

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What happens if the sterilisation is unsuccessful?
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If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.

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Where can I get it?

A sexual health clinic or GP will ask about your circumstances and provide information and counselling before agreeing to refer you for the procedure. In some areas, waiting lists for sterilisation on the NHS can be quite long. You can pay to have the operation done privately.

You should only be sterilised if you are certain that you do not want to have any, or any more, children. If you have any doubts, consider another method of contraception until you are completely sure.