Birth Control is Not One-Size-Fits-All.
Find the methods that may be right for you.
Thinking about sterilization?
Here are some of the most common questions we hear about sterilization for women.
Sterilization is a form of birth control. All sterilization procedures are meant to be permanent.
During a sterilization procedure, a health care provider closes or blocks a woman's fallopian tubes. Closing the tubes can be done in several ways.
One way is by tying and cutting the tubes — this is called tubal ligation. The fallopian tubes also can be sealed using an instrument with an electrical current. They also can be closed with clips, clamps, or rings. Sometimes, a small piece of the tube is removed.
Sometimes, tiny inserts are put in the tubes. Tissue grows around them and blocks the tubes. The brand name for this type of sterilization is Essure.
Eggs are made in a woman's ovaries. One egg is released each month. It passes through one of the fallopian tubes toward the uterus. Sterilization blocks each tube. Pregnancy cannot happen if sperm cannot reach the egg.
Most women can be sterilized safely. But like any medical procedure, there are risks.
One possible risk is that the tubes may reconnect by themselves — but this is rare. When women get pregnant after being sterilized, about 1 out of 3 has a pregnancy that develops in a fallopian tube. This is called ectopic pregnancy. Ectopic pregnancy is serious and may be life threatening.
The Signs of Ectopic Pregnancy
The signs of ectopic pregnancy include
If you think you may have an ectopic pregnancy and can't reach your health care provider, go to a hospital emergency room right away.
Other risks depend on the type of sterilization. Read below about the different types of sterilization and their risks. And talk with your health care provider about whether sterilization is likely to be safe for you.
Sterilization is safe and, because it lasts for life, it is simple and convenient. It allows a woman to enjoy sex without worrying about pregnancy. Many women and men report that they have more sexual pleasure because they don't have to think about unwanted pregnancy anymore.
Sterilization does not change your hormones. The hormones that affect hair, voice, sex drive, muscle tone, and breast size, are still made in the ovaries. Those hormones still flow through the body after sterilization. It will not cause symptoms of menopause or make menopause happen earlier. And most women who have been sterilized will still have normal periods.
Sterilization may be right for you if
There are several possible disadvantages of sterilization.
Sterilization may not be a good choice for you if you
You should consider any possible life changes, such as divorce, remarriage, or death of children. You don't need your partner's permission to be sterilized, but it may be helpful to discuss it with your partner or anyone else who could be part of the decision-making process.
There are risks with any medical procedure, including sterilization. It's important to understand the risks before being sterilized. Read below about the risks of each type of sterilization.
Considering Other Birth Control Options
Can Sterilization Be Reversed?
If you are thinking about reversal, sterilization may not be right for you. Reversals require complicated surgery and cost thousands of dollars. Even though tubes can sometimes be rejoined, there are no guarantees. For many women, reversals are not possible because there is not enough of their tubes left to reconnect.
There are a few different types of sterilization. One type does not require an incision — a cut. It is called hysteroscopic sterilization. All the other methods require an incision.
Your health care provider will help you decide which kind of sterilization might be right for you. Your medical history, including your weight and previous surgeries, may influence which kind will be best and safest for you.
Effectiveness is an important and common concern when choosing a birth control method. Sterilization is nearly 100 percent effective.
Most kinds of sterilization for women are effective right away. But it takes about three months before Essure is effective.
To use Essure, a health care provider puts a tiny insert called a microinsert into each of the fallopian tubes. Once in place, the inserts cause natural tissue to grow, blocking the tubes.
During the procedure, the health care provider uses local anesthesia to numb the cervix. You may be offered other medication to help you relax and reduce your discomfort. Some women report mild to moderate pain while the inserts are being placed. A small, rigid, tube-like instrument called a hysteroscope is inserted into the vagina and through the cervix. The inserts are placed in the opening of the tubes.
Like vasectomy, Essure is not effective right away. Three months after insertion, a special x-ray is performed to make sure the tubes are fully blocked. You must use another form of birth control until then, or you may get pregnant.
Essure offers some advantages over other methods of sterilization:
With Essure, no incisions are necessary. So you won't have any visible scars.
Studies have shown that Essure is safe, but there are still some possible risks:
Other rare complications include too much fluid build up in your bloodstream, changes in the menstrual cycle, infection, and pelvic or back pain.
Talk with your health care provider about the benefits and risks of Essure to help you decide if it may be right for you.
Laparoscopy is one of the two most common types of sterilization.
First you will get either general, regional, or local anesthesia. Then, your abdomen is inflated with an injection of harmless gas (carbon dioxide). This allows your health care provider to see your organs clearly. Then the provider makes a small cut near your navel and inserts a laparoscope (a rod-like instrument with a light and a viewing lens) to locate the fallopian tubes. The health care provider also may insert an instrument for closing the tubes, usually through a second small opening. Sometimes only one incision and one instrument are used.
The procedure can be performed in outpatient surgical clinics. It usually takes 20–30 minutes. Very little scarring occurs. Women often go home the same day.
Mini-laparotomy is another common type of sterilization. It is often performed after childbirth. No gas or laparoscope is used. Usually, local anesthesia is used. A small cut is made in the lower abdomen, just above the pubic hair or just below the navel. The health care provider locates the tubes, then ties, clips, or uses a probe with an electrical current to block them off. Women usually recover in a few days.
Laparotomy is major surgery. It is less commonly used than the other incision methods.
The health care provider makes a two-to-five-inch cut in the abdomen. The provider locates and closes off the tubes. The operation requires general or regional anesthesia. You may need to be hospitalized for 2–4 days. It may take several weeks at home to completely recover. If the procedure is done after delivery, your hospital stay may be extended by 1–2 days.
Complications can occur with any kind of surgery. These incision methods are considered low-risk surgeries. The complications that can occur during or after these them include
Infection is rare. It is treated with antibiotics. Very rarely, the bowel, bladder, uterus, or blood vessels are injured. You may need additional surgery to repair this.
Complications may develop in 1–4 out of every 100 sterilizations that are performed through the abdomen. Death resulting from sterilization is extremely rare and is usually caused by a reaction to general anesthesia.
Hysterectomy is the removal of the uterus. It is major surgery and is not usually used for sterilization. It is used to correct serious medical conditions.
If you have a hysterectomy, you will no longer have your period. Usually, it will not affect your fallopian tubes. However, some medical conditions also call for the removal of a tube and/or ovary, on one side or both.
Hysterectomy is performed through the abdomen and/or vagina. Women need to spend several days in the hospital. They usually spend several weeks at home recovering. They should abstain from sexual intercourse for 4–6 weeks, until the health care provider says it is safe to have sex.
Complications after hysterectomy, such as infection or blood loss, occur in 10–20 out of every 100 cases. Because hysterectomy is usually performed as a result of a serious medical problem, the risk of death is much greater than it is for more common sterilization methods.
Your health care provider will give you medicine to make sterilization as comfortable as possible. Numbing medication and/or sedatives will be used. The choice depends on your health and the method of sterilization being used. Conscious sedation allows you to be awake but deeply relaxed. Local and regional anesthesia block the feeling of pain in certain areas of your body. These are much safer than general anesthesia.
General anesthesia is entirely painless. It allows you to sleep through the procedure.
When you get local or regional anesthesia, you may feel brief discomfort. The pain is relieved with medications and, sometimes, sedatives. Most likely, you will feel little or no discomfort during the procedure.
The discomfort you feel after the procedure depends on your general health, the type of procedure, and how well you deal with pain. You may feel tired and have slight pain in your abdomen. You may occasionally feel dizzy, nauseous, bloated, or gassy, or have shoulder pain or abdominal cramping. Women who use Essure may have vaginal discharge, like a light menstrual period. Most symptoms will last 1–3 days.
Contact your health care provider immediately if you
It depends on your general health, lifestyle, and the method of sterilization that you use. With mini-laparotomy and laparoscopy, recovery is usually complete in a day or two. You may want to take it easy for the next week or so. In any case, you should avoid heavy lifting for about one week. Recovery from sterilization with Essure is faster — some women return to normal activities the same day as the procedure. Others take a day or two.
Talk with your health care provider about when it's safe to start having sex again. Remember, if you've had Essure, you need to use another birth control method until your health care provider confirms that your tubes are blocked.
If you are interested in getting sterilized, talk with a health care provider. Contact your local Planned Parenthood health center, your gynecologist, family doctor, a local hospital, or a local public health department. Sterilization can be performed in a medical office, hospital, or clinic.
There may be state or federal requirements for sterilization, such as age restrictions or waiting periods. Ask if there are any restrictions when you make an appointment.
After Birth, Miscarriage, or Abortion …
About 1 out of 2 sterilizations are performed shortly after childbirth or abortion. You need to make arrangements with your health care provider in advance if you want to combine sterilization with other procedures.
Nationwide, the cost of sterilization ranges from $0 to $6,000. (The cost of vasectomy is much less.) If you need to have your procedure in a hospital, it may be more expensive.
Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs.
Call your local Planned Parenthood health center to get specific information on costs.
Q&A with Dr. Cullins