Many women spend decades using birth control of one kind or another, except for when they’re trying to conceive or are pregnant. So when you know you’re done having babies or if you plan to stay child-free, you might be interested in a permanent option that eliminates the need for pills, IUDs, rings and other contraceptive methods.
A surgery called a salpingectomy removes the fallopian tubes and makes a woman sterile so that she can no longer become pregnant.
The more commonly used term, tubal ligation—“getting your tubes tied”—refers to a surgery that accomplishes the same thing by cutting or banding a small segment of the tubes.
“Removing the fallopian tubes virtually eliminates the possibility of a future pregnancy,” says UNC Health OB-GYN Steven Dudick, MD. “It ensures you never have to think about birth control again.”
If you’re a woman considering tubal sterilization, here are seven things to know.
1. Sterilization is performed in a hospital under general anesthesia.
If you decide to undergo sterilization, you’ll be put under general anesthesia—meaning you’ll be unconscious and won’t feel anything during the procedure.
In a typical salpingectomy, the surgeon will make three small incisions, one in your belly button and one on either side of the lower abdomen, Dr. Dudick says. They will fill your abdomen with carbon dioxide so they can see and reach your reproductive organs.
The surgeon will identify each fallopian tube, use a heat device to separate it from the other tissues and coagulate bleeding, and remove it from your body. You’ll spend about an hour in the operating room, though the surgery itself takes just about 20 minutes, Dr. Dudick says.
2. Salpingectomy is irreversible—and it could reduce your cancer risk.
The fallopian tubes are where fertilization takes place: an egg travels from the ovary into the tube where it meets the sperm. With the fallopian tubes removed, there is no way for an egg to be fertilized.
Sterilization has been performed in different ways historically, sometimes using methods that cut, clamped or burned a segment of the tubes but did not fully remove them—that’s tubal ligation. In those cases, it’s possible to try to reverse the procedure and suture the tubes back together, Dr. Dudick says, though it often doesn’t work. In very rare cases, fallopian tubes can even grow back together and pregnancy is possible (though unlikely).
But then researchers discovered that removing the fallopian tubes in their entirety reduces a woman’s risk of ovarian cancer, so now salpingectomy is the standard of care, Dr. Dudick says. Ovarian cancer typically develops silently with no symptoms and is detected at a later stage when it’s difficult to treat, so prevention is a major benefit.
“There is a growing body of evidence that shows that a lot of the high-risk forms of ovarian cancer, the more aggressive forms, come from cells that arrive from the fallopian tubes,” Dr. Dudick says, explaining that the ovaries themselves are not removed.
Of course, when the fallopian tubes are completely gone, there is no chance of reversing the sterilization.
3. Tubal sterilization is often performed immediately after a cesarean section birth.
Tubal sterilization is typically performed laparoscopically, which means your surgeon accesses the fallopian tubes through a few small incisions rather than a large cut. A common exception is when sterilization is performed immediately after a C-section, before the larger abdominal incision is closed.
During your prenatal care, your provider may ask what your plans are for your family. If you tell them that you intend for this to be your last baby, they will discuss your options.
“If you’re confident with your decision, having the procedure done at the same time as the C-section avoids the needs for another cut or general anesthesia, and it takes care of your contraception forever,” Dr. Dudick says.
Tubal sterilization also can be performed immediately after a vaginal delivery, though then you’ll still require general anesthesia and incisions, Dr. Dudick says.
4. A vasectomy may be a better choice for your family.
Many monogamous couples looking for permanent birth control choose a vasectomy, the sterilization surgery for men, instead of tubal sterilization.
“A vasectomy would be the less invasive, less risky, more easy-to-recover-from option,” Dr. Dudick says.
Tubal sterilization is safe and low-risk, similar to any other abdominal laparoscopic surgery, but it’s more invasive than a vasectomy, Dr. Dudick says. Complications are unlikely but include infection, bleeding and damage to nearby organs.
“This is an important conversation OB-GYNs should have with their patients,” he says.
5. Recovery from tubal sterilization takes time and rest.
After your tubal sterilization, it’s normal to have abdominal soreness and pain or cramping that will improve a bit each day, Dr. Dudick says.
“It usually takes about a week for someone to feel back to normal again, sometimes two,” he says.
You may wake up from the procedure with a sore throat because of the breathing tube used during surgery. Some people report shoulder pain from the gas used to inflate the abdominal cavity.
Because the incisions are typically very small, there are not usually restrictions on lifting children, pets, groceries or anything else, but “it probably won’t be comfortable, and most people wouldn’t want to,” Dr. Dudick says. (There are lifting restrictions if you have a healing C-section incision.)
Whether it’s housework, exercise or sex, listen to your body and go slow. Rely on any supports you have, including a partner, friends or relatives, to allow you to rest and recover.
6. Sterilization doesn’t stop your periods or change the timing of menopause.
While undergoing tubal sterilization means you can’t get pregnant, you will still have your period and eventually transition to menopause the same way you would without the surgery, Dr. Dudick says. Your ovaries will release eggs that are reabsorbed into the body instead of heading down the fallopian tubes, and your uterine lining will still build up and shed each month.
The timing of menopause will not be affected by tubal sterilization.
7. If you’re not sure, there are long-acting contraception options.
There are no rules that you must be a certain age or have had children to choose sterilization. Younger women and women who don’t want any children have the procedure, just as middle-aged women and mothers of several kids do, Dr. Dudick says.
“From what patients have shared with me, they’re happy they had it done,” he says. “But beforehand, we do talk extensively about any potential risk of regret and other options that are not permanent, if they’re not sure.”
There are options for long-acting but reversible contraception that is effective for several years, including hormone-releasing intrauterine devices (IUDs) and Nexplanon, an implant that goes in the arm. The longest available reversible option is a nonhormonal copper IUD, which is good for 10 years. These options prevent pregnancy at rates comparable to tubal sterilization.
If you have questions about your reproductive health, talk to your doctor or find one near you.