Tubal Ligation

A tubal ligation is a procedure done for birth control purposes. This can be done in a number of ways. Usually it is done laparoscopically (“keyhole surgery”) but sometimes it is done at the time of a c-section if requested. It can involve the removal of all or part of the fallopian tubes, or cauterizing/destroying part of the fallopian tubes, or putting clips on the fallopian tubes.

There is no age that must be reached or number of children you must have in order to request and receive a tubal ligation, but having this procedure done at a younger age is associated with an increased risk of later regretting having it done. If you understand this, as well as the risks of surgery and all the alternatives available to you, and you still want it done, it can be done.

For most people, the alternatives to tubal ligation are less risky than surgery and therefore we strongly recommend pursuing these first. Birth control pills, patches, and rings are good options for most people. For longer term and more reliable contraception, hormonal IUDs (Mirena, Jaydess, Kylena) are as effective at preventing pregnancy as a tubal ligation is, and also have the added benefit of improving menstrual flow. Depo provera can also be used for long term reliable contraception. The other alternative if you are in a long term monogamous relationship is for your partner to have a vasectomy! This procedure is less risky than a tubal ligation because the plumbing is on the outside and it can be done without a general anesthetic.

If none of the alternative options are for you and you still want to have a tubal ligation, you have the option of having a portion of the tube removed, cauterized, or clipped, versus having the fallopian tubes removed entirely. There is some evidence that some ovarian cancers may start in the fallopian tubes and that the risk for this can be reduced by removing the whole tube. However, if the entire tube is removed then there is no possibility of reversing the procedure if you were to later change your mind. If only a portion of the fallopian tube is removed, cauterized, or clipped, and you regretted that decision later, you could potentially have the procedure reversed. It is important to note that a reversal of a tubal ligation is not covered by OHIP, is very expensive ($5000+), and does not always work. For this reason if you want a tubal ligation, you should be absolutely positive.

Tubal ligations have the same surgical risks as any laparoscopy, including bleeding, infection, damage to intra-abdominal structures, conversion to laparotomy (open surgery), and post op complications such as DVT (blood clots) and PE (pulmonary embolism). In addition, there is a small risk that your tubal ligation could fail. Although rare, there is a very small possibility of pregnancy after a tubal ligation.

Some women will notice that after they have their tubes tied, their periods become heavier! This is not a side effect of the surgery, but commonly occurs because once a woman has her tubes tied, she usually comes off of whatever she was using for contraception until then. Birth control pills and hormonal IUDs generally keep the lining of the uterus thinner and therefore can keep period flow tolerable, light, or even non-existent. Once a person stops taking these, she might find her periods getting heavier as the lining of the uterus gets back to its usual thicker state. Periods also often get heavier as a woman gets into her 40s, which is a common time to be considering permanent contraception.