What Are Your Permanent Birth Control Options?

Pregnancy prevention comes in many forms. There are barrier methods such as condoms and diaphragms. There's also hormonal birth control. And then there are sterilization procedures for women who want permanent birth control options.

Permanent birth control is a good option for people who know they never want to get pregnant or who have experienced pregnancy and want to prevent it in the future. But like any other elective surgery, sterilization warrants research. It's a big decision after all.

Overview of options for women

Nearly 19 percent of American women of childbearing age opt for female sterilization, according to the Centers for Disease Control and Prevention (CDC). For women, there are only two permanent birth control options: tubal ligation, known as "getting your tubes tied," and bilateral salpingectomy, or the removal of both fallopian tubes. These surgical procedures are intended to eliminate the chance of future pregnancies, but not sexually transmitted infections (STIs).

Gynecologists take the request for sterilization very seriously because of the risks of surgery and potential regret after permanent birth control, according to OB-GYNs Sarah Yamaguchi, M.D., of Los Angeles, and Jennifer Lew, M.D., based in Sycamore, Illinois. Their job is to guide patients to the best, safest solutions for their reproductive desires, then to respect the patient's final decision.

Talking to your doctor about permanent birth control

It is normal and expected for your gynecologist to thoroughly explain all available birth control options when you first raise the topic of permanent birth control. Once you have all the information, the final decision should be left up to you, Yamaguchi said.

Yamaguchi said she covers several points in her consultations about permanent birth control options. First, she describes every available birth control option. She also ensures the patient knows that while vasectomies for men can be performed under local anesthesia, female sterilization requires surgery under general anesthesia. Next, she explains that permanent birth control is not always reversible and there is a possibility of regret with sterilization. According to 2018 data published in the Journal of Marriage and Family, about 1 in 4 sterilized women report interest in a reversal.

After discussing your options and desires, speak up about lingering questions or concerns. Yamaguchi suggested clarifying whether your entire fallopian tube will be removed and what will happen if the surgery is impossible to perform laparoscopically.

Navigating pushback

There have been reports of pushback toward women seeking sterilization after recent antiabortion legislation.

"I definitely keep myself alert for signs that my patient is actually getting this done out of fear of recent antiabortion laws," Yamaguchi explained. "I don't want patients to make this decision out of fear, as IUDs are also excellent methods of contraception that avoid the risks of surgery.”

While the American College of Obstetricians and Gynecologists (ACOG) recommends presterilization counseling that includes discussing other birth control methods, ACOG also says doctors must respect a patient's wishes. You have the right to request this procedure with or without your partner's consent.

If you are uncomfortable with pushback over sterilization from your current healthcare provider, consider consulting a different doctor.

Tubal ligation: What to expect

Tubal ligation involves blocking or cutting the fallopian tubes, the pathway for an egg to travel from an ovary to the uterus. With no eggs released for sperm to fertilize, pregnancy can't occur.

"Although tubal reversal procedures are available, they do not always work, nor are they necessarily covered by insurance," Lew said.

Before the procedure, your doctor should explain when to start fasting from food and drink, Lew said. You will be put under general anesthesia, which can cause lingering drowsiness, so you should arrange for a ride home.

Tubal ligation is performed laparoscopically in a hospital or outpatient surgery center. Once a patient is sedated, the surgeon makes a small cut near the naval and inserts a tiny camera to see the fallopian tubes. Next, the fallopian tubes are blocked by clamping, tying, cutting or sealing them off with heat.

After the procedure, Lew said it's common to need a few days or even a week of rest. You should also avoid sex and exercise for a week or two.

While tubal ligation is considered safe, it's not entirely risk-free. About 1 in every 1,000 women experience complications, including infection, damage to internal organs, anesthetic risks and blood clots. Some tubal ligations are unsuccessful, leaving about 1 in every 200 women at risk of post-procedure pregnancy.

Bilateral salpingectomy: What to expect

A bilateral salpingectomy removes both fallopian tubes, permanently preventing any of your eggs from meeting a partner's sperm.

Lew said this is the preferred method of female sterilization for two reasons. First, it eliminates the risk of ectopic (tubal) pregnancy, and second, it reduces the risk of ovarian cancer.

"The downside is that it cannot be reversed, whereas the other types of tubal ligation have a potential of future reversal," she added.

Preparation for this procedure is the same as for tubal ligation. This surgery is also typically performed laparoscopically.

"Clarify what will happen if the surgery is impossible to perform laparoscopically," Yamaguchi recommended. "Some women want the procedure done only if it can be done with cameras, and other women want the procedure done no matter what, even if that means a cesarean-type incision and longer recovery."

Post-op recovery and risks for fallopian tube removal are the same as for tubal ligation. The exception is if you have an open abdominal salpingectomy rather than a laparoscopic procedure. In this case, you will probably need to stay overnight at the hospital.

Takeaways

Tubal ligation and bilateral salpingectomy are considered safe options for women who know they never want to get pregnant. However, it is vital to understand the risk of regretting the procedure.

If you feel pressured by someone to have the procedure or there is any possibility you may want to get pregnant in the future, consider other birth control types. Both Lew and Yamaguchi suggested considering long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs), before undergoing a procedure for permanent sterilization.

Do your research on permanent birth control options. Talk to your gynecologist about potential risks and your suitability as a surgery candidate. While you aren't required to get your partner's consent before these procedures, if you have a partner, it's still a good idea to have an open, honest conversation about your reasons and concerns.

"Contraception is a choice that my patients should make for themselves and not feel pressure from other people about whether it is to get surgery or not," Yamaguchi said. "I see my job as to keep them safe and aware of their choices, but just like abortion is a personal choice, so is contraception, and a woman's right to choose should be respected."