Tuesday, July 25, 2017  

Permanent Contraception: Simple, Safe Solutions for Women

Women who are finished having children now have more options when it comes to preventing future pregnancies. While tubal ligation, the longstanding go-to procedure for women wanting to prevent pregnancy, is effective, another procedure offers very similar results with
even fewer risks.

Tubal Ligation:

Surgical Permanent Contraception

Tubal ligations (also known as “having one’s tubes tied”) are performed under either general anesthesia or local anesthesia through an epidural. Several different methods exist for actually blocking the fallopian tubes, including cutting and repositioning the tubes, using clamps to prevent blood flow to a certain portion of the tubes, inserting mechanical rings that prevent blood flow to the tubes and cauterizing a small portion of each tube. Completely removing the fallopian tubes is also considered a type of tubal ligation.

Depending on which method is used, tubal ligations may be performed through laparoscopy, which requires inserting a viewing tool through a small incision in the abdomen; laparotomy, in which an incision is made in the abdomen; or through minilaparotomy, in which the abdominal incision is less than two inches wide.

Women can undergo tubal ligation immediately after a cesarean birth or as a separate procedure. In either case, the procedure is considered a serious surgery that presents risks, such as bleeding, infection and disruption of other organs during surgery, though these complications are not common. Most women need at least 24 hours before resuming normal activities, but it can take up to a week for patients to feel completely recovered.

Tubal ligations are highly successful. However, women may still become pregnant if their fallopian tubes grow back together or a new passage forms. Pregnancy after tubal ligation typically occurs a year or longer after the procedure was done. One year after tubal ligation, about 5 out of 1,000 women will become pregnant, about 0.5%. After five years, approximately 13 out 1,000 women will become pregnant, about 1.3%. Women who do become pregnant following tubal ligation are at a greater risk of ectopic pregnancy compared to women who have not undergone tubal ligation.

Tubal Implants:
Non-Surgical Permanent Contraception

Non-surgical permanent contraception is relatively new, only becoming available within the past five years, and many women are welcoming another option for long-term contraception. The process is extremely safe and requires very minimal recovery time. Many women return to their normal activities within a day of having the procedure done.
The outpatient procedure can be performed in either the office or hospital setting. At Riverside Tappahannock Women’s Center, patients are put under anesthesia and undergo the procedure in an operating room. It usually takes less than thirty minutes, and most patients return home within an hour of waking up.

No incision is required. Rather, a camera called a hysteroscope is inserted into the cervical opening of the uterus and into the fallopian tube. An instrument is then used to fire a burst of energy into each tube and place a small, silicon tube inside each fallopian tube to prevent eggs from traveling into the uterus. These silicon tubes remain in the fallopian tubes, and eventually scar tissue develops around the implant, completely blocking passage.

It takes several weeks for passage through the fallopian tubes to become completely obstructed. As a result, women should continue some form of birth control until confirming their tubes have been blocked. Twelve weeks after the procedure, patients undergo a follow-up X-ray of the fallopian tubes called a Hysterosalpingogram, or HSG. Nearly 99% of women report completely blocked fallopian tubes at this time.

The procedure is highly effective with current results comparable to those of tubal ligation. Though long-term statistics are not available, recent studies show that fewer than 2 out of 100 women became pregnant two years after receiving tubal implants.

While the risks associated with tubal implants are minimal, they do include bleeding and infection. Additionally, there is a possibility that the fallopian tubes will be difficult to see during the initial appointment, requiring the patient to return a second time to complete the procedure. Women should also note that because the process is so new, the long-term risks, if any, are unknown.

Non-surgical permanent contraception does not affect the uterus or ovaries, and women will continue to experience their normal pattern of menstruation after undergoing the procedure. This may prove advantageous for women who later experience a common symptom of perimenopause. Heavy, prolonged periods are often seen in women between the ages of 40 and 50. A quick, low-risk procedure known as endometrial ablation can help treat this common complaint.

Women undergoing an endometrial ablation are advised to have permanent contraception. A tubal implantation procedure can be safely performed at the same time as an endometrial ablation. Tubal implants do not prevent a woman from being able to have an ablation in the future, which some forms of tubal ligation do.

Permanent Contraception is a Permanent Decision

The most important factor to remember when considering any form of permanent contraception is that it is designed to be absolutely irreversible. Women who choose this method of contraception should be completely sure they do not wish to have a biological child in the future. When discussing birth control methods with your doctor, make sure you understand all your options. With so many choices—an intrauterine device, surgical tubal ligation, non-surgical implants, even a vasectomy for your partner—it’s vital to have all the information you need to make an informed decision about what is right for you.