Episode Transcript
Dr. Erica Schipper:
A woman who is wanting to make this decision for herself is able to do so. We certainly encourage you to have conversations with loved ones who are important to you, but that is your decision.
Courtney Collen (host):
Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. These are new conversations about age-old topics from pregnancy to postpartum, managing stress, healthy living, and more. “Her Kind of Healthy” is here to bring you the honest conversations about self-care, happiness, and your overall well-being with our Sanford Health experts.
In this episode, we are talking about the tubal ligation procedure to prevent pregnancy, most commonly referred to as getting your tubes tied. I have Dr. Erica Schipper joining me for this conversation. She is chief medical officer at Sanford Health in the Sioux Falls region and a practicing gynecologist. Dr. Schipper, hello. Welcome.
Dr. Erica Schipper (guest):
Hello, Courtney. I’m glad to be here.
Courtney Collen:
I so appreciate you being here to talk through this with me. Starting really broadly here to define tubal ligation. What happens during this procedure, Dr. Schipper? Are we actually tying tubes?
Dr. Erica Schipper:
So sometimes yes. We tend to refer to it more generally as tubal sterilization. The idea being that we are somehow disrupting the fallopian tube to prevent the egg and the sperm from coming together in order to prevent pregnancy. And there’s multiple techniques by which that can be done.
We can sometimes tie the tubes. We can cut or burn the tubes. More often now, we are frequently removing the tubes completely. And the reason for that is, first, when we just cut or tie or burn the tubes, there is a risk of failure. It’s less than 1% in most cases, but, you know, if a tubal sterilization fails, there’s a higher risk of having a future pregnancy that could either be a normal pregnancy or it could be an ectopic pregnancy. That’s a pregnancy in the tube, and that is, that’s an emergency.
And so, we learned one that if we take out the tubes, that’s much less likely of course, but also we’ve learned that removing the tubes can lower a woman’s risk of ovarian cancer. So even though she’ll still have her ovaries and she’ll still have her hormones, she will not have those tubes.
And a lot of what we thought were ovarian cancers, we now know start in the tube. So, the society of gynecologic oncologists, the cancer surgeons told us that, “Hey, if a woman does not want to be able to get pregnant in the future, perhaps removing the tubes would be a better option than just tying them.”
Courtney Collen:
Is it effective for women who really do not want to get pregnant anymore?
Dr. Erica Schipper:
It is extremely effective, particularly if the tubes are removed. Risk of pregnancy, I will never say zero. There are always weird cases where strange things happen. But it’s very close to zero.
Courtney Collen:
Is it reversible?
Dr. Erica Schipper:
If the tubes are removed, it is not reversible. Pregnancy would still be possible, but it would only be through in vitro fertilization if the tubes are quote “tied” or cut or burned. Sometimes it’s reversible, but not always. And that’s kind of an intricate procedure. A limited number of physicians do that, and it doesn’t always work. So I do tell my patients, you should be very sure that you want a permanent form of contraception if you go ahead with this.
And the other thing to consider is that we do have great forms of long-acting reversible contraception. So if you want highly dependable contraception that isn’t permanent, those are out there.
For example, an intrauterine device or the Nexplanon arm implant or even the Depo-Provera shot are things you don’t have to worry about every day that are very effective in preventing pregnancy. The IUD is actually as effective as a traditional tubal ligation.
Courtney Collen:
Let’s talk through some of the benefits of a tubal ligation. Why would a woman want to get this done?
Dr. Erica Schipper:
I think first is just to not have to worry about an unplanned pregnancy. I think for some women, one of the reasons it comes to mind, and I’ve seen this in my practice, is, you know, maybe they’re not in a stable relationship or maybe they’ve been a victim of sexual violence. And we know for women, sometimes sex is not always their choice. And so this is a way for them to have that control if they don’t want to be pregnant in the future.
And for some women, it’s just a matter of they don’t tolerate hormonal birth control very well, and they know their family is complete, and so this is just the most logical option.
Finally, there are some reasons that women would do a tubal instead of hormonal birth control. For example, a woman who’s had an endometrial ablation or is having an ablation for heavy periods, pregnancy is contraindicated after an ablation, but it’s not in itself a form of birth control. So we’ll often do those two things together.
And then some women who have to be on long-term medications that could be harmful to a fetus would potentially want to have reliable long-term contraception. Some women who know they have an inherited condition in their genetics that they don’t want to pass on may choose a permanent form of contraception, and then choose to either do donor egg or adoption if they want to have a family.
Courtney Collen:
What would qualify a woman for this procedure?
Dr. Erica Schipper:
Any woman who is of course, an adult and can make her own medical decisions and who is certain that her childbearing is complete and she doesn’t want any more children or in some cases any children at all, and who is a reasonable candidate to undergo a general anesthesia and have surgery would all be reasonable candidates for a tubal sterilization procedure.
Courtney Collen:
Thank you. What should a patient consider or know before having this done? Are there any risks involved?
Dr. Erica Schipper:
There are risks. Tubal ligation or tubal removal called salpingectomy is a surgical procedure. It does require that the woman go under general anesthesia and then it’s done laparoscopically. So if it’s just a tubal ligation, it’s usually two incisions in the abdomen. If it’s a tubal removal, it’s usually three.
And so it carries all the surgical risks of any abdominal surgery. So there’s a risk of bleeding, there’s a risk of infection, and then there’s a risk of injury to anything else in the abdomen. There’s always a risk of needing a larger incision or encountering scar tissue, meaning we can’t complete the procedure. Any risk that comes with any laparoscopic surgery comes with this one.
That said, this is a procedure that is done quite frequently and usually goes very well.
So the risk of regret is something to take into consideration. We know that the rate of regret is higher under the age of 30 and even higher under the age of, say, 25. And those are the times to maybe think about doing a long acting reversible until you’ve had more time to be sure. But that is very much a patient decision. One of the things I will ask my patients, because I want to ensure that they’ve really thought about this, is, you know, if something were to happen to your partner and maybe you would meet someone else and they wanted a child, would you still be sure that wasn’t what you wanted?
Courtney Collen:
Yeah. If a woman just gave birth, she’s certain that her childbearing years are over, can this be done right after childbirth?
Dr. Erica Schipper:
Yes, it can. In fact, sometimes we do it when if a woman has an epidural in labor, we can even leave the epidural in place and use it to help with pain management. It’s done a little bit differently immediately postpartum because the uterus is enlarged. Oftentimes, it’s done through a very small incision just below the belly button rather than laparoscopically.
Courtney Collen:
Let’s talk through recovery and what this looks like.
Dr. Erica Schipper:
Yeah, so this varies a little bit from patient to patient, but for most patients it’s typically about a week off of work or resting. I usually tell patients you might want to limit your lifting for about two weeks to really allow those incisions to heal.
Now, that can be a little hard on new moms, so you want to take into consideration lifting a baby in a child carrier seat. But that can usually be accommodated.
Typically, there will be a little bit of pain, some incisional pain, and so you’ll be on some pain medicine. Some women only need, say, Tylenol and ibuprofen, while some women do need a little bit stronger medication for a little while. And so as OB/GYNs, we’re very careful to ensure we prescribe something that’s safe in breastfeeding if we have a breastfeeding mom.
Courtney Collen:
Now let’s talk about life after the procedure. Any side effects, hormone changes, like will a woman continue having a period or need any birth control after a tubal ligation?
Dr. Erica Schipper:
That’s a great question and really important to consider. So first of all, because we’re removing the tube, we’re really not disrupting the whole hormonal cycle. Hormones are produced from the brain to the ovaries, and really the uterus and the tubes are not involved in the hormones themselves. The hormones do talk to the uterus, which is how we have our periods.
So a woman who’s had her tubes tied or removed will continue to have periods the way she would have otherwise. Some women, when they get their tubes tied, they’re coming off of having been on hormonal birth control. And often that’s a pretty big change.
So if you’ve been on, say, a birth control pill or you’ve had a progesterone-based therapy like an IUD or the shot, you might find that your periods are heavier or maybe a little more painful because the hormonal birth control was keeping them a little bit better under control for you.
Additionally, a lot of women undergo tubal sterilization at a time in their lives when periods are starting to change anyway. Often in that sort of early perimenopausal period where periods can get a little bit heavier or irregular, there’s not really an obvious medical reason why a tubal itself should affect periods. But some patients do report that they feel their periods are different after their tubal and that’s still something we don’t fully understand.
Courtney Collen:
What about birth control?
Dr. Erica Schipper:
You should not need birth control. Once again, there is a small risk of failure if the tubes are ligated as opposed to being removed. And so if you wanted extra reassurance, you could certainly use additional birth control.
And of course the other option that we haven’t talked about yet is the option of a vasectomy. For a woman who’s in a monogamous heterosexual relationship, her partner can certainly get a vasectomy, which is really as effective as a tubal and less invasive. And so that’s something to consider when you’re thinking about your options, if you as a couple have decided you’ve completed your family.
Courtney Collen:
If a patient is interested in getting this done, where should they start?
Dr. Erica Schipper:
Generally, you want to start with your OB/GYN, and if you don’t have an OB/GYN, you can certainly ask your primary care provider for a referral.
Courtney Collen:
And is there a consultation involved? Like what does the conversation look like at the beginning? And maybe what questions should a patient bring to the table?
Dr. Erica Schipper:
So when they first meet with the OB/GYN, there will be a pre-surgical consultation. Questions about, for instance, your periods. Are you having undiagnosed abnormal bleeding or pelvic pain, things that we should address before we do a surgery?
And of course, if you’re absolutely certain that your childbearing is complete, one of the other risks of tubal sterilization is regret. And we know that regret is greater in women under the age of 30. That doesn’t mean you can’t do it before the age of 30, but you just want to be really sure about your decision.
And so I think some good questions for women to bring are, you know, certainly go over those surgical risks and ensure that your questions are all answered about what those risks entail and what your recovery’s going to be like.
And then I think the bigger conversation really needs to happen before you get to your consultation with whoever’s important in your life, that needs to be a part of that decision. So whether that’s a spouse or a partner or a supportive friend or family member or your faith leader, it’s critical to have those conversations that weigh on your decision before you move forward.
Courtney Collen:
Thank you for that. Is there anything else that we didn’t talk about here that you hear from patients topics around a tubal ligation that are important to share?
Dr. Erica Schipper:
I would say historically there was some misunderstanding, and historically there has been some paternalism by the medical community around tubal ligation. It used to be that a woman had to get her husband’s permission to have her tubes tied. There were physicians who would not do a tubal in a woman who’d never had children. That is not a requirement.
So a woman who is wanting to make this decision for herself is able to do so. We certainly encourage you to have conversations with loved ones who are important to you, but that is your decision. There’s no requirement to have a partner sign a piece of paper saying that you can do this. There’s no requirement that you have to have had a child before saying that you can have your tubes tied.
Courtney Collen:
Very insightful. Such good information and really appreciate your time and all of your insights and all that you do here at Sanford.
Dr. Erica Schipper:
Well, thank you, Courtney. It was a pleasure to do this.
Courtney Collen:
Thank you. I sure hope you learned as much as I did from our conversation today. This was another episode of the “Her Kind of Healthy” podcast series, brought to you by Sanford Health. For Sanford Health News, I’m Courtney Collen. Thanks for being here.
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Posted In Family Medicine, General Surgery, Gynecology, Sioux Falls, Women's
