Female Sterilisation

Max Brinsmead PhD FRANZCOGOctober 2008

Women contemplating sterilisation need to be aware of:

AlternativesReversibilityMethod to be usedOperative RisksFailure RiskShort term sequaleLong term sequelaeNeed for contraception

Alternatives to Sterilisation

Vasectomy

Mirena

Implanon

Hysterectomy

Methods

LaparoscopicFilshie clipsFalope ringsDiathermy (and divide)

LaparotomyPartial salpingectmyFimbriectomy

HysteroscopicEssure

ReversibilityThis operation is not designed to be reversible so check:

Understanding of alternatives

Reasons for seeking the operation

Gender balance in family

Relationship

Women who seek reversal (1-2%) are more likely:To be young (age <30 years at time of op.)

Low parity

In a new relationship

Sterilised for medical reasons

There is no Medicare for reversal

Risk of Failure

Excluding technical problems and operator error the risk of failure is:

1:200 for women >35 years

1:100 for women <30 years

(this is a lifetime risk not per year)

Risk is higher if done at the time of Caesarean or Termination Pregnancy

About 1/3 of pregnancies are ectopic

Operative Risks

Are the general risks associated with the method used

i.e Laparoscopy, Laparotomy or Hysteroscopy

Short Term Sequelae

Day only surgery

Requires another day to recover

5-10% patients require longer

Long Term Sequelae

MenorrhagiaPelvic painDysmenorrhoeaEndometriosisHysterectomy

However, these occur just as commonly after

partner vasectomy and are therefore unrelated to the procedure They arise as a consequence of uninterrupted cycles of ovulation and menstruation

Max’s Maxim Number 3

Nature did not intend that a woman should have too many menstrual periods

She is supposed to be pregnant, breast- feeding, postmenopausal or dead

And the next best alternative is being on the Pill

Or putting the Pill into her uterus (Mirena)

Need for Contraception

Tubal ligation is effective immediately

But other reliable methods of contraception need to be continued until the day of surgery