Choosing permanent contraception is an important personal decision. For some women, tubal ligation can be a solution when they are certain they do not want a pregnancy in the future.
Unlike temporary contraceptive methods, tubal sterilisation is designed as a permanent method. The decision therefore requires complete information, time for reflection, and discussion with the doctor about the various contraceptive options.
What is tubal ligation?
The fallopian tubes normally allow the egg and sperm to meet.
Tubal sterilisation involves permanently preventing this meeting by interrupting the continuity or patency of the tubes.
Several surgical techniques can be used depending on the clinical situation and the strategy chosen: occlusion, cutting, or treatment of the tubes, and, in certain situations, removal of the tubes, called salpingectomy.
The choice of technique must be discussed with the surgeon according to each patient's medical situation.
Is tubal ligation permanent?
Yes. Tubal sterilisation should be considered permanent contraception.
Even though certain procedures aiming to restore tubal patency can sometimes be considered, their success is not guaranteed. The theoretical possibility of reconstructive surgery should not, therefore, be regarded as a guarantee of being able to achieve a spontaneous pregnancy later on.
This is why the decision must be made on the understanding that the contraception will be permanent.
Who can request a tubal ligation in France?
In France, sterilisation for contraceptive purposes can be performed on an adult who requests it, under the conditions set out by law.
There is no legal requirement to:
- have already had children;
- have a minimum number of children;
- be married or in a relationship;
- obtain the agreement of a spouse or partner.
The decision belongs to the person concerned.
During the consultation, the doctor must notably present the different contraceptive methods available, the permanent nature of sterilisation, the different possible techniques, and their benefits, limitations, and risks.
Why is there a four-month reflection period?
French legislation provides for a four-month reflection period between the first consultation, during which the request is made, and the sterilisation procedure itself.
This period allows the patient to reflect on her choice after receiving the necessary information.
At the first consultation, written information must be given to the patient, along with a certificate of consultation.
After the legal period has passed, if she maintains her decision, the patient confirms in writing her wish to undergo the procedure.
The four-month period does not, therefore, mean the patient's decision is being questioned: it is a step required by French law for any sterilisation performed for contraceptive purposes.
How does the procedure take place?
The technique depends on the method chosen and the medical situation.
Tubal sterilisation can notably be performed by minimally invasive surgery, generally by laparoscopy.
The surgeon operates on the tubes in order to permanently prevent the egg and sperm from meeting.
A pre-operative consultation allows the following to be explained precisely:
- the technique proposed;
- the type of anaesthesia;
- how the procedure will be carried out;
- postoperative recovery;
- possible risks and complications;
- the alternatives available.
Each situation must be individually assessed.
What is the difference between tubal ligation and salpingectomy?
In everyday language, the term "tubal ligation" is often used to refer to different techniques of female sterilisation.
There is, however, a difference.
Traditional tubal sterilisation aims to occlude or interrupt the tubes, whereas bilateral salpingectomy involves removing both tubes.
Salpingectomy is now being discussed in certain situations, notably because scientific data suggests that some epithelial ovarian cancers may originate in the fallopian tube.
Removal of the tubes can thus help reduce the risk of certain ovarian cancers, without, however, eliminating this risk entirely.
This potential preventive strategy should be distinguished from the contraceptive indication alone, and should be discussed individually with the surgeon.
Is it an effective contraceptive method?
Tubal sterilisation is among the most effective contraceptive methods.
It is not, however, considered 100% effective in every situation and with every technique.
According to data cited by the Haute Autorité de Santé, the number of unwanted pregnancies during the first year after female sterilisation is approximately 0.5 per 100 women.
Long-term effectiveness can also vary according to the technique used and the age at which the procedure was performed.
Can you still become pregnant after a tubal ligation?
It is rare, but a pregnancy remains possible after tubal sterilisation.
A late period or symptoms suggestive of pregnancy should therefore lead you to take a test and consult.
When a pregnancy occurs after tubal sterilisation, it is important to quickly determine its location, notably to rule out an ectopic pregnancy.
Significant pelvic pain associated with a late period, bleeding, or feeling faint requires prompt medical assessment.
Does tubal ligation cause menopause?
No.
Ligation or occlusion of the tubes does not involve removal of the ovaries.
The ovaries therefore continue to produce their hormones normally.
The Haute Autorité de Santé states that tubal sterilisation methods have no expected impact on hormonal balance.
Tubal sterilisation should therefore not be confused with removal of the ovaries, which is a completely different procedure and can, when performed bilaterally before natural menopause, cause surgical menopause.
Do you still have periods after a tubal ligation?
Yes.
Tubal sterilisation is not intended to change hormonal function or the menstrual cycle.
A woman can therefore continue to ovulate and have periods after the procedure.
Changes in the cycle observed after sterilisation can sometimes be related to other factors, notably the simultaneous discontinuation of hormonal contraception that had previously been influencing periods.
In the event of a significant or persistent change in menstruation, a gynaecological consultation can help identify the cause.
Does tubal ligation affect sexuality?
Tubal sterilisation does not remove the ovaries or sex hormones.
According to the Haute Autorité de Santé, it has no expected impact on sexual desire or pleasure.
Sexuality, however, depends on many physical, psychological, relational, and hormonal factors. Any new or persistent difficulty therefore deserves to be discussed with a healthcare professional rather than being automatically attributed to the procedure.
What are the risks of tubal ligation?
Like any surgical procedure, tubal sterilisation carries risks.
They depend notably on the technique used, the surgical approach, the anaesthesia, and the patient's history and state of health.
Potential surgical complications can notably include bleeding, infection, anaesthetic complications, or, more rarely, injury to a nearby organ.
There is also a risk of contraceptive failure, low but not zero.
These risks must be explained individually during the pre-operative consultation.
Can you regret permanent sterilisation?
This is an essential question before the procedure.
A change in personal or family circumstances, a new relationship, or simply an evolving life plan can later change your desire for pregnancy.
It is impossible to predict with certainty what you will want several years later.
This is why the permanent nature of sterilisation, and the possibility of future regret, must be discussed before the procedure.
This is not about questioning a woman's choice, but about allowing her to make her decision with all the necessary information.
What alternatives exist before choosing permanent contraception?
Before sterilisation, the various reversible contraceptive methods can be discussed.
These notably include:
- the copper intrauterine device;
- the hormonal intrauterine device;
- the contraceptive implant;
- hormonal contraception, when suited to the medical situation;
- other contraceptive methods according to each patient's needs and contraindications.
When a couple is seeking permanent contraception, vasectomy can also be among the options to discuss.
The choice should not rest solely on effectiveness: the patient's preferences, history, any contraindications, and life plans must also be taken into account.
Does tubal ligation protect against sexually transmitted infections?
No.
Tubal sterilisation prevents pregnancy but does not protect against sexually transmitted infections (STIs).
When protection against STIs is needed, condom use remains recommended regardless of the contraception used.
How do I know if permanent contraception is right for my situation?
There is no single answer for all women.
The consultation notably allows discussion of:
- your contraceptive plans;
- your certainty regarding the absence of a future desire for pregnancy;
- your medical and surgical history;
- contraceptive methods already used;
- reversible alternatives;
- the surgical technique that could be considered;
- the benefits, risks, and limitations of the procedure.
The decision must be made freely, after clear information and sufficient time for reflection.
Key points to remember
Tubal ligation is a permanent contraceptive method intended for women who do not wish for a future pregnancy.
In France, it can be requested by any adult under the conditions set out by law, regardless of the number of children she has or her marital status.
A legal four-month reflection period must be observed before the procedure.
The decision deserves a dedicated consultation to compare the various contraceptive methods, understand the permanent nature of the procedure, and, when sterilisation is chosen, select the technique best suited to the individual situation.
Medical information: this article provides general information and does not replace a medical consultation. The indications, contraindications, and details of a procedure must be individually assessed with a healthcare professional.
Medical and Institutional Sources
Haute Autorité de Santé (HAS). Stérilisation à visée contraceptive chez l'homme et chez la femme. Recommandation de bonne pratique, 2019. https://www.has-sante.fr/jcms/c_1752765/fr/sterilisation-a-visee-contraceptive-chez-l-homme-et-chez-la-femme
Code de la santé publique, article L. 2123-1 — stérilisation à visée contraceptive.
American College of Obstetricians and Gynecologists (ACOG). Sterilization for Women and Men. Patient guidance.
American College of Obstetricians and Gynecologists (ACOG). Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention. Committee Opinion No. 774.
Organisation mondiale de la Santé (OMS). Informations et recommandations relatives à la contraception et aux dispositifs intra-utérins.
Consult Dr. Yasmine Maazouzi at the Hôpital Privé Beauregard (23 Rue des Linots, Bât. B5 ICOGM, Marseille 13004) to discuss your contraceptive plans.