Female Sterilisation

Max Brinsmead MB BS PhDMay 2015

Women contemplating sterilisation need to be aware of:

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

Alternatives to Sterilisation

VasectomyMirenaImplanonHysterectomy

Methods

LaparoscopicFilshie clipsFalope ringsDiathermy (and divide)

LaparotomyPartial salpingectmyFimbriectomy

HysteroscopicEssure

ReversibilityThis operation is not designed to be reversible so check:

Understanding of alternativesReasons for seeking the operationGender balance in familyRelationship

Women who seek reversal (1-2%) are more likely:To be young (age <30 years at time of op.)Low parityIn a new relationshipSterilised 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 years1:100 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 surgeryRequires another day to recover5-10% 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

Any Questions or Comments?

Please leave a note on the Welcome Page to this website