female sterilisation max brinsmead phd franzcog october 2008
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Female Sterilisation
Max Brinsmead PhD FRANZCOGOctober 2008
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Women contemplating sterilisation need to be aware of:
AlternativesReversibilityMethod to be usedOperative RisksFailure RiskShort term sequaleLong term sequelaeNeed for contraception
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Alternatives to Sterilisation
Vasectomy
Mirena
Implanon
Hysterectomy
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Methods
LaparoscopicFilshie clipsFalope ringsDiathermy (and divide)
LaparotomyPartial salpingectmyFimbriectomy
HysteroscopicEssure
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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
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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
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Operative Risks
Are the general risks associated with the method used
i.e Laparoscopy, Laparotomy or Hysteroscopy
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Short Term Sequelae
Day only surgery
Requires another day to recover
5-10% patients require longer
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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
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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)
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Need for Contraception
Tubal ligation is effective immediately
But other reliable methods of contraception need to be continued until the day of surgery