Mirena Poster

Dr Diana Mansour answers your questions

  • Do women ever regret being sterilized?
  • Why are long-acting contraceptives a good alternative to sterilization?
  • In what situations might a woman consider sterilization as a form of contraception?
  • If a woman wants to have children after being sterilized, how successful is the reversal procedure?
  • How reversible is sterilization?
Read video transcript

Considering sterilization

If you are considering sterilization as your preferred form of contraception, then it is important that you consider carefully what is involved. That’s because once you decide on this form of contraception, it can be very difficult to reverse it. Long-acting reversible contraceptives (LARC) can offer you a comparable level of contraceptive protection but with the benefit of it being reversible1. Moreover, the intrauterine system is also recommended for women with heavy periods as it has been scientifically proven to be effective in reducing bleeding2.

Who is sterilization suitable for?

As sterilization is intended to be a permanent method of contraception, it is suitable for women who either never want children or are sure that they do not want more children. Sterilization is not suitable if you are considering having children in the future.

How sterilization works

Female sterilization works by stopping the egg and the sperm coming into contact and thereby preventing fertilization and a pregnancy. Since fertilization normally happens in the Fallopian tubes (the tubes that lead from your ovaries to your womb), female sterilization is based on blocking or tying the tubes. Male sterilization is based on a similar principle on the vas deferens (the tubes through which sperm are transported) and is not covered in this website.

How is sterilization performed?

There are several techniques used to block the Fallopian tubes. They include tying, cutting or removing a small piece of the tubes or applying clips or rings. The tubes are accessed by laparoscopy, a surgical technique is where a doctor makes a small incision and places a thin rod like device (the laparoscope) that allows him/her to see the fallopian tubes and perform the sterilization procedure. The procedure is normally done under general anesthetic and is immediately effective in preventing pregnancy.

Another type of sterilization, known as the hysteroscopic technique, involves placing small inserts into the Fallopian tubes via the body’s ‘natural’ pathway of the vagina, cervix and womb3. During the next 3 months, the body reacts to the inserts by forming a natural barrier that stops sperm from reaching the egg3. The procedure is generally performed under local anesthesia. During the 3 months after the procedure, another form of birth control must be used to avoid pregnancy. After this period, the blockage of the Fallopian tubes must be ensured by performing a test using ultrasound or X-ray, and only after both tubes are found to be blocked, this form of sterilization is effective3.

Effectiveness of sterilization (in preventing of pregnancy)

The effectiveness of sterilization depends on which method is performed, but the pregnancy rates in general are very low. Overall, about 5 out of a thousand women may become pregnant within the first year following the procedure4. If pregnancy occurs after sterilization, it may be ectopic (i.e. in the Fallopian tube).

Impact on your periods

Your periods are not affected by sterilization and should continue with the same regularity as before the procedure. However, if sterilization is used to replace a hormonal form of contraception, your periods may become heavier if one of the effects of the hormonal contraceptive was to reduce menstrual bleeding.

Reversal of sterilization

While sterilization is meant to be a permanent contraception method, it can in some cases be reversed but the procedure is not always successful and can depend on how and when the operation was performed. Studies have shown that the pregnancy rates following a reversal procedure range from between 31% and 92%3. In selected patient groups, particularly those who were sterilised with clips or rings, successful reversal may be at the top end of this range3. If the sterilization was performed using the hysteroscopic method, it is never reversible3.