Female sterilisation: permanence, alternatives, risks and recovery

Sterilisation works by blocking the route between the ovaries and the womb so that egg and sperm cannot meet. It suits someone who has completed their family or never wants children, who has thought through the decision, and for whom other methods are unsuitable or unwelcome. The NHS describes it under permanent contraception, sometimes called having your tubes tied.

It is the wrong choice for anyone who might want a pregnancy in future. The Gloucestershire leaflet says that you should not have it if there is a chance of wanting children, and it points out that regret is higher in women under 30 or in a relationship that may not last. Counselling before the operation exists to test that decision. Because the procedure also does not protect against sexually transmitted infections, condoms may still be needed.

The Plymouth leaflet states that long-acting reversible contraception, such as a hormonal coil or an implant, is as effective as sterilisation and is reversible, and that male sterilisation is more effective than the female operation. The Gloucestershire leaflet compares failure rates, quoting about 5 in 1,000 for female sterilisation against 2 per 1,000 for a hormonal coil.

Vasectomy is a shorter operation, usually under local anaesthetic, and is effective once a sperm test confirms it has worked. For some couples the choice comes down to who prefers surgery, general anaesthetic risk, or the timing of effectiveness. Contraception can also be started simply and stopped at will, which sterilisation cannot.

You will be asked to use reliable contraception until the day, and a pregnancy test is checked. The operation is often timed for early in the menstrual cycle for that reason. If you rely on a coil or implant, ask whether to keep it until the operation or after it.

Anaesthetic fasting rules apply and you should bring loose clothes, arrange a lift home and have someone with you for the first night.

• Tell the team about previous abdominal surgery, which can make keyhole access harder.

• Mention weight, since higher body weight raises the chance of a technical difficulty according to one leaflet.

• Ask about the possibility of having the whole tube removed rather than clipped.

You are asleep for the operation. A small cut below the navel allows a laparoscope to be inserted, and a further one or two small cuts of up to a centimetre allow instruments in. Gas is introduced so the surgeon can see the womb and tubes. A clip is placed across each tube or, in salpingectomy, the whole tube is removed.

The Plymouth leaflet says clips are slightly quicker than removing the tube, and that salpingectomy is more effective than clips. Most people leave on the same day, though pain or dizziness after the anaesthetic can mean an overnight stay.

Both leaflets rate the failure rate at about 5 in 1,000 or 1 in 200 with clips. Failure can occur years later and, when it does, a pregnancy is more likely than usual to implant in a tube, so any positive pregnancy test or sudden one-sided pain should be treated as urgent.

Operative risks are bleeding, infection and injury to the bladder, bowel or blood vessels, with risk rising after previous abdominal operations or with obesity. The Plymouth leaflet notes that very occasionally a larger cut is needed to manage a complication. A positive point is that sterilisation does not affect hormones or periods.

You will have two small scars and may feel shoulder pain from the gas. One leaflet says most people resume work within three or four days and should avoid driving and strenuous activity for a week. Keep using contraception until your team says the operation is effective, which is usually from the next period or as advised.

GOV.UK says to ask your doctor if unsure about driving and to inform the DVLA if you are still unable to drive three months after an operation.

• Worsening tummy pain, fever or vomiting: see urgent care or NHS 111.

• Pain on one side with dizziness or a missed period: possible ectopic pregnancy, so go to A&E.

• Redness, swelling or discharge at a scar.

• A swollen calf, chest pain or breathlessness: 999 if severe.

• Why do you suggest clips rather than removing the tubes?

• How does this compare with a coil, implant or vasectomy in my situation?

• What happens if I change my mind later?

• When is the operation safe to rely on?

Access to sterilisation on the NHS can depend on local arrangements, so ask your GP how referral works in your area. Private care is often quicker to arrange. In both settings the counselling step, the consent and the information about alternatives should be the same, and you should ask what reversal would involve before deciding, because it is not simple.