Sterilisation

Question 1

What are the methods of sterilisation?

Answer 1

• Hysteroscopic sterilisation - expanding springs inserted into tubal ostia via hysteroscope
• Tubal occlusion (laparoscopic) - occlude fallopian tubes with Filshie clips

Question 2

What advice should be given to women considering sterilisation?

Answer 2

• Irreversible/reversal requires high skilled and is difficult
  
  • Vasectomy = safer, quicker and associated with less morbidity
• High proportion of women regret sterilisation
• Does not protect against STIs
• Requires thorough counselling about risks, SE, irreversibility, alternative contraception
• Prior to the procedure = abstain from UPSI for 3 weeks and have a pregnancy test
  
  • Protected sex is ok
• Effective contraception is required until:
  
  • Laparoscopic procedure: the next menstrual period
  • Hysteroscopic procedure: 3 months
• Pregnancy following female sterilisation
  
  • Increased risk of ectopic pregnancy

Question 3

What are the indications for sterilisation?

Answer 3

• Desire for permanent contraception (>99% effective)

Question 4

What are the complications of female sterilisation?

Answer 4

• Generic
  
  • Bleeding
  • Infection
  • Damage to local structures
  • Procedural failure (1 per 200, 1% peripartum)
  • Anaesthetic complications
• Increased risk of future ectopic pregnancy
• VTE damage to other organs
• Risk of conversion to open procedure
• Reversal is only successful in 30-70%