Considering Sterilization?

Completely You: Peace & Wellness: Sound Body
By Mimi Zieman, MD for Completely You

Q: My husband and I have decided we are done having kids. Does that mean one of us should be sterilized?

A: Female or male sterilization are certainly options. The advantages include very high efficacy and permanence. The disadvantages include the need for surgery -- and permanence! About 20 percent of women who are sterilized regret their decision. You may change your mind if you are: young, unmarried, change partners later in life and decide that you want another child, or are close to the end of a pregnancy (postpartum, or after a miscarriage or abortion). Sterilization is difficult and costly to reverse. One alternative is to consider having an IUD inserted. The chance of pregnancy with an IUD is about the same as after sterilization. Each carries a small risk of failure. The ParaGard IUD is good for 10 years of protection and the Mirena IUD 5 years. Either can be removed if you change your mind! They are placed in your uterus, during a routine office visit. Discuss this decision with your healthcare provider.

Mimi Zieman, MD, is the director of Family Planning and an associate professor in the Department of Obstetrics and Gynecology at Emory University School of Medicine in Atlanta. She is a Board Certified obstetrician/gynecologist specializing in gynecology and contraception. Dr. Zieman is an author of two books: A Pocket Guide to Managing Contraception for Clinicians and A Personal Guide to Managing Contraception for Women and Men.

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mummadee's picture

This is a very big decision to make but if you have problems with birth control pills, the shots, etc, I recommend it. My doctor made me wait 1 year before he would do the procedure after I told him I was considering it, and I have no regrets. After years of trying various methods of birth control and spending a fortune on pills that made me sick, a shot that made me sicker, this seemed like the best way to go.
Drawbacks for me--my cramps are definately worse during my menstrual cycle and its much heavier. I was told by my doctor that this could happen, and it did.
My husband would not even consider it, unfortunately.
Overall, its nice not to worry about getting pregnant again. My last 2 pregnancies were high risk and there was a lot of worry. This was definately a factor in my decision.

Jilsyt's picture

Just FYI, we got the Paraguard after baby #2, and it's been great!! We may still have more children, since I'm only 24, but wanted to space them out more, and I didn't want hormonal side effects (tried pills, shot, etc, YUCK!). If anyone wants to ask questions of someone who has had (and still has!) one, I'm willing to answer, though I may be biased cuz I've loved it!

Anhata's picture

What's Paraguard? Why haven't I heard of this is another question to which you do not have to respond.

Your Family's General Store, Naturally

Becky's picture

I can't answer your other question though.

Sparrow's picture

At least, this is what my mother says: Within a year of having her tubes tied (at 40-42 years of age?) she went into menopause. She tells me that another friend of hers had warned her that that might happen, that "doctors say it doesn't but women say it does," and indeed it did. I get the feeling from talking to her that she wishes that she'd done something else. I have no idea how common this is or whether it would've happened anyway, but it's a possibility that may be worth investigating if you're considering the surgery.

jennye's picture

We knew that four children was enough for us (well, I wouldn't mind a few more if I could afford it). But told my DH that if he didn't want any more children that he needs to get the snipping. By golly, if I have to have 9 1/2 pound kids coming out of me, he can stand that! LOL! He hasn't done it yet though (waiting for an opportunity to get to the big city I guess. He knows the gal in the office here. LOL!).

Marlene's picture

Hubby was snipped after DS was born 15 years ago. It went great, he missed one day of work, and I will attest that intimate time is much better and spontaneous knowing we don't have to worry about more babies. Maybe TMI but if anyone reading this is bugging DH to go.....Randy says there is nothing to it and it does NOT affect performance at fact, he agrees that not having to worry about pregnancy makes it that much better!

Guest's picture

Just because menarche happens around at the same time as a sterilization procedure does not mean there is a causal effect. 42 is not an atypical age to begin menopause. Many women go into in their middle to late 30s and the average age of menopause is 51. Since women tend to choose permanent contraception later in life, it would stand to reason that many would begin peri-menopause within the same period of time. This may also be the case for some of the reports of menstrual patterns changes among some women within the same time span. Not to say that an association will never be confirmed, but thus far long-term studies do not support and association.

A. Mayberry
CFPHW (Certified Family Planning Health Worker), CCRA (Certified Clinical Research Associate), CCRP (Certified Clinical Research Professional), RAC (Regulatory Affairs Certified)

Guest's picture

The 20% percent number is not quite accurate. I assume this rate is from CREST, which is one of the largest and most accepted analyses of sterilization in the USA, which reports that younger women (below 30 years of age) have a higher rate of regret (at about 20% after 14 years), while the average rate of regret is 5.9% among women who received their sterilization after the age of 30. Another large US study reports that at 5 years, 7% of the women who were sterilized regretted their decision. This study also reports that 2% of women who are sterilized eventually seek reversal. As stated in the original commentary, regret is associated with young age at sterilization, post-partum sterilizations, drastic life changes (like divorce of death of a child) spousal opposition, pressure from the family against the decision to be sterilized, as well as spousal pressure to undergo the procedure, and inadequate counseling by some health care providers.

The decision to choose a permanent method is a very BIG one and warrants careful consideration. If one is not absolutely sure that they want no more children, s/he should choose another method (such as the IUDs as described by Dr. Zieman in the post, which are excellent long-term temporary choices, as is the Implanon (a hormonal implant); however, in the right situation sterilization for women and vasectomy for men are both highly effective, generally safe (although surgical and hysteroscopic sterilization carry some rare serious risks) and are very economical choices. If the woman has a male partner, who is willing to undergo vasectomy, this is one of the safest and most effective of the currently approved contraceptive options, (and far safer than surgical sterilization for women).

On that note health care providers have a special responsibility to educate themselves about good family planning counseling practices and the contradictions and pros & cons of all methods. It is very important for those considering a permanent method (or any contraceptive) to educate them-selves and consider the possibility & ramifications of sterilization regret and method failure.

A. Mayberry
CFPHW (Certified Family Planning Health Worker), CCRA (Certified Clinical Research Associate), CCRP (Certified Clinical Research Professional), RAC (Regulatory Affairs Certified)

1. Jamieson D, Kaufman S, Costello C, Hillis S., Marchbanks P, Peterson HB, for the US Collaborative Review of Sterilization Working Group. 2002. “A Comparison of Women's Regret After Vasectomy Versus Tubal Sterilization.” Obstetrics & Gynecology. June 2002 - Volume 99 - Issue 6 - p 1073–1079.
2. Hillis S, Marchbanks P, Tyler Ratliff L, Peterson HB. 1999. “Poststerilization Regret: Findings From the United States Collaborative Review of Sterilization.” Obstetrics & Gynecology. June 1999 - Volume 93 - Issue 6 - p 889-895.

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