1. Max Brinsmead PhD FRANZCOG October 2008
Female Sterilisation
Max Brinsmead PhD FRANZCOG
October 2008

2. Women contemplating sterilisation need to be aware of:
Alternatives
Reversibility
Method to be used
Operative Risks
Failure Risk
Short term sequale
Long term sequelae
Need for contraception

3. Alternatives to Sterilisation
Vasectomy
Mirena
Implanon
Hysterectomy

4. Methods Laparoscopic Laparotomy Hysteroscopic Filshie clips
Falope rings
Diathermy (and divide)
Laparotomy
Partial salpingectmy
Fimbriectomy
Hysteroscopic
Essure

5. Reversibility
This 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

6. 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

7. Operative Risks Are the general risks associated with the method used
i.e Laparoscopy, Laparotomy or Hysteroscopy

8. Short Term Sequelae Day only surgery Requires another day to recover
5-10% patients require longer

9. Long Term Sequelae Menorrhagia Pelvic pain Dysmenorrhoea Endometriosis
Hysterectomy
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

10. 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)

11. Need for Contraception
Tubal ligation is effective immediately
But other reliable methods of contraception need to be continued until the day of surgery