Tubal sterilization: focus on the U.S. experience

Abstract

Objective: To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience.

Design: A review of U.S. health care statistics and English-language literature using a MEDLINE search, bibliographies of key references, and U.S. government publications.

Patient(s): Women seeking tubal sterilization.

Intervention: Tubal sterilization.

Main outcome measure(s): Effectiveness and long-term risks and benefits.

Result(s): Half of the 700,000 annual bilateral tubal sterilizations (TS) are performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies find higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women.

Conclusion(s): Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evidence for hormonal or menstrual changes due to TS is weak. Tubal sterilization is associated with decreased risk of ovarian cancer.

PIP: This paper examines the frequency, effectiveness, and clinical sequelae of tubal sterilization (TS) with a focus on the US experience. A review of US health care statistics and English-language literature, as well as bibliographies of key references and US government publications showed that half of the 700,000 annual bilateral TS are performed postpartum and half as ambulatory interval procedures. In addition, 11 million US women aged 15-44 years rely on TS for contraception. Failure rates vary by method with one-third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies reported higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. In conclusion, TS is a highly effective and safe method of contraception.