From the Guidelines
Tubal ligation is associated with both short-term and long-term risks, including bleeding, infection, damage to surrounding organs, and post-tubal ligation syndrome, with a risk of serious complications occurring in fewer than 1% of procedures. The potential complications of tubal ligation can be significant, and it is essential to consider these risks when deciding on this form of contraception. According to the most recent evidence 1, the effects of labour and childbirth on subsequent pregnancy can be substantial, and tubal ligation may be associated with secondary infertility due to uterine wall repair.
Short-term Complications
Short-term complications of tubal ligation may include:
- Bleeding
- Infection
- Damage to surrounding organs (particularly bowel, bladder, or blood vessels)
- Adverse reactions to anesthesia
- Incomplete closure of the fallopian tubes which could lead to pregnancy
Long-term Complications
Long-term complications can include:
- Post-tubal ligation syndrome (characterized by irregular menstrual cycles, heavy bleeding, and pelvic pain)
- Increased risk of ectopic pregnancy if pregnancy does occur
- Regret about the procedure (especially in younger women)
- Changes in hormone levels that could affect menstruation
The risk of serious complications is low, with major complications occurring in fewer than 1% of procedures, as noted in the 2019 guidelines 1. Recovery typically takes 1-2 weeks, during which patients should avoid strenuous activity and sexual intercourse. It's essential to understand that while tubal ligation is considered permanent, the effectiveness rate is about 99%, meaning pregnancy can still occur in rare cases. Women considering this procedure should discuss all potential risks and alternatives with their healthcare provider before making a decision, taking into account their individual anatomy and physiology, as recommended in the 2018 guidelines 1.
From the Research
Complications of Tubal Ligation
The complications of tubal ligation (tubal sterilization) can be categorized into several types, including:
- Febrile complications: Women infected with Chlamydia trachomatis at delivery are more likely to experience febrile postoperative complications after tubal ligation 2.
- Surgical complications: Complications such as bladder and bowel injuries, and postoperative infection can occur, especially in cases where the surgeon lacks experience or the patient has risk factors such as obesity or previous abdominal surgery 3.
- Vascular complications: Major vascular injury is a potentially fatal complication that can occur after laparoscopic tubal ligation, although it is rare 4.
- Infectious complications: Pelvic inflammatory disease (PID) can occur after bilateral tubal ligation, including cases caused by group A Streptococcus 5.
Risk Factors for Complications
Several risk factors can increase the likelihood of complications after tubal ligation, including:
- Chlamydia infection: Women infected with Chlamydia trachomatis at delivery are at higher risk of febrile complications 2.
- Obesity: Obesity can increase the risk of surgical complications, although one study found no association between increased BMI and morbidity after postpartum tubal ligation 6.
- Lack of surgeon experience: The skill and experience of the surgeon can affect the risk of complications, with less experienced surgeons being more likely to cause injuries or other complications 3.
- Previous abdominal surgery: Women who have had previous abdominal surgery may be at higher risk of complications after tubal ligation 3.