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Contraception - Management
What are the advantages, disadvantages, and risks of tubal occlusion?

  • Advantages:
    • Tubal occlusion is very effective in preventing pregnancy (failure rates are given below).
    • It is (for practical purposes) permanent.
    • Sex need not be interrupted to use contraception.
  • Disadvantages:
    • Tubal occlusion requires a surgical procedure.
    • People may regret having had the procedure:
      • The assessment process is designed to ensure that people at risk for regret are identified and fully informed about alternative long-acting reversible contraceptive methods.
    • It cannot easily be reversed, and the NHS rarely provides reversal procedures.
    • It does not protect against sexually transmitted infections.
    • It can fail, but this is uncommon:
      • The failure rate 10 years after tubal occlusion with the Filshie clip (the most common method used in the UK) is about 5 per 2000 procedures.
  • Risks:
    • Tubal occlusion is performed using laparoscopy when possible, and by laparotomy when not:
      • With laparoscopy, the risk of a major complication (injury to bowel, bladder, or blood vessels requiring laparotomy or leading to death) is about 2 per 1000 procedures. The risk of death with a laparoscopy is 1 in 12,000.
      • The risk of complications and need for laparotomy are increased by previous abdominal or pelvic surgery, previous pelvic inflammatory disease, and obesity.
    • If tubal occlusion fails, the resulting pregnancy may be ectopic.
    • There is an association with a subsequent increased hysterectomy rate, although no evidence indicates that tubal occlusion leads to problems that require a hysterectomy.
    • Women should be reassured that tubal occlusion is not associated with an increased risk of heavier or irregular periods when performed after 30 years of age.
      • There is little information on the effect on menstruation when tubal occlusion is performed for women less than 30 years of age.
    • The procedure entails the risk of the anaesthetic.
Basis for recommendation
  • These recommendations are based on guidelines published by the Royal College of Obstetricians and Gynaecologists [RCOG, 2004].

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