For our grandparents, citrus juice may have been considered a viable contraceptive option, and they probably would have never imagined the many contraception options available to today’s generation.
There are condoms and vasectomies for men. And for women there is the Pill. But for women there are also other contraceptive options, of a more long term nature.
tubal ligation
This procedure blocks the fallopian tubes so that the egg and sperm cannot meet and pregnancy cannot result. The unfertilised egg and sperm die and are simply reabsorbed by the body.
The menstrual cycle continues as normal so periods will continue. Some women have reported heavier periods after having this procedure, however the cause is unknown. It is thought there may be a degree of over-reporting attributed to some women comparing their menstrual loss with that of their periods before the procedure when they were taking the oral contraceptive pill which tends to make periods lighter.
As with all types of contraception, there is a failure rate. About one in 100 will fail and result in a pregnancy with a higher than normal risk of it being an ectopic pregnancy (a pregnancy that grows outside the uterus, usually in the tube itself). If it does fail, it does not necessarily mean the procedure was carried out incorrectly, but is rather a reflection of the body’s incredible ability to repair and regenerate itself.
Tubal Ligation is performed via a laparoscope (a telescope that looks into the stomach) in a day-case procedure under general anaesthetic. It usually takes less than 30 minutes and you would be home the same evening. You could be feeling fine after a day or two, although some people take a little longer to get back to feeling 100%.
As with any operation, there are recognised complications. The risk of damage to bladder or bowel is around three per 1000 procedures, and there is also a risk of bleeding. If complications occur, most are resolved via the laparoscope, but occasionally a larger cut in the stomach is required (this is called a laparotomy).
A laparotomy can be required if extensive scarring in the pelvis prevents the tubes from being seen through the laparoscope. Problems are more likely to occur in women who are overweight, have had previous operations in the abdomen involving an up and down stomach scar, extensive endometriosis, or previous pelvic infections. Your doctor will discuss these issues with you before you give your consent.
the procedure - The contraceptive effect is immediate, unless you are already in the early stages of pregnancy. Ovulation and fertilisation takes place two weeks before you miss a period, so it is important to use adequate contraception prior to the procedure.
timing - It can be done at any time as long as you are sure that your family is completed. If you have made this decision and discussed it with your doctor while you are currently pregnant, then it can be done via the laparoscope at six weeks after you have given birth. If you have a Caesarean section, Tubal Ligation can be done easily at the same time without altering the recovery period from your Caesarean operation.
Sometimes a Tubal Ligation can be done the day after a vaginal birth. This cannot be done through the laparoscope as the uterus is too large. Instead the tubes are accessed via an up and down cut about one inch long just below the belly-button. This requires an extra 24-48 hours in hospital after the baby is born.
If this option appeals to you, it is vital to discuss it with a doctor while you are still pregnant. Not all hospitals can offer this service, so check with your Lead Maternity Carer.
hysteroscopic tubal occlusion
In this procedure, the tube is blocked from the inside rather than from the outside as with Tubal Ligation. Completed in a day-case procedure under local anaesthetic, it can be done with or without sedation. General anaesthetic is also an option.
A small telescope is passed into the uterus via the vagina and cervix to locate the entrance of each fallopian tube. A small spring/coil-like device is then placed inside each tube, and the telescope removed.
Because no stomach cuts are made and general anaesthetic is not always required, the recovery time is quicker. Operative complications tend to be few but, as with all contraception options, failure is a possibility. The success rates are quoted at around 99.8%. Again, if pregnancy results, ectopic pregnancy is a concern.
The contraceptive effect is not immediate; it takes three months for tubal blockage to occur and an x-ray is taken to ensure the spring/coil-like device is in the correct place. Occasionally, an x-ray with dye (hysterosalpingogram) is required to confirm adequate tubal blockage. During these three months, alternative contraception should be used.
The menstrual cycle continues as usual and periods will remain as normal.
mirena - long-term but also reversable
If you are not absolutely certain your family is complete, an excellent alternative is the Mirena intrauterine contraceptive device.
The Mirena looks like a coil and sits inside the uterus releasing a tiny amount of a progesterone type hormone that thins out the womb lining. The amount of hormone absorbed into the body is the equivalent of taking two mini-pills a week.
The failure rate is similar to that of tubal ligation, but its contraceptive effects are reversible. If you decide to get pregnant again, it is easily removed, and fertility returns immediately.
This device makes periods shorter and lighter, and one in five women using it for more than a year will have no periods at all. Ovaries and hormone levels remain as normal, but because the device thins the womb lining, periods are generally lighter.
Mirena can be put in by your family planning clinic, and some GP’s. It does not require an anaesthetic and takes less than 10 minutes. The best time to do it is just after your period has finished, and the earliest it can be put in after giving birth is six weeks.
Side effects are minimal for most people. Irregular bleeding for up to six months is common and tends to be spotting only. Mirena does need to be replaced after five years when the hormone reservoir runs out.
Kirstie Peake, Specialist Obstetrics and Gynaecology
