Tubal ligation—a surgical procedure to prevent pregnancy—may not be as effective as using some intrauterine devices (IUDs), according to research published last week. The findings call into question what has been considered the gold-standard method for permanent birth control.
"This is the first real world study comparing the safety and effectiveness of these 'highly effective' contraceptive procedures," lead study author Eleanor Bimla Schwarz, MD, chief of the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, told Health.
For the study, published February 22 in the Journal of General Internal Medicine, researchers analyzed six years of data from Medi-Cal, California's Medicaid health care program, on patients who received an IUD or tubal ligation. At the one-year mark, researchers discovered that patients with a levonorgestrel (hormonal) IUD had the lowest pregnancy rates, followed by those who had a tubal ligation and those with a copper (non-hormonal) IUD.
"Tubal ligation is really no longer the gold standard for pregnancy prevention," Dr. Schwarz said in a press release.
Though researchers aren't necessarily recommending against tubal ligation to prevent pregnancy, they want women to be aware of all their options—including the risks and effectiveness of each—when deciding between a permanent, invasive procedure like tubal ligation and a long-acting (though temporary) IUD.
How IUDs compare to tubal ligation
Tubal ligation—sometimes known as female sterilization or "getting your tubes tied"—and IUDs have similar purposes: to prevent pregnancy in the long term, either permanently or for multiple years.
IUDs, both hormonal and non-hormonal, work to create an inhospitable environment for sperm and implantation, while tubal ligation physically blocks or cuts the fallopian tubes to prevent eggs from meeting with sperm.
Because tubal ligations are permanent, invasive procedures, researchers wanted to look at their safety and effectiveness as compared to longer-lasting devices like IUDs.
While analyzing the more than 83,000 study participants—35,705 patients with a hormonal IUD, 23,628 patients with a copper IUD, and 23,965 patients who underwent tubal ligation—researchers found that hormonal IUDs were more effective than the other two options. In the year following the procedure, 2.4% of hormonal IUD patients became pregnant, compared to 2.99% of those with copper IUDs, and 2.64% of those who had a tubal ligation.
Complications and infections were also significantly more common within 30 days of tubal ligation, according to the researchers. Placement of an IUD also resulted in fewer complaints of pelvic, abdominal, and genitourinary pain in the 6–12 months post-procedure, compared to tubal ligation.
What to know when choosing between these birth control methods
In a press release accompanying the new research, Dr. Schwarz said patients should try using an IUD to prevent pregnancy before opting for tubal ligation.
When you're choosing a birth control method, it's worth noting how long each option lasts. Tubal ligation is permanent, Jessica Shepherd, MD, an OBGYN in Texas and Chief Medical Officer of Verywell Health, told Health. If you're looking to avoid pregnancy for the time being, but might be open to it in the future, the reversibility of an IUD might be more in line with your goals, Michael Cackovic, MD, an OGBYN and maternal-fetal medicine physician at the Ohio State University Wexner Medical Center, told Health, explaining that IUDs are "immediately effective and immediately reversible." Your IUD will have to be replaced every three to seven years, depending on which one you choose.
Getting an IUD might be the best option if you want to avoid surgery. "You're also looking at having a surgery with a tubal ligation vs. no surgery with an IUD—sometimes patients want to avoid surgery at all costs," Dr. Cackovic said.
Your age at the time of the procedure can affect your chances of getting pregnant afterwards, he adds. "If you do a tubal ligation on a 20-year-old woman, who has maybe 30 years of fertility left, there's plenty of time for the tubal to find its way back together," he said. "But, if you do it on a 40-year-old woman it's a little different, because there's less time." IUDs are also unappealing to patients who don't want any medical devices placed in their bodies: "Sometimes people just don't want to have anything in their bodies and would prefer not to have an IUD," Christine Greves, MD, an OBGYN at the Winnie Palmer Hospital for Women and Babies in Orlando, told Health. Also, hormonal IUDs provide a benefit that neither tubal ligation nor non-hormonal IUDs offer: they can lead to lighter periods, Dr. Greves said.
Both an IUD and tubal ligation "are not without potential complications," she added. You should ask your OBGYN or another health care provider, such as a primary care physician, to help you make an informed choice.
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