Tubal ligation (female sterilisation): eligibility and techniques
In brief
Tubal ligation (tubal sterilisation) is a permanent surgical method of contraception. In France, it is available to any adult woman, with no conditions on age or number of children. French law requires an information consultation followed by a 4-month reflection period before the operation, which is usually performed by laparoscopy. It is highly effective from the day of surgery, but should be considered irreversible.
What is tubal ligation?
Tubal ligation, or tubal sterilisation, means blocking or removing the fallopian tubes. Sperm can no longer reach the egg, so fertilisation becomes impossible. It is a permanent method of contraception and one of the gynaecological surgery procedures regulated by law.
The operation does not affect the uterus or the ovaries. The ovaries keep producing their hormones: periods and the age of menopause are not changed. According to the French National Authority for Health (HAS), the operation has no effect on hormonal balance, sexual desire or pleasure.
It does not protect against sexually transmitted infections: condoms are still useful with a new partner.
Who can have a tubal ligation in France?
Since the law of 4 July 2001 (article L2123-1 of the French Public Health Code), any adult can request sterilisation for contraception. The French National Authority for Health (HAS) points out that there are no conditions on age, number of children or relationship status. Specific, more protective rules apply to adults under legal protection because of a mental disability.
Consent is personal: you can involve your partner in the decision, but only your own consent is required. A doctor may decline to perform the operation; they must tell you so at the first consultation and refer you to a colleague.
What are the steps before a tubal ligation?
In France, the pathway is set by law and summarised in the HAS fact sheet:
- Information consultation: the surgeon discusses your reasons, presents other contraceptive options (especially long-acting methods such as the IUD (coil)), and explains the technique, its risks and its irreversible nature. You are given an information booklet and a certificate of consultation.
- A 4-month reflection period between this first consultation and the operation. This period cannot be shortened.
- Written confirmation of your request, at a pre-operative consultation.
- The operation in a hospital or clinic, after an anaesthetic consultation.
During these 4 months, you need to keep using effective contraception. If your current method does not suit you, say so: a temporary alternative can be offered (see the different methods of contraception).
What are the different tubal sterilisation techniques?
The HAS lists three main techniques for women: tying and cutting the tubes, electrocoagulation, and placing rings or clips. They are usually performed by laparoscopy (keyhole surgery), under general anaesthesia, through two or three small incisions in the abdomen. Sterilisation can also be carried out during a caesarean section if the request was made within the legal timeframe.
| Technique | How it works | Key points |
|---|---|---|
| Clips (Filshie, Hulka) | A clip is closed onto each tube | Short procedure. Surgical repair is sometimes attempted, with no guarantee. |
| Electrocoagulation | A segment of tube is destroyed with electric current | A variable length of tube is destroyed; repair is very difficult. |
| Tying and cutting, or salpingectomy | A segment is cut, or the tubes are removed entirely | Irreversible. |
Why is salpingectomy discussed more and more?
Complete removal of the fallopian tubes (salpingectomy) is one of the possible techniques. Whether to choose it rather than tying or clips is discussed with you at the information consultation.
What about Essure implants?
Essure tubal implants, placed by hysteroscopy, have not been available in France since early August 2017: their CE mark was suspended and stock was withdrawn. They are therefore no longer offered. If you have them and no symptoms, removal is not recommended. If you do have symptoms (pain, bleeding, general symptoms), talk to your doctor: surgical removal may be considered.
How effective is tubal ligation?
Tubal sterilisation is effective from the day of surgery with laparoscopic techniques. The HAS reports a pregnancy rate of about 0.5% in the first year.
However, the risk of failure is not zero and persists over time. In the large American CREST cohort (more than 10,000 women followed for up to 14 years), the cumulative 10-year risk of pregnancy depended on the technique: it was lowest after unipolar coagulation or postpartum partial salpingectomy (7.5 per 1,000) and highest after clips (36.5 per 1,000). It was higher in women sterilised at a young age.
If the method fails, the pregnancy is more likely to be ectopic. A late period, pelvic pain or abnormal bleeding after sterilisation means you should see a doctor promptly (see ectopic pregnancy).
Do women regret having their tubes tied?
Some do, which is why there is a reflection period. Most women do not regret their choice. But in the CREST study, the probability of expressing regret within 14 years was 20.3% in women sterilised at age 30 or younger, compared with 5.9% in those sterilised after 30. The risk was also higher when sterilisation took place within a year of giving birth.
Some useful questions to ask yourself:
- Would my decision still stand if my relationship changed, or if I lost a child?
- Am I choosing this method out of conviction, or because other methods have let me down?
- Could long-acting reversible contraception (IUD, implant) suit me for a few more years?
- Is my partner considering a vasectomy, a simpler procedure usually done under local anaesthesia?
If you regret it, surgery to repair the tubes is sometimes possible after clips, with uncertain results. More often, IVF (in vitro fertilisation) is offered.
What happens during and after the operation?
The operation is short and is done under general anaesthesia, at Hôpital privé Geoffroy Saint-Hilaire (Paris 5th), Clinique de la Muette (Paris 16th) or Clinique Ambroise Paré (Neuilly-sur-Seine); the length of stay is specified at the consultation.
- After the operation: pain in the abdomen and shoulders (caused by the gas used for laparoscopy) for a few days, relieved by simple painkillers.
- Recovery: normal activities within a few days; the length of sick leave is specified at the consultation.
- Contraception: no other method is needed after laparoscopic sterilisation.
- Costs: you are given a quote before the operation.
Complications are rare but possible, as with any laparoscopy: bleeding, infection, injury to an organ (bowel, bladder, blood vessel) that may require open surgery, and risks related to anaesthesia.
When should I seek urgent advice after tubal ligation?
Contact the surgeon or the clinic straight away if you have:
- a temperature above 38 °C;
- abdominal pain that gets worse instead of better, a swollen abdomen, vomiting;
- redness, discharge or bleeding from a scar;
- pain or swelling in a calf, or breathlessness.
If you feel faint, have severe abdominal pain or difficulty breathing, call 15 (SAMU) or 112 in France, or your local emergency number.
Frequently asked questions
Do I need to have had children to get a tubal ligation?
No. French law sets no conditions on age, number of children or relationship status: you only need to be an adult and observe the 4-month reflection period.
Can the 4-month waiting period be shortened?
No. In France, this legal period starts from the first information consultation. It also applies when sterilisation is planned during a caesarean section.
Will I still have periods after a tubal ligation?
Yes. It does not cause early menopause: the ovaries stay in place and keep working. Periods continue and the age of menopause is not changed by the operation.
Does my partner have to consent?
No. Only your own consent is required. You can still bring your partner to the consultations if you wish.
Is tubal ligation reversible?
It should be considered permanent. According to the HAS, surgery to repair the tubes is sometimes possible but difficult, with uncertain results; after complete removal of the tubes it is impossible. If you later want a pregnancy, IVF is usually offered.
How long is the hospital stay and how much does it cost?
According to the HAS, laparoscopic sterilisation usually requires a hospital stay of 1 to 3 days, under general anaesthesia; the length of your stay and of any time off work is discussed at the consultation. Fees are set out in a written quote given in advance.
References
- Haute Autorité de santé (HAS). Stérilisation à visée contraceptive chez l’homme et chez la femme [Contraceptive sterilisation in men and women]. Fact sheet, 2013, updated July 2019. has-sante.fr
- Peterson HB, et al. The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol, 1996. doi:10.1016/s0002-9378(96)70658-0 — PMID 8623843
- Hillis SD, et al. Poststerilization regret: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol, 1999. doi:10.1016/s0029-7844(98)00539-0 — PMID 10362150
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
A question about your situation?Appointments at the practice or by video consultation, usually within one week to 10 days.
Book an appointmentGeneral information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.