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Female Sterilisation

Female Sterilisation. Max Brinsmead PhD FRANZCOG October 2008. Women contemplating sterilisation need to be aware of:. Alternatives Reversibility Method to be used Operative Risks Failure Risk Short term sequale Long term sequelae Need for contraception. Alternatives to Sterilisation.

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Female Sterilisation

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  1. Female Sterilisation Max Brinsmead PhD FRANZCOG October 2008

  2. Women contemplating sterilisation need to be aware of: • Alternatives • Reversibility • Method to be used • Operative Risks • Failure Risk • Short term sequale • Long term sequelae • Need for contraception

  3. Alternatives to Sterilisation • Vasectomy • Mirena • Implanon • Hysterectomy

  4. Methods • Laparoscopic • Filshie clips • Falope rings • Diathermy (and divide) • Laparotomy • Partial salpingectmy • Fimbriectomy • Hysteroscopic • Essure

  5. Reversibility • This operation is not designed to be reversible so check: • Understanding of alternatives • Reasons for seeking the operation • Gender balance in family • Relationship • Women who seek reversal (1-2%) are more likely: • To be young (age <30 years at time of op.) • Low parity • In a new relationship • Sterilised for medical reasons • There is no Medicare for reversal

  6. Risk of Failure • Excluding technical problems and operator error the risk of failure is: • 1:200 for women >35 years • 1:100 for women <30 years • (this is a lifetime risk not per year) • Risk is higher if done at the time of Caesarean or Termination Pregnancy • About 1/3 of pregnancies are ectopic

  7. Operative Risks • Are the general risks associated with the method used i.e Laparoscopy, Laparotomy or Hysteroscopy

  8. Short Term Sequelae • Day only surgery • Requires another day to recover • 5-10% patients require longer

  9. Long Term Sequelae • Menorrhagia • Pelvic pain • Dysmenorrhoea • Endometriosis • Hysterectomy However, these occur just as commonly after partner vasectomy and are therefore unrelated to the procedure They arise as a consequence of uninterrupted cycles of ovulation and menstruation

  10. Max’s Maxim Number 3 • Nature did not intend that a woman should have too many menstrual periods • She is supposed to be pregnant, breast- feeding, postmenopausal or dead • And the next best alternative is being on the Pill • Or putting the Pill into her uterus (Mirena)

  11. Need for Contraception • Tubal ligation is effective immediately • But other reliable methods of contraception need to be continued until the day of surgery

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