Birth Control & Family Planning
Tubal Ligation vs. Salpingectomy: Permanent Birth Control Options
Tubal ligation ("getting your tubes tied") blocks, cuts or seals the fallopian tubes. A salpingectomy removes the tubes completely. Both are permanent birth control that prevent more than 99% of pregnancies, and many surgeons now offer salpingectomy because removing the tubes may also lower your risk of the most common type of ovarian cancer.
The side-by-side
| Tubal ligation | Salpingectomy | |
|---|---|---|
| What happens | Tubes blocked, cut or sealed | Tubes fully removed |
| Pregnancy prevention | More than 99% | More than 99%; possibly slightly higher |
| May reduce ovarian cancer risk | Possibly modestly | Yes, likely more |
| Reversible | Sometimes, with surgery | No |
| Surgery time | Usually shorter | Can take somewhat longer |
| Ectopic pregnancy risk if failure | Higher than average | Very low, since tubes are gone |
| Effect on hormones and periods | None | None |
How permanent birth control works
Each month an egg travels from an ovary through a fallopian tube toward the uterus. Fertilization usually happens in the tube. Block or remove the tubes, and sperm and egg can't meet.
Your ovaries and uterus stay put. You still ovulate, make your own hormones and get periods. People ask this constantly ("Will I go into menopause?"), and the answer is no.
Tubal ligation, explained
Tubal ligation closes off the tubes by:
- Cutting and tying a section of each tube
- Sealing them with heat (cautery)
- Placing clips or rings on them
It's done through small cuts in the belly with a camera (laparoscopy), through a small cut under the belly button soon after a vaginal birth, or during a cesarean.
Salpingectomy, explained
A bilateral salpingectomy removes both fallopian tubes, using the same approaches, most often laparoscopy or during a cesarean.
Research suggests many high-grade serous ovarian cancers, the most common and deadly type, likely start in the fallopian tubes. ACOG says that for people choosing permanent birth control, salpingectomy can be offered as an option that may reduce ovarian cancer risk.
Will removing my tubes affect my hormones? The ovaries stay in place. Research so far hasn't shown that salpingectomy causes early menopause or meaningfully changes hormone levels. You'll keep having periods until natural menopause.
What recovery is really like
For laparoscopic surgery:
- It's usually outpatient. You go home the same day, and you'll need someone to take you.
- Expect belly soreness, bloating, and an oddly specific shoulder pain for a few days. That's from the gas used to inflate your belly during surgery, and walking around helps it pass.
- Many people go back to desk work within about a week. Your surgeon will give you lifting and activity limits.
When it's done during a cesarean, it adds little recovery time beyond the birth itself.
Risks
Serious problems are uncommon. Risks include:
- Reactions to anesthesia
- Bleeding or infection
- Injury to the bowel, bladder or blood vessels
- Pregnancy afterward, which is rare. If it happens, the chance of an ectopic pregnancy is higher.
Is permanent birth control right for you?
There's no medical rule that you have to have children first. ACOG supports respecting a patient's informed decision. Expect your clinician to talk through permanence, alternatives and your reasons. That's standard for everyone, not a sign they doubt you.
Honest things to weigh:
- Regret: research shows regret is more common in people sterilized at a younger age. That doesn't mean young people can't choose it.
- Alternatives: IUDs and the implant are as effective as sterilization and fully reversible. See our birth control options guide.
- Partner vasectomy: simpler, office-based and lower-risk than tubal surgery, if it fits your relationship.
- Future fertility: IVF is possible after sterilization, but it's expensive and not always covered.
Tubal surgery vs. vasectomy
| Tubal surgery | Vasectomy | |
|---|---|---|
| Where it is done | Operating room, usually with general anesthesia | Usually an office, with local numbing |
| Recovery | About a week for most people | A few days for most people |
| When it works | Right away | After a semen test confirms no sperm, often a few months later |
| Effectiveness | More than 99% | More than 99% |
Planning it with your delivery: the Medicaid timing rule
Many people choose to have the procedure during a cesarean or shortly after a vaginal birth. This takes planning, especially with Medicaid.
Federal rules for Medicaid-funded sterilization require that you be at least 21 and sign a consent form at least 30 days before the procedure. There are limited exceptions, such as premature delivery, when the form was signed at least 30 days before your expected due date and at least 72 hours before the procedure.
The practical problem: people who mention it for the first time at 37 or 38 weeks, or whose babies come early, sometimes miss the window. Ask your prenatal provider to complete the form early in pregnancy, and bring a copy to the hospital. More on options in birth control after giving birth.
Insurance in New York
Most health plans cover female sterilization as preventive care under the Affordable Care Act, usually without cost sharing. New York Medicaid covers sterilization when federal consent rules are met. Reversal procedures generally aren't covered. Ask your plan about anesthesia and facility fees, which sometimes bill separately.
What about Essure?
A device placed through the cervix (Essure) used to be an option, but it's no longer sold in the U.S. If you had one placed and have concerns, talk with your gynecologist.
Questions to ask your surgeon
- Do you recommend tubal ligation or salpingectomy for me, and why?
- Will it be laparoscopic, after a vaginal birth, or during a cesarean?
- What kind of anesthesia will I have?
- When can I lift, exercise and go back to work?
- What are my options if I change my mind later?
- What will my insurance cover, including anesthesia and facility fees?
When to see a doctor
Book a consultation with a gynecologist if you're considering permanent birth control. After surgery, call your provider right away for:
- Fever over 100.4°F
- Pain that's getting worse instead of better
- Redness, swelling or pus at an incision
- Trouble breathing or chest pain
- A missed period or positive pregnancy test
Your next step
OB/GYNs and gynecologic surgeons do both procedures, and Complex Family Planning specialists can help you weigh permanent and long-acting options. Search the directory for a provider in your area. If you're pregnant and on Medicaid, bring up the consent form at your next prenatal visit.
Frequently asked questions
Is salpingectomy better than tubal ligation?
Both are highly effective. Salpingectomy removes the fallopian tubes entirely, which may lower the risk of the most common type of ovarian cancer. ACOG says removing the tubes can be offered to people choosing sterilization. Your surgeon can explain which fits your situation.
Can a salpingectomy be reversed?
No. Once the tubes are removed, they cannot be reconnected. Some tubal ligations can be surgically reversed, but success varies and reversal is often not covered by insurance. IVF remains an option after either surgery.
Will getting my tubes tied cause menopause?
No. Your ovaries stay in place and keep making hormones. You will still have periods and go through menopause at your natural time.
Is there a waiting period for sterilization with Medicaid?
Yes. Federal rules for Medicaid-funded sterilization require you to be at least 21 and to sign a consent form at least 30 days before the procedure, with limited exceptions.
Sources
- ACOG — Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention (Committee Opinion 774)
- ACOG — Sterilization of Women: Ethical Issues and Considerations (Committee Opinion 695)
- ACOG — Sterilization by Laparoscopy (patient FAQ)
- CDC — Contraception: How Effective Are Birth Control Methods?
- U.S. Department of Health and Human Services — Federal sterilization consent requirements (42 CFR 50 Subpart B)
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.