World Health Organization

Selected woman’s characteristics
Breastfeeding Status:
Time Selected: Between 0 hours and 12 months
Method Selected: Female Sterilization
Note: Some methods are unavailable for specific time ranges
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Description

Permanent contraception to block or cut the fallopian tubes

How it works

Eggs are blocked from meeting sperm

Effectiveness to prevent pregnancy

>99%

Comments

Voluntary and informed choice is essential

Female Sterilization

Given that sterilization is a surgical procedure that is intended to be permanent, special care must be taken to assure that every client makes a voluntary, informed choice of the method.
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Female sterilization

Given that sterilization is a surgical procedure that is intended to be permanent, special care must be taken to assure that every client makes a voluntary, informed choice of the method.

Particular attention must be given in the case of young people, nulliparous women, men who have not yet been fathers and clients with mental health problems, including depressive conditions. All clients should be carefully counselled about the intended permanence of sterilization and the availability of alternative, long-term, highly effective methods. This is of extra concern for young people. The national laws and existing norms for the delivery of sterilization procedures must be considered in the decision process.

Transcervical methods of female sterilization are not addressed in these recommendations.

There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special). For some of these conditions and circumstances, the theoretical or proven risks may outweigh the advantages of undergoing sterilization, particularly female sterilization. Where the risks of sterilization outweigh the benefits, long-term, highly effective contraceptive methods are a preferable alternative. Decisions in this regard will have to be made on an individual basis, considering the risks and benefits of sterilization versus the risks of pregnancy, and the availability and acceptability of highly effective, alternative methods.

Sterilization procedures should only be performed by well-trained providers in appropriate clinical settings using proper equipment and supplies. Appropriate service-delivery guidelines, including infection-prevention protocols, should be followed to maximize client safety.

Sterilization does not protect against sexually transmitted infections (STIs), including HIV. If there is a risk of STI/HIV, the correct and consistent use of condoms is recommended. When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms.

Explanation of A, C, D and S categories:

A = accept: There is no medical reason to deny sterilization to a person with this condition.
C = caution: The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D = delay: The procedure is delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
S = special: The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other back-up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if referral is required or there is otherwise any delay.

MEC categories for contraceptive eligibility

Category 1 A condition for which there is no restriction for the use of the contraceptive method
Category 2 A condition where the advantages of using the method generally outweigh the theoretical or proven risks
Category 3 A condition where the theoretical or proven risks usually outweigh the advantages of using the method
Category 4 A condition which represents an unacceptable health risk if the contraceptive method is used
For further information, please refer to: Medical eligibility criteria for contraceptive use, fifth edition.

Explanation of A, C, D and S categories

A = accept There is no medical reason to deny sterilization to a person with this condition.
C = caution The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D = delay The procedure is delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
S = special The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other back-up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if referral is required or there is otherwise any delay.
For further information, please refer to: Medical eligibility criteria for contraceptive use, fifth edition.

Explanation of I and C

I = initiation
C = continuation
For further information, please refer to: Medical eligibility criteria for contraceptive use, fifth edition.

Conditions / Subconditions

Breastfeeding Status:

No breastfeeding status was selected using the "Women’s characteristics" filters.

Breastfeeding Category Clarifications/Special considerations
a) < 7 days postpartum A Clarification: If exploratory surgery or laparoscopy is conducted and the patient is stable, repair of the problem and tubal sterilization may be performed concurrently if no additional risk is involved.
b) 7 to < 42 days postpartum D
c) ≥ 42 days postpartum A
d) Pre-eclampsia/eclampsia
i) mild pre-eclampsia A
ii) severe pre-eclampsia/eclampsia D
e) Prolonged rupture of membranes, 24 hours or more D
f) Puerperal sepsis, intrapartum or puerperal fever D
g) Severe antepartum or postpartum haemorrhage D
h) Severe trauma to the genital tract (cervical or vaginal tear at time of delivery) D
i) Uterine rupture or perforation S
Non-breastfeeding Category Clarifications/Special considerations
a) < 7 days postpartum A Clarification: If exploratory surgery or laparoscopy is conducted and the patient is stable, repair of the problem and tubal sterilization may be performed concurrently if no additional risk is involved.
b) 7 to < 42 days postpartum D
c) ≥ 42 days postpartum A
d) Pre-eclampsia/eclampsia
i) mild pre-eclampsia A
ii) severe pre-eclampsia/eclampsia D
e) Prolonged rupture of membranes, 24 hours or more D
f) Puerperal sepsis, intrapartum or puerperal fever D
g) Severe antepartum or postpartum haemorrhage D
h) Severe trauma to the genital tract (cervical or vaginal tear at time of delivery) D
i) Uterine rupture or perforation S

Medical Condition:

No medical conditions were selected using the "Women’s characteristics" filters.

Cardiovascular disease Category  Clarifications/Special
considerations
Current and history of ischaemic heart disease D There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D(delay) or S (special).
Stroke C
Diabetes Category Clarifications/Special considerations
a) History of gestational disease A There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).
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b) Non-vascular disease
i) non-insulin dependent C
ii) insulin dependent C
c) Nephropathy/retinopathy/neuropathy S
d) Other vascular disease or diabetes of > 20 years’ duration S

Diabetes

  • There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).
  • Clarification: If blood glucose is not well controlled, referral to a higher-level facility is recommended.
  • Clarification: There is a possible decrease in healing and an increased risk of wound infection. Use of prophylactic antibiotics is recommended.
Headaches Category Clarifications/Special considerations
a) Non-migrainous (mild or severe) A
b) Migraine
i) without aura, at any age A
ii) with aura, at any age A
HIV WHO Stage 3 or 4 Category Clarifications/Special considerations
Severe or advanced HIV clinical disease (WHO stage 3 or 4) S There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).Read More

HIV WHO Stage 3 or 4

  • Clarification: No routine screening is needed. Appropriate infection prevention procedures, including universal precautions, must be carefully observed with all surgical procedures. The use of condoms is recommended following sterilization.
  • Clarification: The presence of an AIDS-related illness may require that the procedure be delayed.
Hypertension CategoryCategory     Clarifications/Special considerations
a) Hypertension: adequately controlled C There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).
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b) Elevated blood pressure levels (properly taken measurements)
i) systolic 140-159 or diastolic 90-99 mm Hg C
ii) systolic ≥ 160 or diastolic ≥ 100 mm Hg S
c) Vascular disease S
HISTORY OF HIGH BLOOD PRESSURE DURING PREGNANCY,(where current blood pressure is measurable and normal) A

Hypertension

  • There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).
  • Clarification: Elevated blood pressure should be controlled before surgery. There are increased anaesthesia-related risks and an increased risk of cardiac arrhythmia with uncontrolled hypertension. Careful monitoring of blood pressure intra-operatively is particularly necessary in this situation.
Obesity Category Clarifications/Special considerations
a) > 30 kg/m2 BMI C There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).
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b) Menarche to < 18 years and ≥ 30 kg/m2 BMI C

Obesity

  • There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).
  • Clarification: The procedure may be more difficult. There is an increased risk of wound infection and disruption. Obese women may have limited respiratory function and may be more likely to require general anaesthesia.
Pelvic Infection Category Clarifications/Special considerations
a) Past PID (assuming no current risk factors for STIs) There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).

Clarification: If no symptoms persist following treatment, sterilization may be performed.
i) with subsequent pregnancy A
ii) without subsequent pregnancy C
b) PID – current D
c) Current purulent cervicitis or chlamydial infection or gonorrhoea D
d) Other STIs (excluding HIV and hepatitis) A
e) Vaginitis (including Trichomonasvaginalis and bacterial vaginosis) A
f) Increased risk of STIs A
g) Puerperal sepsis,intrapartum or puerperal fever D
Tuberculosis Category Clarifications/Special considerations
a) Non-pelvic A There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special).
b) Pelvic S
Venous thromboembolism Category Clarifications/Special considerations
a) History of DVT/PE A There is no medical condition that would absolutely restrict a person’s eligibility for sterilization, although some conditions and circumstances will require that certain precautions are taken, including those where the recommendation is assigned as Category C (caution), D (delay) or S (special). Clarification: To reduce the risk of DVT/PE, early ambulation is recommended.
b) Acute DVT/PE D
c) DVT/PE and established on anticoagulant therapy S
d) Family history (first-degree relatives) A

Drug Interactions:

No drug interactions were selected using the "Women’s characteristics" filters.

Anticonvulsants Category Clarifications/Special considerations
a) Certain anticonvulsants, (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) No assigned category
b) Lamotrigine
Antimicrobial Therapy Category Clarifications/Special
considerations
a) Broad-spectrum antibiotics No assigned category
b) Antifungals
c) Antiparasitics
Rifampin/rifabutin No assigned category
Antiretroviral Therapy Category Clarifications/Special considerations
a) Nucleoside reverse transcriptase inhibitors (NRTIs) No assigned category
Abacavir (ABC)
Tenofovir (TDF)
Zidovudine (AZT)
Lamivudine (3TC)
Didanosine (DDI)
Emtricitabine (FTC)
Stavudine (D4T)
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Efavirenz (EFV)
Etravirine (ETR)
Nevirapine (NVP)
Rilpivirine (RPV)
c) Protease inhibitors (PIs)
Ritonavir-boosted atazanavir (ATV/r)
Ritonavir-boosted lopinavir (LPV/r)
Ritonavir-boosted darunavir (DRV/r)
Ritonavir (RTV)
d) Integrase inhibitors
Raltegravir (RAL)

Other:

No other conditions were selected using the "Women’s characteristics" filters.

Adolescents Category Clarifications/Special considerations
Adolescents D Clarification: Young women, like all women, should be counselled about the permanency of sterilization and the availability of alternative, long-term, highly effective methods.
Smoking Category Clarifications/Special considerations
a) Age < 35 years A
b) Age > 35 years
i) < 15 cigarettes/day A
ii) > 15 cigarettes/day A
Note: Some methods are unavailable for specific time ranges
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