Female Sterilisation (Permanent contraception for women)

Threshold

Elective female sterilisation may be achieved by the occlusion or interruption of the fallopian tubes. Most commonly this is done via laparoscopy, when the fallopian tube is occluded with a tubal ring or clip, a modified Pomeroy technique can be performed using endoscopic sutures or bilateral salpingectomy.

Please note – Male/female sterilisation reversal is not routinely funded by NWICB and patients who have undergone a sterilisation will be ineligible to access assisted conception services funded by NWICB.

As a first line treatment option, an IUS should be offered in preference to sterilisation.

Male sterilisation should be considered as an option in preference to female sterilisation. The benefits of male vasectomy should be discussed with all women seeking female sterilisation.

The patient should be fully counselled*. This should include:

• a discussion about their options including consideration of all other forms of long-acting contraceptives, and, if the patient has a partner, vasectomy.
• the patient is aware that sterilisation is considered permanent, and that reversal is not routinely funded on the NHS.

The patient may be referred for consideration of permanent sterilisation if they meet the following criteria:

• Where there is a clinical indication that a pregnancy should be avoided, such as multiple caesarean deliveries, diagnosed genetic or medical condition which is not in the patient best interest, or the patient is unable to tolerate any forms of contraception and meets the above criteria, treatment will be funded.

AND

• There is an absolute clinical contraindication to Long-Acting Reversible Contraception (LARC) methods, either the LNG-IUS, Implant or Injectable (DMPA) or the patient has severe side effects to the use of LARC.

OR

• is intolerant or unsuitable for these treatments.

An IUS could be offered under sedation or anaesthetic where indicated.

https://www.nhs.uk/conditions/contraception/iud-coil/

NOTE:  Patients who are referred to secondary care for sterilisation, will be offered a trial of IUS in the first instance unless this is contra-indicated or not considered appropriate. IUS procedure can be undertaken for patients in Primary Care

The patient understands that sterilisation does not prevent against the risk of sexually transmitted infections and Clinicians should remind the patients that periods will continue and could become heavier post sterilisation because of the patient ceasing other contraceptive methods e.g. contraceptive pill.

https://www.nhs.uk/conditions/contraception/female-sterilisation/

*Counselled: Additional care must be taken when counselling individuals requesting sterilisation who are under the age of 30 years, who have no children, who have recently been pregnant, who have recently lost a relationship, are at risk of coercion, or who are experiencing any cultural, religious, psychosexual or psychological issues.

Cases for Individual Consideration (For patients who do not meet the policy criteria)

On a case-to-case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.