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Roughly 16% of patients who received tubal ligation or bilateral salpingectomy reported experiencing regret, according to a new study.

In recent years, the landscape of available contraceptive options in Canada has expanded to include more highly effective reversible methods, such as intrauterine devices (IUDs). Researchers from Queen's University and the Huron Perth Health Alliance aimed to evaluate regret among patients who had received tubal sterilization and update the available data.

The cross-sectional survey was advertised on social media platforms and collected responses from 844 Canadians aged between 18 and 60 years who had undergone tubal ligation or bilateral salpingectomy. About 16% of respondents reported regret, which is consistent with data obtained in the 1980s and 1990s. The study also found that 9.5% of respondents reported an element of coercion in their decision, and 33.3% did not recall discussing alternative forms of contraception before the surgery.

"The most important point from our study was recognizing that regret is a possible outcome for patients who choose permanent contraception, but that regret rates remain low in our modern contraceptive landscape," study author Melinda-Sue Rodowa, MD, gynecologist at Huron Perth Health Alliance in Stratford, Ontario, Canada, told Medscape Medical News.

The study was published on January 23, 2024, in the Journal of Obstetrics and Gynaecology Canada.

Consistency Over Time

"Since the initial studies on regret following tubal ligation, we have seen a wide range of new options," said Rodowa. A range of hormonal birth control pills with different dosages and hormone formulations are now available, and more patients are accessing long-acting, reversible options. When IUDs first came to the market, for example, they were not recommended for younger patients or those who had not previously had children, Rodowa explained.

Given the greater number of options, the investigators hypothesized that rates of regret would decrease among patients who had chosen permanent contraception. They were surprised to find these rates consistent with those in the literature, said study author Ashley Waddington, MD, MPA, associate professor of obstetrics and gynecology at Queen's University in Kingston, Ontario, Canada.

The lack of change may indicate a lag introduced by respondents who had the procedure when fewer options were available, said Waddington. In addition, it can take time for providers and patients to become aware of new options on the market, added Rodowa. Both authors said that researchers may see changes in the future and would recommend conducting a similar study in 10 years or so.

The study may also overestimate rates of regret due to selection bias, Rodowa and Waddington acknowledged. To obtain a large, representative sample from across Canada, the survey was advertised on Facebook, X, and Instagram. Social media allowed the investigators to reach patients of different ages and geographic regions but may have introduced selection bias. "People who are less satisfied may be more likely to respond," said Waddington.

Importance of Counseling

In addition to examining rates of regret, the survey asked participants about the counseling they had received before the surgery. As a family planning specialist, Waddington was concerned to find that not all patients were properly informed of other options or the consequences of tubal ligation. About 33% reported that they did not recall discussing alternative forms of contraception, and 4.5% were unaware that the surgery was permanent.

"I hope it serves as a reminder of the importance of going over all of the options with your patients," said Waddington. Even for patients who are confident in their decision, she added, "part of consenting to a surgical procedure is being informed about what the alternatives are."

The study also provided more data regarding patients who had trouble accessing care promptly after deciding to have tubal ligation: A phenomenon that had previously been reported anecdotally, Waddington said. "It's our job to inform [patients] about the potential risks, including the risk of regret, but it's really not our job to be gatekeepers."

By taking a quantitative approach, the researchers were limited in the information they were able to gather about patients' experiences. "Every person who filled out this survey has their own story to tell about their experience of having a tubal [ligation] and why they did or did not regret it," said Waddington.

An Interesting Update

Commenting on the study for Medscape Medical News, Julie Thorne, MD, MPH, gynecologist at the University of Toronto and family planning lead for Women's College Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada, said that it provided an interesting update to older data. "The study confirmed either what we have demonstrated in data before or what we know anecdotally from clinical practice can be true," Thorne said.

Thorne was dismayed to see some patients report that the counseling they received was limited, though she noted that the retrospective data collection relies on patient memory. The nature of data collection does not allow for more nuanced questions regarding these experiences or control for the time between a patient's procedure and response, Thorne added. Ideally, Thorne would like to see qualitative and quantitative prospective studies.

Ultimately, she said, it is important for providers to have open, honest discussions with their patients about the pros and cons of contraceptive options — including permanent methods. "Tubal sterilization remains a contraceptive option that practitioners need to remember to have clear discussions around."

Funding for the study was not reported. Rodowa reported receiving honoraria from Bayer and Organon for educational presentations on IUD use and Nexplanon. Waddington reported receiving honoraria from Bayer, Organon, Searchlight, and Duchesney for education presentations and physician training. Rodowa and Waddington did not have any disclosures to declare related to tubal sterilization or salpingectomy. Thorne belongs to the Bayer Canada LNG-IUS medical advisory board and is a master trainer for Nexplanon with Organon Canada.

Gwendolyn Rak is a health reporter for Medscape Medical News based in Brooklyn, New York.