In females, sterilization can be achieved by hysterectomy or tubal occlusion. In the USA, female sterilization is the second commonest method of contraception overall, and the most common method used by married women and women aged over 30. Prior to deciding on a sterilization operation, the woman or preferably the couple should be given information about alternatives, especially long-acting reversible method of contraception (LARC) and also vasectomy. They should understand that vasectomy has a lower failure rate and fewer complications than tubal sterilization. Various approaches to tubal occlusion described in this chapter are laparoscopic filshie clips, and hysteroscopic approach. Women choosing laparoscopic sterilization are more likely to have a successful procedure. Approximately 5% of women who have a failed hysteroscopic attempt declined further sterilization. The options for women who have been sterilized and wish to restore fertility are to undergo sterilization reversal or to attempt in vitro fertilization (IVF).

Male or female sterilisation is chosen by almost 50% of British couples in their 40s as their main method of contraception. Of these, 15% of men and 12% of women choose either vasectomy or tubal occlusion. Vasectomy is the most effective contraceptive method available, with failures now quoted as having a life-time risk of one in 2000 after two azoospermic samples taken 2-4 weeks apart at least 8 weeks after the procedure. Mirenai (Schering), the levonorgestrel-releasing intrauterine system (LNG-IUS), is an ideal contraceptive method for the older woman. Epidemiological data support the prescribing of combined hormonal contraceptives (CHCs) to non-smoking, normal-weight, low-risk women who do not suffer from migraine until the menopause. The median age of the menopause in Western women who do not smoke is 51.3 years. Symptoms of the menopause are often masked in women using CHCs but some may complain of vasomotor symptoms in the hormone-free week.