plumbing doesn't work but still...
May 18, 2022 9:32 AM   Subscribe

I'm childfree by choice. I also am not able to have children even if I wanted to. But this potential overturn of Roe v. Wade is wigging me out. Help me figure out my options.

I am 37 years old. I have PCOS and do not ovulate. This has been established medically about me since I was 16 years old. I am fine with this as I have never wanted to have kids, even before I was diagnosed with PCOS. My long term partner has two kids who I have known since they were small. We wouldn't be together if I wanted kids of my own - he doesn't want more. I do take hormonal birth control as part of my PCOS treatment but I skip the placebo pills most of the time so I only get a period 4x a year. (I have very bad PMDD symptoms during my period.)

So all good, right?

Except now in the wake of this Roe v Wade thing I'm contemplating nightmare scenarios. Birth control pills are not 100% effective (I know two women who got pregnant while on hormonal BC). What if one day one of my wonky ovaries drops an egg and my BC fails and I get pregnant? What if one day one of my wonky ovaries drops an egg and it's in the wrong place and I end up with an ectopic pregnancy? Are these things I unlikely? Yes, very much so, but it wouldn't be unprecedented - I also have a friend who was diagnosed with PCOS, told she'd never get pregnant, and then ended up getting pregnant. (This was a good thing for her. Would not be for me.)

I live in New York state and have significant financial means so it's also unlikely that I would not be able to have access to safe abortion options should they be needed. But once that Supreme Court opinion got leaked I cannot unring this bell of fear.

I've thought it was fucking stupid for years that I should even have to have periods (even the "fake" ones that occur from hormonal BC) if I was childfree by choice and otherwise infertile. I have all of these reproductive organs in my body that I will never use, taking up space and needing to be dealt with for literally no reason. It's a fucking hassle.

If I wanted to do something to ensure a measure of permanent birth control, what would be my options? Tubal ligation? Hysterectomy? Are there any other possibilities? What are the downsides? Yes I know vasectomies exist and trust me that is very much on the table, but my non-working reproductive organs cause me nothing but a lot of headache and that would be the case even if I were single so I want to know what sorts of things I could start looking into before my next gynecologist appointment.

Thanks.
posted by nayantara to Health & Fitness (25 answers total)

This post was deleted for the following reason: posters request -- frimble

 
I was SO HAPPY to get my tubes tied. I’m in Canada - it’s free (or paid by taxes I guess). The freedom and autonomy that comes with not having to worry about pregnancy is a godsend, but you know what’s even better? What I think about every month?

I don’t have to beg a doctor, a pharmacist or an insurance company for pills, or an IUD. If I get into trouble I don’t have to beg a doctor for help. My gynaecologist was amazing and supportive. I literally only wish i had done it in my 20s.
posted by Dressed to Kill at 9:38 AM on May 18, 2022 [7 favorites]


I did get a tubal ligation in my 20s. Best thing I ever did for myself.

Hysterectomies cause what I think is called medical menopause, which is Serious Business that can have serious negative health implications. A laparoscopic tubal ligation, for me, was an outpatient procedure, a day or so of moderate pain, a week of careful motion and minor pain, and no other sequelae whatever.

I just want to add that I believe you when you say you don't want children. I was asked whether I was "sure" kind of a lot. You may be too. If it helps, it's to reduce their supposed legal liability in case we change our minds. Which we haven't and won't, but there's no magic way to prove that.
posted by humbug at 9:46 AM on May 18, 2022 [7 favorites]


Best answer: I haven't had one myself but it seems the hot thing in childfree circles is a bisalp, or bilateral salpingectomy. Removal of your fallopian tubes.


Also I haven't had a period in years, I run my pill packs back to back. For literally years. Doctor doesn't care. The police so far have never come to ask me about it. Why even bother with the 4 a year you're having?
posted by phunniemee at 9:48 AM on May 18, 2022 [7 favorites]


Best answer: Bilateral salpingectomy is the removal of both Fallopian tubes. It is so effective, apparently, that medical professionals will actually get off your ass and understand that you are really and truly not pregnant if you have had one. Plus it has the benefit of reducing the risk of some kinds of ovarian cancer that start in the tubes and spread to the ovaries.
posted by corey flood at 9:50 AM on May 18, 2022 [7 favorites]


Best answer: Hey there.

I'm someone who had a hysterectomy back in 2018, because of a large fibroid. My doctor and I chose to keep my ovaries in, as I didn't want to go through a premature menopause, and the ovaries were unaffected by the fibroid. So, that is a possibility; they only removed the uterus, cervix, and fallopian tubes.

I haven't had any problems since, and I went into natural menopause a couple of years later. However, I had to sign a waiver acknowledging that this was gonna make me sterile (yay!), and also I had to wait 48 hours to make my decision for my fibroid treatment.
posted by spinifex23 at 9:52 AM on May 18, 2022 [6 favorites]


The only downside I can see to a tubal ligation is a nightmare scenario where you end up with an ectopic pregnancy. (TL is a risk factor for ectopic.) It's very rare, but still. This happened to someone I know; she had an abortion which saved her life. Some of the anti-abortion laws that would be triggered if Roe is overturned do not make an exception for those cases.
posted by basalganglia at 10:14 AM on May 18, 2022 [3 favorites]


I was happy with my hysterectomy. I did open surgery to keep my cervix.I am very happy with that choice even though it meant a larger scar and more recovery time. I still need paps. But I feel better keeping that muscle structure in place and not trading the cervix for scar tissue.

I kept only one ovary. In my case it had to be removed and I’m in menopause. But that’s my weird body issues. My spouse had a vasectomy prior to that.

We were very happy with vasectomy for birth control, but like you I did not enjoy the organs that were causing me pain. Very happy with the hysto. But it’s not for everyone and has side effects and risks. Tubal removal is another option.
posted by Crystalinne at 10:15 AM on May 18, 2022 [1 favorite]


Long-acting reversible contraception provides slightly more protection against pregnancy than sterilisation. About 2-5 women out of 1,000 will become pregnant after laparoscopic sterilisation. Only around 1 in 3,000 sexually active women using the implant will become pregnant each year, often because they were actually pregnant at the time of insertion, and this is the lowest failure rate of any contraception including sterilisation.

So, if you really as much protection as possible, get the implant.
posted by plonkee at 10:17 AM on May 18, 2022 [1 favorite]


This is going to be a "talk to your doctor" thing, but some just plain don't want to do permanent birth control on women of reproductive age, so...the options available to you will depend entirely on the gynecologist.
posted by jenfullmoon at 10:25 AM on May 18, 2022


Best answer: Bilateral salpingectomy is more effective than just tying the tubes. They take the tubes and throw them away. I had this procedure after my last c-section.

But, it doesn’t change your period cycle if that is a factor. And I’m not sure what the pain/recovery/availability for this is if you aren’t having a c-section. Having it done when I did seemed like no big deal, just a little add on.
posted by MadMadam at 10:41 AM on May 18, 2022 [3 favorites]


Best answer: This is timely! I meet with my OB/GYN next month to FINALLY get the sterilization I’ve been asking for since I was *17* years old. With the impending removal of rights from my person, I emailed my OB/GYN and was like “hey, not ok with stupid old-ass white men telling me what I can and can’t do with my body; still don’t want kids, partner has grown kids and doesn’t want more, worried about losing access to my Paraguard.” Surprisingly, no pushback, and I’m scheduled for an exam and information on my upcoming bilateral salpingectomy. I am PSYCHED and actually I’m getting ready to pose an Ask for advice and information.
You go home the same day, and basically I can’t go to work (I have a physical job) or go to the gym for 14 days. That’s it. No more worrying, no more background stress for myself or my partner, no more personal worry about what evils some stupid legislators have planned for people capable of birthing other people through adult activities. Oh, and I’ll be 39 this fall (in a very purple state) so even though I’m not in prime baby times, it’s still way too close for me to feel comfortable without taking action.
posted by sara is disenchanted at 10:50 AM on May 18, 2022 [4 favorites]


Best answer: You may find this Childfree Friendly Doctors List helpful! It's a collective list of many people's individual experiences with doctors who provided voluntary sterilization to them. You can check out the notes about doctors in your state/area with brief descriptions of specific procedures that people had.
posted by dreamyshade at 11:33 AM on May 18, 2022 [4 favorites]


Another thing you may want to do is ask your uterus owning family members if they happen to have a history of fibroids. And then, get scanned for fibroids yourself.

Though they are rarely dangerous by themselves, fibroids can cause anemia due to heavy bleeding. They can also do weird things like grow outside of the uterus, while attached to it, thus impacting other organs. My orange-sized fibriod decided to grow outside of my uterus, right on top of my bladder, using it as a lovely pillow to rest on. This obviously caused bladder issues, and surgery was definitely needed to remove it, to prevent permanent damage to the bladder. The hysterectomy I got to treat the fibroids permanently was just a nice bonus.

That may be something to keep track of, and may also be a route to getting a hysto sooner than later.
posted by spinifex23 at 11:34 AM on May 18, 2022


Hysterectomy is a major abdominal surgery with the associated risks so I probably wouldn’t go there unless your uterus specifically was causing problems. I think most other surgeries you can do in that region can be done laparoscopically which is way less invasive.
posted by nouvelle-personne at 11:35 AM on May 18, 2022 [1 favorite]


It sounds like you have complicated issues with your reproductive organs. It might be simpler and more expedient to have your partner get a vasectomy. If they are done with child-bearing, it's a great thing to do. Otherwise, I think working with your healthcare provider, if you trust them, to come up with a permanent sterilization option for you is a good idea.
posted by amanda at 11:35 AM on May 18, 2022 [1 favorite]


Best answer: In your circumstances, I would ask to have my tubes removed. I believe most insurance covers it, it’s more effective that tubal ligation, and it significantly decreases your risk of ovarian cancer.
posted by maleficent at 1:20 PM on May 18, 2022 [1 favorite]


Hi, I had a hysterectomy and ovary removal a few years ago for bleeding fibroids, nothing to do with contraception. Since my mother had ovarian cancer I elected to have them removed.

I just want to let y'all know that these procedures can be done laparoscopically; it's what I had. I went to a big academic medical center, so I'm not sure if this is commonly available in other hospitals. Good luck to you in your search for permanent contraception, and perhaps PCOS relief.
posted by citygirl at 2:46 PM on May 18, 2022 [1 favorite]


Response by poster: I learned something new today! I did not know that bilateral salpingectomy was a thing, and it frankly sounds awesome - especially knowing that it decreases risk of ovarian cancer (which runs in my family).

Though it is a bummer that I'll still have to deal with stupid periods. phunniemee, to answer your question about why I even bother with 4 periods a year - basically after 3-4 months of taking my pills continuously I start spotting quite heavily, to the point where it's basically a period and I have to use my menstrual cup so as not to destroy clothes and upholstery, so basically my gynecologist told me I may as well empty out the pipes, so to speak, quarterly, with intention, rather than be surprised by heavy spotting out of the blue. Being able to mentally prepare for a period knowing that it only comes 4x a year for me allows me to do what I need to do in order to contend with the PMDD symptoms (and actually, switching to a different brand of birth control has also helped with the PMDD).

Follow up question: a friend of mine who was AFAB but identifies as non-binary recently had an endometrial ablation as a way to deal with some major body dysmorphia issues they were having. This basically means they don't get a period anymore, and was a huge psychological relief and helped them feel more affirmed in their gender identity. I know this is a question for my doctor but on the off chance anyone here has had one - do you think a bilateral salpingectomy + endometrial ablation would be a combination that a doctor would sign off on? That way I get the childfree permanent birth control and also no more damn periods. I'm not a doctor. I know you are not my doctor. Just spitballing here.
posted by nayantara at 2:48 PM on May 18, 2022


Best answer: nayantara, I have some sports friends who are all cis women and I know 2 (maybe 3) have had ablations and one had a full hysterectomy. Most all of this was for either cancer prevention and/or all of the terror that can come from these types of reproductive parts. Most were in their early 40s when they had these procedures done. They all seem happy, and have said that they appreciate relief they gained from the procedures (physically and mentally).

IANAD - covering my butt. That being said, if you have a history of menstrual issues that could be abated by the ablation, why not ask about it?

I don’t do social media and rely on rolling my eyes at BuzzFeed articles; however, check out this article about young woman with a uterus and such who underwent these procedures: she looks so happy.
posted by sara is disenchanted at 4:17 PM on May 18, 2022 [1 favorite]


An ablation is not contraception and needs to be combined with IUD or surgical sterilisation.
posted by chiquitita at 12:51 AM on May 19, 2022 [1 favorite]


Best answer: Bisalp + ablation last year. I'm 40, had fibroids leading to an oversized uterus, and am done having kids. My obgyn likes to do the bisalp with the ablation as it prevents conception, since ablation only prevents proper implantation (thus higher risk of ectopic).

Mine was laparoscopy+transvaginal I believe. It was a bigger recovery than my two previous laparoscopies. Bruising more, feeling ick. Since then I spot once a month, I still have the hormonal effects but without the major iron deficiency. Mine is mostly migraine, exhaustion, digestion effects, higher emotional lability, and I do get cramps on occasion. I don't ovulate every month, but do feel it.

I highly recommend it.
posted by geek anachronism at 3:00 AM on May 19, 2022


Response by poster: geek anachronism, if it's not too impertinent to ask, can I get a sense of the location and size of your surgical scar from the bisalp? I don't expect that to be a deciding factor in asking my gyno to give me the procedure, but I'd like to know ahead of time just for curiosity's sake/letting my SO know ahead of time so he doesn't panic (he is going through a potential skin cancer scare right now - we're waiting for biopsy results - and so if this comes to fruition I'd like to let him know what to expect ahead of time because the poor guy just is very panicky right now, the idea of me having surgery might literally make him cry).
posted by nayantara at 6:36 AM on May 19, 2022


Best answer: This doesn't answer your questions about permanent birth control but can maybe offer assurance that there are "safe" doctors out there... I'm in a situation where i have a higher than normal probability of ectopic pregnancy or non-viable pregnancies that do not resolve themselves. I also live in a state where my reproductive freedom was in jeopardy ages ago. All three of my drs on my treatment team independently told me "what happens in this office stays in this office."
posted by BlueBear at 7:53 AM on May 19, 2022 [1 favorite]


Best answer: I had my bilateral salpingectomy, specifically for sterilization, in 2015. (link to my Ask from before the procedure)

While they were in there, they discovered (and treated) endometriosis. I had no idea! (Thanks terrible Texas anatomy/sex-ed) I was told the endo was very unlikely to come back, and my cycles have been much less terrible since. That, and the reduced chance of cancer, were big bonuses. When I was a young teen, I witnessed my mother miscarry an ectopic pregnancy after her tubal ligation. When I was discussing my options with my surgeon, I let him know that I was TERRIFIED of that happening to me. That's when he offered to remove the tubes entirely.

I'm told nobody ever guarantees a 100% chance of anything, but my surgeon said he'd eat his medical license if I were to get pregnant.

Mine was through mini-laproscopy (yay robots?), and I did not have an ablation. The scar is mostly unnoticeable, just a couple of small lines below my belly button. Recovery was easy and quick. My boss was yelling at me for attempting to lift things on day 3. Of course, YMMV, etc.

Feel free to MeMail if you'd like to chat further.
posted by MuChao at 2:06 PM on May 19, 2022 [1 favorite]


Best answer: I have existing laparoscopy scars, got a new one on the left and one at the bottom of my stomach, they went through the belly button and another one up higher I think? The scars are very small and one of them is in a stretchmark. I had issues healing because I lived in a mouldy bedroom + had another unrelated surgery + first vax + hyperthyroidism, so one scar is a bit more noticeable. Smaller than the ones from my gallbladder surgery though!

For the most part they are unnoticeable unless you're looking - I scar white and I'm pale, so once they calm down it's barely visible. The stitches are dissolvable and require very little care afterwards as well. I was very drowsy from the anaesthetic, and bruised and sore. Part of that is because it's my third laparoscopy and there is scar tissue on top of the ablation and "bulky uterus". Part is that I am overweight as well.

In general, my partner came over the day of, put on tv and cooked. He went home the next day, and I slept a fair bit (I'm very susceptible to anaesthetic so that's normal for me).
posted by geek anachronism at 4:07 AM on May 20, 2022


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