Sterilisation will not be available on non-medical grounds unless the woman has had at least 12 months’ trial using Mirena® or a long acting etonogestrel-releasing implant (such as Nexplanon®), and found it unsuitable (in line with the FSRH UKMEC 2016 – Eligibility Criteria on Contraception Use). If a woman has a personal history of breast or other hormonal cancer and wishes to avoid all hormonal methods then a copper intrauterine device (IUCD) should be suggested for the trial period
The CCGs will fund this procedure:
- Where sterilisation is to take place at the time of another clinically appropriate gynaecological procedure such as caesarean section
- Where there is a clinical contraindication to the use of a Mirena®/Nexplanon®
- Where there is an absolute clinical contraindication to pregnancy, including butnot limited to:
- young women (under 45 years of age) undergoing endometrial ablation for heavy periods
- women with severe diabetes
- women with severe heart disease
For a sterilisation to be considered on the above grounds, the patient must also pass the following criteria with regards to expert counselling1:
- Is the woman certain her family is complete or that she never wants children?
- Is the woman aware that the procedure is considered permanent and that reversal is not routinely funded on the NHS?
1 Regret rates after female sterilisation are quoted as between 6% and 20% often because of a change of relationship or change of mind. It is therefore important that women requesting sterilisation understand that this procedure is considered irreversible and have tried other long-term methods first
Has the woman received counselling about her options including consideration of all other forms of long-acting contraceptives and her other contraceptive options? The referring GP should ensure the patient is properly counselled on this decision and this counselling evidenced before making a referral
Does the woman have sound mental capacity, refer to page 3 of FSRH guidance 2014 – Male and Female Sterilisation for guidance on mental capacity
An exception to this is where the woman has an absolute clinical contraindication to pregnancy and therefore it is felt that counselling regarding the irreversibility of the procedure is inappropriate. However, counselling relating to the psychological effects of having such a procedure should be offered
Women should be informed that vasectomy carries a lower failure rate in terms of post-procedure pregnancies and that there is less risk related to the procedure