Franziska Bohm long knew she didn’t want kids and asked her family doctor to have her tubes tied, known officially as tubal ligation. At 28, she had her fallopian tubes removed after the surgeon recommended the procedure instead of the tubal ligation.
The procedure followed years of back and forth with her family doctor, who advised against undergoing a permanent form of birth control in her 20s.
“My doctor in Edmonton kind of brushed me off, referred me to different methods,” such as intrauterine devices (IUDs), said the 35-year-old.
Several women have reached out to CBC’s White Coat, Black Art to share their challenges of trying to get a referral from their family physician for tubal ligation as a method of permanent birth control while in their 20s.
Bilateral salpingectomy, in which both fallopian tubes are removed, is increasingly replacing tubal ligation, where the tubes are clipped or cut, says Dr. Fiona Mattatall, an obstetrician gynecologist working out of Rockyview General Hospital in Calgary.
That’s because researchers found that the removal of the fallopian tubes could reduce a woman’s risk of the most common ovarian cancer.
But a group of B.C. researchers and physicians say the procedure isn’t widely known across Canada and they are trying to change that.
They’re educating general surgeons about this procedure that can be done at the same time as another surgery in the abdomen or pelvic area, without removing the ovaries.
That’s what’s called an opportunistic salpingectomy, and the hope is for more eligible women to have it.
“I think we’re going to start to see a real increase,” said Gillian Hanley, an associate professor in the University of British Columbia’s obstetrics and gynecology department.
Hanley and colleagues recently published a study that looked at population health data of 85,000 people in B.C. who had a gynecological surgery between 2008 and 2020. When looking at rates of ovarian cancer among those who had opportunistic salpingectomy to those who didn’t, they found that those who had their fallopian tubes removed were 78 per cent less likely to develop the most common type of ovarian cancer (known as high-grade serous carcinoma) compared to those who didn’t.
That’s because researchers have found that the commonly diagnosed ovarian cancers start in the fallopian tube, not the ovaries.
The work now is to get the word out about the procedure that could lower a woman’s chance of ovarian cancer, Hanley says.
Concerns around regret
For most of her 20s, Angel LaMae heard from her family doctors that she was too young for tubal ligation, she’d meet someone later in life and change her mind.
“I just thought that’s not their place to be saying those things to me. I know my own mind. This is my choice,” said LaMae, who lives in Edmonton.
White Coat Black Art26:29Preventing ovarian cancer
Some doctors believe a minor gynecological procedure called an opportunistic salpingectomy can reduce dramatically the risk of ovarian cancer.
She says it was a bonus to hear from the surgeon that bilateral salpingectomy could also potentially lower her risk of certain ovarian cancers.
“I said if I have protection at the slight chance that it could ever happen to me, let’s take it. Whatever we need to do.”
LaMae, 41, eventually had bilateral salpingectomy in 2021. Five years on, she feels great.
“Having had that procedure done now, my quality of life in that respect has vastly improved because that burden, that worry and just that overall tension has lifted.”
There can be many reasons why a physician may not want to send a referral for permanent birth control. Not every woman is a good candidate for the procedure either, physicians say.
Dr. Catherine Clelland, a family physician and medical director of primary care with BC Cancer, which leads planning and delivery of cancer care in that province, says the challenge comes with women under 35.
She says it’s important women know the procedure is permanent.
“There is a little bit of a ‘Hmm, I’m concerned about doing this because it’s not at all reversible.’ Your only option, should you later on decide you want to have a child, is going to be in vitro fertilization,” she said.
Canadian researchers published data in 2024 from an online survey asking people who had tubal ligation and bilateral salpingectomy if they regretted their decision.
They found that about 16 per cent of the 844 people who responded to the survey in 2021 regretted the procedure later in life for a variety of reasons.
However, the authors noted that those who experienced regret may have been more likely to participate than those who were satisfied with their choice.
Guidelines for physicians on the procedure are in the works, says Dr. Nicholas Leyland, president of the Society of Obstetrics and Gynecology of Canada.
A spokesperson with the College of Family Physicians of Canada says the college does not have a position on salpingectomy or bilateral salpingectomy.
How accessible is the surgery?
Hanley has heard anecdotally that some general surgeons have begun counselling patients about the surgery.
On top of B.C., general surgeons in Winnipeg and Quebec are doing the procedure regularly, says Dr. Heather Stuart, a surgical oncologist and division head of general surgery at Vancouver General Hospital.
“It’s slowly catching,” she said.
Hanley and others are offering several live training events to surgeons and have brochures in 14 languages on the procedure in doctors’ offices across B.C.
More women are having bilateral salpingectomy in B.C., Hanley said. In 2023, she says roughly 3,000 women had the procedure, according to unpublished numbers found in the B.C. Discharge Abstract Database.
That’s about 200 more women than the year before and does not include women who had it done at the same time as another surgery.
Leyland didn’t know what average wait times for this procedure are in Canada, but says he would like to see women wait no more than three to six months for this type of procedure. But he added that limited operating room time for women’s health procedures remains a big challenge in Canada.
Mattatall tells her patients in Calgary the wait will be about a year.
“It’s going to be longer and shorter for other gynecologists in Canada.”
Asking for the surgery
For those wanting the procedure for contraception reasons, Clelland recommends that women have a list of reasons why they want permanent birth control.
If that doesn’t work, Mattatall recommends asking for a second opinion.
Bohm said she often tells women about the procedure to help get the word out.
“I really wish I had somebody who could have said ‘I did what you did,’ or I want to go down that path. It’s just nice not to be alone.”
