Q: I am four days late but I had a tubal three years ago.
A: Whenever you have regular menstrual periods and you are late, there is a chance that you may be pregnant. A tubal ligation does not always work in preventing pregnancy. Depending on the type of tubal ligation, there is a one to three in 1,000 chance it doesn't work. When you get pregnant after a tubal ligation, you are more likely to have an ectopic pregnancy -- a pregnancy outside the uterus, usually in the fallopian tube. The incidence of an ectopic pregnancy is usually about one in 120 pregnancies, but after a tubal ligation it's probably as high as one in 5 pregnancies. An ectopic pregnancy could be life-threatening. So when you miss your period after a tubal ligation you want to learn right away if you are pregnant and where the pregnancy is located. Besides missing your period, other signs of an ectopic pregnancy include lower abdominal pain on one side and vaginal spotting. You should do a pregnancy test right away and see your doctor to make sure that you are OK.
Tubal ligation, also known as “getting your tubes tied,” is an option for women who no longer want to have children. This outpatient surgical procedure involves blocking or cutting the fallopian tubes. It prevents an egg that’s released from your ovary from traveling to your uterus, where the egg could typically be fertilized.
While tubal ligation is effective in preventing most pregnancies, it isn’t an absolute. An estimated 1 out of every 200 women will become pregnant after tubal ligation.
Tubal ligation can increase your risk of an ectopic pregnancy. This is where a fertilized egg implants in the fallopian tubes instead of traveling to the uterus. An ectopic pregnancy can turn into an emergency. It’s important to be aware of the symptoms.
When a surgeon performs a tubal ligation, the fallopian tubes are banded, cut, sealed, or tied. Tubal ligation can result in pregnancy if the fallopian tubes grow back together after this process.
A woman is at greater risk of this occurring the younger she is when she has a tubal ligation. According to the University of Pittsburgh Medical Center, the rates of pregnancy after tubal ligation are:
- 5 percent in women younger than 28
- 2 percent in women between ages 28 and 33
- 1 percent in women older than 34
After a tubal ligation procedure, a woman may also discover she was already pregnant. This is because a fertilized egg may have already implanted in her uterus before her procedure. For this reason, many women opt for tubal ligation just after giving birth or just after a menstrual period, when the risk of pregnancy is lower.
If your fallopian tube has grown back together after tubal ligation, it’s possible you could have a full-term pregnancy. Some women also opt to have a tubal ligation reversal, where a doctor puts the fallopian tubes back together. This isn’t always effective for women who want to get pregnant, but it can be.
Symptoms associated with pregnancy include:
- breast tenderness
- food cravings
- feeling sick when thinking about certain foods
- missing a period
- nausea, especially in the morning
- unexplained fatigue
- urinating more frequently
If you think you may be pregnant, you can take an at-home pregnancy test. These tests aren’t 100 percent reliable, especially early in your pregnancy. Your doctor can also perform a blood test or ultrasound to confirm a pregnancy.
Having previous pelvic surgery or tubal ligation can increase the risk of an ectopic pregnancy. This is also true if you use an intrauterine device (IUD) as a contraceptive method.
The symptoms associated with an ectopic pregnancy can initially look like a traditional pregnancy. For example, if you take a pregnancy test, it will be positive. But the fertilized egg isn’t implanted in a place where it can grow. As a result, the pregnancy can’t continue.
Besides traditional pregnancy symptoms, symptoms of an ectopic pregnancy can include:
- abdominal pain
- light vaginal bleeding
- pelvic pain
- pelvic pressure, especially during a bowel movement
These symptoms shouldn’t be ignored. An ectopic pregnancy can cause the fallopian tube to rupture, which can result in internal bleeding that leads to fainting and shock. Seek immediate medical treatment if you experience the following symptoms with an ectopic pregnancy:
- feeling extremely lightheaded or passing out
- severe pain in your stomach or pelvis
- severe vaginal bleeding
- shoulder pain
If your doctor determines that your pregnancy is ectopic at an early stage, they may prescribe a medication called methotrexate. This medication can stop the egg from growing further or causing bleeding. Your doctor will monitor your levels of human chorionic gonadotropin (hCG), a hormone associated with pregnancy.
If this method isn’t effective, surgery may be needed to remove the tissue. Your doctor will try to repair the fallopian tube. If that’s not possible, the fallopian tube will be removed.
Doctors treat a ruptured fallopian tube with surgery to repair or remove it. You may require blood products if you’ve lost a lot of blood. Your doctor will also monitor you for signs of infection, such as fever or difficulty maintaining normal blood pressure.
While tubal ligation is a very effective contraception method, it doesn’t protect against pregnancy 100 percent of the time. It’s important to remember as well that the procedure doesn’t protect against sexually transmitted infections. If you and your partner aren’t monogamous, it’s important to use a condom each time you have sex.
Talk to your doctor if you’re concerned your tubal ligation won’t be effective. If you had your procedure at a young age or if it’s been more than a decade since you had your procedure, you could be at a small but increased risk of pregnancy. You and your partner can use other contraception options to reduce the risks. These could include a vasectomy (male sterilization) or condoms.