Bilateral Salpingectomy 10 Years Later

Wow. It’s been ten years since I had my laparoscopic bilateral salpingectomy. Well, it was ten years last October, but I had a lot going on then and forgot I meant to do this update. And then I started this and moved on to writing about other things. So now it's ten and a half years. Oops.

Post surgery apple juice

I wrote my original post mostly because I knew I’d always want to remember, but also because it was the hot new thing at the time and there wasn’t a lot of information about the procedure or recovery. I figured other people would want to know. And they did! That first post has had 42,000 views and 140 comments (though half are my replies). My 6-week update has had over 6,000 views and 43 comments, my 1-year update had 4,000 views and 18 comments, my insurance rant had nearly 3,000 views and 2 comments, and my FAQ post had 2,400 views and 10 comments. Altogether that’s close to 58,000 views and 106 original comments (not counting my replies).

One day: Gnarly incisions

Most of the comments expressed gratitude for the posts. It’s a little disappointing that, even a decade after I documented my experience, these types of detailed accounts are not that common. There are reddit communities with written accounts but lacking photos and other accounts that don’t have the same level of detail or follow up, and loads of fear mongering stories about what went wrong and phantom side effects. This can leave people confused and afraid. Any surgery has risks, and some people are more at risk than others, and those should be discussed in depth with a doctor. But there’s also a targeted effort to remove the ability for women to take complete charge of their fertility, and fear mongering is having a moment. The truth is that most recoveries are as easy as mine was.

6 weeks: I forgot I had a belly button ring!

One year later: the scars are still there but hard to see.

But let’s talk about the downsides for a minute. The biggest one is that I still had a period all this time. It didn’t occur to me that this would be a downside, but after the first few I was like, wait, what’s the point anymore? It used to be a nice signal that I wasn’t pregnant. But as soon as I knew I couldn’t get pregnant it became unnecessary. And because I stopped taking birth control, I also couldn’t control when I got my periods. Which meant trips, birthdays, anniversaries, and other times you don’t want to have a period would get inconvenient. Ten years later I’m still annoyed by my period. I asked a doctor once about getting a uterine ablation to remove the lining, but she said the approval process would almost ensure I’d be rejected. Which is genuinely bonkers. Why can’t I, as a grown-ass adult who doesn’t want a period, choose an elective procedure to take care of that need? Do all people with nose jobs have a medical need? Fuck no. At least my periods were predictable. I always had a 28-day on the dot cycle. Now that I'm probably in perimenopause my periods are becoming less predictable and I’m having to be in an office for work, there’s an element of anxiety once again that I don’t appreciate.

I struggle to think of any other downsides, honestly. As long as I have ovaries there remains the risk of an ectopic pregnancy, but those almost always happen in the fallopian tubes which no longer exist. They can happen on the ovaries themselves or outside the uterus, but that’s really uncommon. I’m also positive that any ectopic pregnancy would have happened by now. So, intellectually, I know I can’t get pregnant.

Unfortunately, knowing that I can’t get pregnant didn’t stop me from panicking about it for about six months when I skipped a period. I was almost 39 and had been sterile for 9 years at that point. The only other time I missed a period was the one right after my surgery. I bought and took a pregnancy test, which was obviously negative, and I only did it because I knew it would be the first question a doctor asked. I started having severe anxiety, irrationally worried I was 8 months pregnant and it would be too late to do anything about it, and then lamenting how my life would change. At one point husband offered to get a vasectomy just to ease my totally irrational worries. Thankfully those have passed and I even had another very late period and didn’t completely lose it.

Did sterilization push me into an early perimenopause? I’m not sure. I’m not 100% sure I’m in it because it’s not something you can really diagnose with certainty. Hormonal tests aren’t reliable, most doctors know next to nothing about it, and as much as I’m trying to learn the information is still hard to find and trust. Forty is admittedly earlier than most but not unheard of. I remember my mom having symptoms when I was in high school, which would have made her around that same age. So it could be genetic. Or I’m just stressed and it’s finally causing erratic periods and rage. <shrug emoji>

Positive: Group then solo trip to Africa

Now, the positives. This was without a doubt the best gift I could have ever given myself. Even if husband had been willing to get a vasectomy at the time, I’m sure I still would have ended up having this done. The peace of mind is unreal, except for those weird months where I was freaking out for no reason. There’s no preparation that needs to happen before sex, I’m not supplementing with hormones, my period tracker app is as reliable as it can be in the perimenopause age, and I generally feel as natural and normal as ever. If the apocalypse happens I won’t have to worry about avoiding pregnancy, and if this deranged administration starts forcing women into pregnancy I’ll escape that fate. Last, I’m not sure this is a positive (because I kind of wish I still had a visible reminder), but for years now when I look for my scars it takes a few seconds to find them, and you have to know what they are to know they’re scars.

I’ve been tracking my periods since going off birth control nearly a year before my surgery, so I still have a decent idea of when to expect my period even though there’s some hormonal fluctuations. Fluctuations mean highs and lows, and the highs include being absolutely randy during my ovulation week. So that’s been the fun side of perimenopause.

It took about a year to stop feeling like I forgot my birth control pills, which means it’s been a solid nine years of not having to think about preventing pregnancy at all. Once it was normalized in my head, it just was. To the point even when I learn that friends still take pills and use condoms I can’t imagine that life anymore and wonder why anyone puts up with it, especially those who don't want kids or any more kids. Sterilization is the most set it and forget it way to stay unpregnant. And I’m also really glad that I had the forethought to get a salpingectomy rather than a tubal ligation, even though it was still new-ish for sterilization purposes and not covered by insurance.

What’s the difference? A tubal ligation is cutting the fallopian tubes in half and doing something to the ends to stop them from growing back. Often they’re tied off (which is why it’s called getting your tubes tied), but some doctors cauterize the ends and others used these little chip clips for a while, but that fell out of fashion when they became associated with complications. My understanding is that now doctors that still do the ligation tie and cauterize the tubes. But salpingectomy is the gold standard for sterilization, so most women go full tubeless.

Just because I think it’s interesting, here’s what a laparoscopic bilateral salpingectomy means in English:

• Laparoscopic: Surgery in the abdomen made with itty bitty incisions and a camera so the surgeons can see
• Bilateral: Both sides of the body
• Salpingectomy: Salping means the fallopian tube (Greek for trumpet, apparently), and ectomy means removal

Altogether, removing both fallopian tubes via tiny incisions in the abdomen. The tubes connect to the ovaries, so the biggest risk with this surgery is that an ovary will get nicked. That can cause all sorts of problems. But surgeons tend to be very good at their jobs and don’t do that. The other risk is that they leave too much of the tube next to the ovary, and somehow little sperm gets to an egg and there’s an ectopic pregnancy on the ovary itself. It’s happened, but it’s extremely, extremely rare.

Husband gets me cards like this on my surgery anniversary

So, what have I done in the last 10 years? Lots! I got married. I got a masters degree. I grew out and cut my hair 3 times. I traveled by myself to Namibia and Kenya. Husband and I bought a condo. I was diagnosed with celiac disease. I quit a job with nothing new lined up. I bought a scooter. I fostered small pets. I ran a marathon. I had six pets at once. I've witnessed two solar eclipses. I paid for chemo for my dog and did subcutaneous fluids for my cat and administered medication that causes reproductive harm. I got tattoos. I traveled for work. I touched the water in the Mississippi River and the Colorado River. We traveled to Colorado and Louisiana and Utah and Montana and Nevada and Hawaii and New York and New Mexico and Washington and all over California. Not all of it was because I’m sterile, but I definitely wouldn’t have been able to do some of these things if I’d become a parent. And I’m so grateful to not have to have taken hormones for another 10 years or dealt with the excruciating pain of an IUD.

What’s next? I might write a book. I’m writing a book. I’m going to figure out what I want to be when I grow up. I’m getting really good at being an aunt. We’ll get more pets. I might run another marathon. I might finally convince husband to move to Seattle. I might try to get my 5k time under 20 minutes (which is really fucking fast). We’ll finally go on our honeymoon. I’ll get more tattoos. We’ll enjoy our quiet nights at home, making dinner together and watching a movie and appreciating the opportunity we get to choose how we live.

Since this ended up being more about how perimenopause is going than an update on sterilization, mainly because there isn't much to report (still don't need to worry about pregnancy, scars are too small to see), I'm not going to do another one of these. Nothing will change at 15 years, 20 years, or beyond. Eventually I won't have had a period for a full year and will be fully and completely barren. It's just nice to be one of the few voices on reddit with this longer term perspective to reassure scared women that, yes, it's going to be fine and this is worth it.