More women are having fallopian tubes removed, not just tied. Here’s why.

Christine and George Steffon knew their third child would be their last, and discussed birth control options with their doctor at Christine’s 32-week checkup. After much conversation, which included health benefits beyond birth control alone, they decided Christine would have her fallopian tubes removed during her scheduled Cesarean section in January.

“My doctor recommended no more C-sections after the third,” said Christine, 32, who lives in Levittown. “We felt removing my fallopian tubes would be the safest mechanism of not having another child and would decrease my risk for ovarian cancer. And we could do it at the time of delivery.”

Steffon didn’t have a particular risk factor for ovarian cancer, such as a genetic predisposition. But that’s true for most women who develop the disease, according to the CDC, so hearing her doctor explain the possible benefit of removing the tubes was persuasive.

The fallopian tube removal added only a few minutes to her procedure at the Hospital of the University of Pennsylvania (HUP). She stayed in the hospital just 48 hours, eager to return home to her children, George, 4, and Benjamin, 3, and introduce them to baby sister Aliza.

In the past, tubal ligation, a surgical procedure during which the fallopian tubes are cut, tied or blocked to permanently prevent a future pregnancy, had been the common practice for permanent contraception.

Salpingectomy, removing the fallopian tubes completely, began about 10 years ago, with data showing that the majority of the most common forms of ovarian cancer originate in the distal fallopian tubes, said Elizabeth Micks, ob/gyn at the University of Washington School of Medicine and coauthor of the American College of Obstetrics and Gynecology’s Practice Bulletin on the Risks and Benefits of Sterilization.

“There is no one standard technique for permanent contraception,” Micks said. “It’s a shared decision-making approach between the surgeon and patient. It varies widely by institution and individual surgeon.”

Although there aren’t statistics available showing how many women are choosing to have their tubes removed, at the Hospital of the University of Pennsylvania, Jefferson Abington Hospital, and other area hospitals, it is an option doctors widely discuss with patients.

Ovarian cancer is the leading cause of death among all gynecological malignancies, and so far, there aren’t many great strategies for prevention or screening among low-risk women, said Tommy Buchanan, gynecologic oncologist at Jefferson Health-Abington.

“Taking out the whole fallopian tube is an excellent form of contraception, and very likely may have some benefit to decrease the risk of cancer,” said Ashley Haggerty, assistant professor of obstetrics and gynecology in the division of gynecologic oncology at HUP.

When performed during a C-section, removal of the tubes adds a negligible amount of time to the procedure, does not affect ovarian function, and hasn’t been known to increase complication rates, blood loss or readmission rates. The procedure can also be performed on its own as a laparoscopic surgery.

But it’s irreversible, so a woman must be absolutely sure she is finished bearing children, though if she still has a uterus and ovaries, she can undergo In vitro fertilization to become pregnant.

The procedure is intended for women at low or average risk for ovarian cancer. Women at higher risk, due to a strong family history or known genetic mutation, such as BRCA1 or BRCA2, should have both their fallopian tubes and ovaries removed by age 40 to 45, depending on the specific mutation. The risk of ovarian cancer in the general population is about 1.3%, but for women with a genetic mutation it can be as high as 40%, according to Haggerty.

“Women should discuss with their physician an adequate family history to assess their need for genetic counseling to determine if they are average or high risk to ensure the appropriate procedure is done,” Buchanan said.

But having your fallopian tubes taken out doesn’t mean you are at zero risk for ovarian cancer, Haggerty said.

Although it is often said that ovarian cancer is the silent killer with no symptoms, studies suggest that there actually are symptoms, including abdominal pain, bloating, change in bowel habits, indigestion, cancer-related fatigue, loss of appetite, or weight loss. But those are all symptoms of other conditions, too, leading to the difficulty in early detection.

“In general, ovarian cancer has limited early detection, and patients tend to present at an advanced stage with poor survival outcomes,” said Haggerty. “Actions like this have potentially profound impact on the development of ovarian cancer in the future.”

Having the procedure has given the Steffons peace of mind.

“I had completed my family with my third baby and I was blessed to have had three beautiful children,” Christine said. “We wanted to prevent another pregnancy and it’s one less thing I have to worry about.”