Salpingectomy can reduce ovarian cancer risk—but access remains uneven
Industry Buzz
I have seen a clear rise in patients asking about permanent contraception and especially complete salpingectomy since the Dobbs ruling returned abortion regulation to the states under the Constitution.
—Greg Marchand, MD, FACS, FACOG, FICS
Permanent-contraception demands are rising. A 2026 four-center study, titled “Changes in female permanent contraception at academic medical centers following the Dobbs decision,” recorded a 51% increase in procedures during the following year, with 47% of surveyed patients saying the political climate influenced their decision-making.[] A national claims study also found continued growth in sterilization rates in states with abortion bans.[]
Removing both fallopian tubes, or salpingectomy, has become the preferred female sterilization procedure in many gynecologic practices. The operation also reduces the risk of high-grade serous carcinoma, the histologic subtype responsible for most ovarian cancer deaths.
Greg Marchand, MD, FACS, FACOG, FICS, a board-certified OB/GYN trained in minimally invasive gynecologic surgery, says, “I have seen a clear rise in patients asking about permanent contraception and especially complete salpingectomy since the Dobbs ruling returned abortion regulation to the states under the Constitution.”
He adds, “In my practice, women now approach family planning with greater seriousness knowing that elective abortion is no longer a convenient fallback in many places, and they want reliable long-term options that also lower ovarian cancer risk.”
Related: Salpingectomy may cut ovarian cancer risk. So why does it still sound experimental?Barriers to access
Yet access still depends on insurance, hospital policy, geography, and whether a clinician accepts a competent adult’s reproductive decision.
ACOG supports discussing salpingectomy with average-risk patients undergoing pelvic surgery.[]
However, the procedure’s contraceptive effect creates policy barriers. Federal Medicaid regulations require patients to be at least 21 years old and generally require 30 to 180 days between consent and sterilization.[]
Title 42 of the Code of Federal Regulations, Part 441, Subpart F, further states that, “Informed consent may not be obtained while the individual to be sterilized is (1) In labor or childbirth; (2) Seeking to obtain or obtaining an abortion; or (3) Under the influence of alcohol or other substances that affect the individual's state of awareness.”[]
Some patients describe extensive consent safeguards. As one woman wrote on Reddit, “My drs asked multiple times and had me sign a dozen papers stating this was me who wanted it and not my husband, I wasn’t being forced into it, etc.”[]
Barriers exist for physicians, too, as Dr. Marchand notes. “The barriers I encounter most often,” he said, “are thoughtful age and parity considerations that many hospitals still require, to reduce later regret, along with the federal Medicaid 30-day consent waiting period, designed to protect vulnerable patients from rushed decisions.” He added that “Insurance coverage can occasionally slow things when documentation is incomplete, but pure marital-status rules have largely disappeared in my experience.”
Dr. Marchand says, “I work hard to clear every appropriate request as quickly as safety allows because these women deserve access to effective permanent contraception without unnecessary obstacles once they have made an informed choice.”
Related: How ‘hysteria’ cast a long shadow on women’s healthcare that still resonatesCounseling points
In its 2024 ethics statement on permanent contraception, ACOG states, “Respect for an individual patient’s reproductive autonomy should be the primary concern guiding permanent contraception provision and policy.” It advises early disclosure when a physician or institution will not provide permanent contraception. The patient should be offered an alternative form of contraception that would be acceptable, or she should be referred elsewhere for care.[]
“I walk every patient through the benefits and the permanence with care, because after more than twenty years caring for women, I know how important it is that this decision truly matches her life goals and values,” Dr. Marchand says.
Furthermore, he says, “I counsel every patient that the main benefit is a substantial reduction in lifetime epithelial ovarian cancer risk along with permanent contraception when desired. As for risks involved when the procedure is added to another surgery, he notes that “Risks include a small increase in operative time and the rare possibility of bleeding or injury, though overall complication rates match those of the primary procedure alone.”