OBJECTIVES: To examine changes in post-tubal ligation complications and their associated costs over time. METHODS: Data were obtained from the US i3 Invision™ Data Mart. Data collected spanned the period from January, 2006 through March, 2010. CPT and ICD-9 codes were used to identify patients who received a tubal ligation as well as a post-tubal ligation complication. Patients were also subcategorized based upon year of tubal ligation (2007, 2008, or 2009) in order to examine if there were any noticeable trends over time.  RESULTS: There were 15,169 women under age 50 who received a tubal ligation and had continuous insurance coverage in the 1 year post-tubal ligation. The mean age at tubal ligation was 35.26 years (SD=5.46) with 10.46% having tubal ligation at the time of a pregnancy. Overall, 21.68% (n=3,288) of women experienced at least 1 complication, with the most common being heavy menstrual bleeding (n=2,190, 14.44%) and surgical complications (n=729, 4.81%). When assessing changes in complications from 2007-2009, diagnoses of heavy menstrual bleeding (p=0.0003), sepsis (p=0.0392), surgical complications (p=0.0240), and any complication (p<0.0001) all showed statistically significant increases over time. Of all women who had a tubal ligation, charges associated with the tubal ligation did not increase significantly from 2007-2009; however, the charge associated with complications did show a statistically significant increase over the same time period. The average charge for women who experienced a complication (n=3,228) was $37,425 (SD=$68,249).  CONCLUSIONS: A substantial number of women experience post-tubal ligation complications and the charges associated with these complications have increased significantly over time.