The Essure Procedure

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The Essure Procedure

Essure Procedure
Essure Procedure. Photo © 2014 Dawn Stacey

The Essure procedure is a non-surgical, permanent birth control option. This type of hysteroscopic sterilization does not require any incisions and consists of soft, flexible inserts (coil implants) that are inserted into the fallopian tubes. It is a good alternative to tubal ligation because all other forms of female sterilization require an incision (are surgical procedures). 

The Essure procedure only takes takes about 10 minutes, is typically performed in a doctor’s office, and does not require an overnight stay.

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Dilation of the Cervix

Dilators. Photo © 2010 Dawn Stacey

The first step during the Essure procedure is cervix dilation. Your physician will use local anesthesia to numb the cervix. Some physicians may also offer additional medication that can help you relax and/or minimize any pain. In order to insert the Essure coils, your physician will have to slowly dilate (or open) the cervix.

Cervix dilation can occur in two ways:

1. Your physician may use a speculum to hold open the vagina. This is a device that resembles a metal beak of a duck. The instrument is inserted into the vagina, and its dull blades are separated and held open. Your physician will then insert a thin, smooth metal rod gently into the vagina and up into the tiny cervical opening. The rod is briefly left in place, taken out, and replaced by a slightly larger rod. This process is repeated until the cervix is wide enough to allow for the implants to be put in place. This takes about 10 minutes, and you may feel cramping and discomfort caused by the stretching of the cervical muscles to accommodate each rod.

2. Another way to dilate the cervix is through the use of an osmotic dilator, a device that absorbs moisture from the tissues around the cervix and slowly expands. The expansion of the dilator slowly opens the cervix and usually causes little discomfort. There are two common types of osmotic dilators:

  • Laminaria is a small tube made of dried seaweed that is inserted into the cervix 8 to 24 hours before the tubal ligation procedure; it usually requires a woman to come in the day before her procedure to have this inserted. Most of the cervical dilation happens within the first 6 hours, with maximum dilation occurring 12 to 24 hours after it is inserted.
  • Dilapan (synthetic dilator) is a dry, sterile sponge that is inserted into the cervix several hours before the Essure procedure. A synthetic dilator tends to be easier to insert and opens the cervix in less time than the laminaria method.

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The Essure Procedure

Essure Insertion. Photo Courtesy of Essure

During the Essure procedure, you will be positioned with your legs open and in stir-ups, similar to how you would be for a pelvic exam. Your physician will insert a catheter and a thin, tube-like instrument (hysteroscope) into the vagina, through the cervix, and up into the uterus. A camera on the end of the scope allows your physician to see into the uterus. The Essure insert is threaded through the catheter and are positioned in the opening of the fallopian tube. The second implant is then placed in the other fallopian tube the same way. You may have some menstrual-like cramping during and after this procedure. Once this is done, an x-ray may be taken to ensure that the coil implants are in place. The entire procedure takes approximately 10-30 minutes.

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What To Expect After the Essure Procedure

Essure Permanent Birth Control (in place). Photo Courtesy of Essure

Women are typically able to go home within 45 minutes after the Essure procedure, and most working women resumed work within 24 hours or less. The majority of women returned to normal activities within 1 to 2 days, but many women report that they were able to resume normal physical activities the same day as the procedure.

After having the Essure procedure, women have reported experiencing:

  • Vaginal bleeding caused by the movement of the uterus during the procedure.
  • Mild to moderate pain and/or cramping for a few days following the procedure.
  • Temporary changes to their menstrual cycles (heavier or longer than normal periods, bleeding or spotting between periods).
  • Pelvic, abdominal, and/or back pain.
  • Regret about their decision.

You can resume sexual intercourse as soon as you feel up to it, and it does not cause pain. For most women, this takes about one week after surgery. It is essential that you use a back-up birth control method for the first three months after the Essure insertion. It takes about this amount of time for the scar tissue to build up around the coils, thereby blocking the fallopian tubes. Until it is confirmed that the tubes are blocked, another contraceptive method must be used.

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The Hysterosalpingogram (HSG) Test

Essure Hysterosalpingogram (HSG) Test. Photo Courtesy of Essure

A test called a hysterosalpingogram (HSG) is performed three months after your Essure procedure to confirm whether or not the fallopian tubes are permanently blocked. This test should be scheduled in the week after your period to ensure that you are not pregnant. You will probably need to sign a consent form as well.

The HSG will be performed in a radiology department using a table with an x-ray machine overhead. Be prepared to lie on the table and place your feet in stirrups, as you do during a pelvic exam. At this time, a dye will be injected through your cervix and uterus via a thin catheter. Then, an x-ray is taken to produce pictures of the uterus and fallopian tubes. The HSG will reveal if the coil implants are in the correct position and show if the tubes have been successfully blocked. If they are, you will no longer have to use another birth control method. Again, additional contraception should be used until an HSG test confirms that the fallopian tubes are fully blocked by scar tissue.

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Advantages to Hysteroscopic Tubal Ligation

Essure Tissue Growth (after 3 months). Photo Courtesy of Essure

The hysteroscopic Essure method of using tubal implants offers some advantages when compared to the traditional, surgical methods of tubal ligation.

Not only is it safer, there are no scars, and women generally report less discomfort.

99% of women who have undergone the Essure procedure rated their long-term comfort as good to excellent and 95% of women said they would recommend the procedure to a friend.

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Disadvantages of Hysteroscopic Tubal Ligation

Essure-Birth-Control.jpg
Essure Birth Control. Photo © 2014 Dawn Stacey

One of the disadvantages of the Essure tubal ligation procedure is the need to use an alternative birth control method for three months until scar tissue forms and blocks the fallopian tubes.

Additionally, the Essure hysteroscopic sterilization procedure is not reversible. Because the fallopian tube tissue and coil implants grow together to create a closed passage, the micro-inserts cannot be surgically removed without damaging the fallopian tubes.

A tubal implant can also be difficult to insert, so a second procedure is sometimes necessary to completely block both tubes. In clinical studies, approximately 1 out of every 7 women were not able to have the implants placed in both fallopian tubes during the first placement procedure.

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Essure Procedure Risks

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Essure Procedure. Photo © 2014 Dawn Stacey

As of a 2014 FDA safety report, the Essure procedure does not appear to cause long-term side effects. As with any type of tubal ligation, there is always a small possibility that an ectopic pregnancy could occur.

According to Planned Parenthood, follow-up studies conducted on women two years after the Essure procedure indicate these potential risks:

  • The micro-inserts may have been expelled out of the fallopian tubes.
  • The coil implants may have been inserted too far, or not far enough, into the fallopian tubes.
  • The micro-inserts may have been pushed through the uterus or fallopian tube wall (perforation). Should this occur, surgery may be needed to repair the situation.
  • The coil implants could become damaged during other medical procedures, such as endometrial biopsy, dilation, and curettage (D&C), or procedures that require the use of radio frequency.

Additional complications that could occur during the insertion of the Essure implants include:

  • Mild to moderate pain
  • Nausea and/or vomiting
  • Fainting following the procedure
  • Infection
  • Undiagnosed pregnancy

Women who have this procedure done during the second half of their menstrual cycle (after ovulation) are at an increased risk of unknowingly being pregnant at the time of the procedure. It is recommended that the Essure procedure takes place during the first half of the menstrual cycle before ovulation occurs.

It is possible for a portion of the insert to break off or for a woman to experience an over-absorption of fluids, though these complications are rarer than the others listed. There have been no reports of a broken insert causing pain or problems in preventing pregnancy. An over-absorption of fluids can result in shortness of breath or the need for medication to get rid of the excess fluid. This must be treated immediately to prevent more serious complications, including death.

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Essure Effectiveness

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Essure Effectiveness. Photo © 2014 Dawn Stacey

Research suggests the Essure hysteroscopic sterilization procedure is the most effective form of tubal ligation, and more physicians are now switching to this approach.

Research has shown that less than 1.7 out of every 1000 women end up becoming pregnant five years after the procedure (99.83% effective).

By the three-month follow-up Hysterosalpingogram (HSG) Test:

  • Approximately 1% of women may have one of the coil implants missing.
  • 96% of women’s fallopian tubes will have been successfully blocked.

By six months after the procedure, 100% of women should have both tubes fully closed.

Additional Considerations About Essure:

Eighty-six percent of women are able to have the coils placed successfully in both tubes after one Essure procedure, yet 10% of women still are unable to have their coils inserted successfully after two procedures. Finally, 3% of women who experience successful placement of the Essure inserts are unable to continue using this as their method of contraception due to other reasons.

References:

(1990). Cervical ripening agents - Synthetic dilator made of polyacrylonitrile hydrogel, Dilapan. American Family Physician, 42(3), 775-776.

Essure Website. (n.d.). Common Questions.

Knowles, J. (2005). Tubal Sterilization. Planned Parenthood.

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