Essure

Overview

The Essure system is a type of permanent birth control for women. It cannot be reversed.

This type of female sterilization involves placing small metal and fiber coils in the fallopian tubes, which creates scar tissue that prevents sperm from reaching an egg. During the procedure, the doctor inserts a flexible tube with a small camera (hysteroscope) through the vagina and cervix and up to the uterus. From here, the doctor can see the opening to the fallopian tubes and place the Essure system coils into them.

It takes about three months for the Essure system to prevent pregnancy. In some women, it may take up to six months. During this time, you must use another form of birth control to prevent pregnancy. Essure doesn't protect you against sexually transmitted infections (STIs).

The company that manufactures Essure plans to stop production of this contraceptive device at the end of 2018.

Why it's done

The Essure system is a type of female sterilization. It's a permanent way to prevent pregnancy.

Benefits of using the Essure system include:

• It works very well. The risk of pregnancy is about 0.1 percent when the coils are placed properly.
• The procedure can be done in the doctor's office. Little or no anesthesia is needed.
• You can return to daily activities the day of the procedure.
• There's no incision or scarring of the skin.
• After your doctor confirms the system is working and your tubes are blocked, you'll no longer need to buy contraception, other than products used to prevent STIs.
• Most women report no long-term side effects.

The Essure system isn't right for everyone, however. Your health care provider may recommend other methods of contraception if:

• You aren't sure whether or not you want to become pregnant in the future.
• You have a metal allergy. The materials used in the inserts may contain traces of nickel or other metals. You may need allergy testing before the procedure.
• You're allergic to the contrast (dye) used during follow-up imaging tests to confirm the procedure worked.
• You have an autoimmune disease, which may trigger excessive inflammation around the coil inserts.
• You've had a baby or an abortion within the past six weeks.
• You have or recently had a pelvic infection.
• A health condition of the uterus or fallopian tubes blocks the tube openings, which means the doctor can't properly place the Essure system.
• You've had your tubes tied (tubal ligation).

Risks

Researchers continue to study the risks associated with or possibly linked to the Essure system. They may include:

• Pelvic pain
• Allergic reaction, including hives, itching and face swelling
• Heavy periods or spotting during ovulation
• Infection from the procedure
• Perforation of the uterus or fallopian tubes
• Shifting of the coils to other places in the abdominal cavity

Sometimes, the coils aren't placed properly or only one tube becomes blocked. This can result in unintended pregnancy. However, less than 1.5 out of 1,000 women get pregnant with the Essure system. When pregnancy occurs, it's usually because:

• Pregnancy occurred before the procedure.
• The coils weren't placed properly.
• Back-up contraception wasn't used for three to six months following the procedure, or until the doctor confirmed tubal blockage.

If you do get pregnant after having the Essure procedure, there's a higher chance that it will be an ectopic pregnancy — when fertilization happens outside the uterus, usually in a fallopian tube. Talk with your doctor right away if you have a positive pregnancy test after the Essure procedure.

After you have the Essure system implanted, you may not be able to have pelvic procedures involving electrosurgery, such as some types of endometrial ablation.

The Essure system doesn't offer protection from sexually transmitted infections (STIs).

How you prepare

Your health care provider will ask you why you are choosing sterilization and explain that the Essure system can't be reversed. You'll talk about the things that might cause you to later regret your decision, such as young age or an unstable relationship. Together, you'll review the risks and benefits of reversible versus permanent contraception.

Before your Essure system procedure, your health care provider will explain the following things:

• Details of the procedure, including the best time to do it
• Side effects and risks
• Reasons why the procedure may fail
• The need to use backup contraception for three months after the procedure, or until tubal blockage is confirmed
• The risk of sexually transmitted infections (STIs) and why and when your partner should use a condom

Your health care provider needs a clear view of your fallopian tube openings to insert the Essure system. For this reason, it's often best to do the procedure shortly after your period, when the lining of the uterus is thin. If you have irregular periods, your health care provider may recommend medication to thin this lining. Options include birth control pills, rings or patches that contain progestin (alone or with estrogen) or an injection of medroxyprogesterone acetate (Depo-Provera).

What you can expect

The procedure to insert the Essure system coils can be done in your health care provider's office. It typically takes 30 minutes or less. You may be given medication before the procedure to prevent pain and reduce spasm of your fallopian tubes, which can make insertion difficult.

During the procedure

Your health care provider places the Essure system inside your fallopian tubes using a hysteroscope, a thin tube with a camera lens attached, as a guide. The scope passes through your vagina and cervix into your uterus, where it provides a view of the opening of each fallopian tube. If the opening to the tubes can be seen, the health care provider inserts the tiny Essure coils through a catheter attached to the scope and up inside each tube.

After the procedure

You may go home immediately after the procedure and return to your normal activities the same day. The most common side effects after the procedure are:

• Cramping
• Abdominal pain
• Nausea or vomiting

Contact your health care provider immediately if you have severe or persistent pelvic pain or a coil falls out.

You must use another form of contraception for three months after the procedure. Around this time, your health care provider will order X-rays or other imaging tests to confirm the coils are in the right position and the fallopian tubes are blocked. If the procedure is successful, you can stop using other forms of birth control at this point.

You should still have a period each month. The Essure system doesn't affect your monthly cycle. If you stop having periods or think you're pregnant at any time after the procedure, contact your health care provider immediately.

The Essure system cannot be reversed.