The Essure system is a type of permanent birth control for women. The Essure system includes two small metal and fiber coils that are placed in the fallopian tubes. They're inserted through the vagina, so no incision is required.
After insertion, scar tissue forms around the coils, blocking off the fallopian tubes and preventing sperm from reaching the egg. It takes time for this to happen. So you must use another form of birth control for the first three months. You'll then have an X-ray (hysterosalpingography) to confirm that your fallopian tubes are blocked.
The Essure system doesn't offer protection from sexually transmitted infections (STIs) and isn't reversible.
Why it's done
The Essure system is a type of female sterilization. Benefits of the Essure system include:
- Lack of significant long-term side effects
- No need to buy contraception, interrupt sex for contraception or seek partner compliance
- No incision
- Convenience — the Essure system can be implanted at your health care provider's office
- No effect on your menstrual cycle
The Essure system isn't appropriate for everyone, however. Your health care provider may discourage you from choosing the Essure system if you:
- Are sensitive to nickel or allergic to the contrast agent used to confirm tubal blockage
- Have a uterine or tubal condition that prevents access to one or both tubal openings
- Might want to become pregnant
- Previously had a tubal ligation
- Recently gave birth or had an abortion
- Recently had a pelvic infection
Less than 1 pregnancy occurs out of 100 women who have had the Essure system successfully implanted. If you do conceive after having the Essure system implanted, there's a higher chance that the pregnancy will be ectopic — when fertilization happens outside the uterus, usually in a fallopian tube. However, because pregnancy after sterilization is rare, the overall risk of ectopic pregnancy is lower than that of the general population.
The Essure system doesn't offer protection from sexually transmitted infections (STIs).
Risks associated with the Essure system include:
- Pelvic pain
- Perforation of the uterus or fallopian tubes
- Tubal blockage occurring on only one side
You may not be able to have some pelvic electrosurgical procedures, such as some types of endometrial ablation, after having the Essure system implanted. This is because the Essure inserts are metallic and can conduct electricity, possibly resulting in tissue damage.
How you prepare
Before you have the Essure system implanted, your health care provider will likely:
- Ask about your reasons for choosing sterilization and discuss factors that could lead to regret, such as a young age or marital discord
- Discuss the causes and probability of sterilization failure
- Discuss the need for you to use another method of contraception for three months following the procedure, or until tubal blockage is confirmed
- Explain the details of the procedure
- Reinforce that the Essure system can't be reversed
- Review the risks and benefits of reversible and permanent methods of contraception
Your health care provider will also talk with you about choosing the right time to do the procedure. He or she will need a clear view of your tubal openings to implant the Essure system. As a result, he or she may recommend that you use a hormonal contraceptive that contains a progestin — such as the combination birth control pill, the minipill or Depo-Provera — for a couple of weeks to thin the lining of your uterus (endometrium). If you don't want to use a hormonal contraceptive, your health care provider will schedule the procedure shortly after your period.
What you can expect
The Essure system is usually implanted as an outpatient procedure. The procedure typically takes about 30 minutes or less. You may be given medication before the procedure to minimize spasm of your fallopian tubes.
During the procedure
Your health care provider will insert a hysteroscope — a thin tube equipped with a camera lens — through your vagina and cervix into your uterus and then fill your uterus with fluid. This will allow your health care provider to check to make sure both fallopian tube openings are accessible. Using a small catheter attached to the hysteroscope, your health care provider will place tiny coils inside your fallopian tubes.
After the procedure
You may be allowed to go home immediately following the procedure and return to your normal activities the same day. Side effects may include:
- Abdominal pain
- Bleeding or spotting
- Dizziness or lightheadedness
- Nausea or vomiting
Contact your health care provider immediately if:
- You have severe or persistent pelvic pain
- A coil comes out of the vagina
During the three months following the procedure, you must use another method of contraception. After three months, you will have an X-ray (hysterosalpingography) or an ultrasound to confirm the correct placement of the Essure system and verify that your fallopian tubes are blocked. If the procedure is successful, you can stop using other forms of birth control at this point.
If you think you're pregnant at any time after the procedure, contact your health care provider immediately.
The Essure system isn't reversible. In addition, because a portion of the coil protrudes into the uterine cavity, the Essure system may interfere with the success of in vitro fertilization (IVF).