The Essure Procedure

The Essure procedure is a discontinued non-surgical, permanent birth control option. Since 2019, this type of hysteroscopic sterilization procedure hasn't been available in the United States. The procedure did not require any incisions and consisted of soft, flexible inserts (coil implants) that were inserted into the fallopian tubes. It used to be a good alternative to tubal ligation, since all other forms of female sterilization require surgical incisions.

Dilation of the Cervix

Graphical representation of X-ray vision of the female reproductive system.


SEBASTIAN KAULITZKI / Getty Images

The first step during the Essure procedure was cervical dilation. A physician used local anesthesia to numb the cervix. Some physicians also offered additional medication that helped you relax and minimized any pain.

In order to insert the Essure coils, physicians had to slowly dilate (open) the cervix. A cervix dilation procedure can be done in different ways.

In the first, the physician uses a speculum to hold open the vagina (the speculum is the device that resembles the beak of a duck). The physician then inserts a thin, smooth metal rod into the vagina and up into the tiny cervical opening. The rod is briefly left in place, then taken out, and replaced by a slightly larger rod.

When using metal rods to dilate the cervix, the doctor must repeat the process until the cervix opens wide enough. This only takes about 10 minutes, but it can cause some cramping and discomfort.

Another way to dilate the cervix is through the use of an osmotic dilator. This is a device that absorbs moisture from the tissues around the cervix, causing it to slowly expand. The expansion of the dilator slowly opens the cervix and usually causes little discomfort.

There are two common types of osmotic dilators:

  • A laminaria stick: This is a small tube made of dried seaweed that is inserted into the cervix eight to 24 hours before a procedure. It usually requires a woman to come in the day before her procedure to have it inserted. Most of the cervical dilation happens within the first six hours, with maximum dilation occurring 12 to 24 hours after insertion.
  • The Dilapan (synthetic dilator): This is a dry, sterile sponge that is inserted into the cervix several hours before a procedure. A synthetic dilator tends to be easier to insert and opens the cervix in less time than the laminaria method.

The Essure Procedure

Essure Insertion

Essure

During an Essure procedure, patients were positioned with their legs open and in stirrups, similar to how you would be for a pelvic exam. The physician then inserted a catheter and a thin, tube-like instrument (hysteroscope) into the vagina, up through the cervix, and up into the uterus. A camera on the end of the scope allowed physicians to see into the uterus.

The Essure insert itself was threaded through the catheter and positioned in the opening of the fallopian tube. The second implant was then placed in the other fallopian tube in the same way. The entire procedure took around 10 to 30 minutes.

What Happened After the Essure Procedure

Essure Permanent Birth Control (in place)

Essure

Women were typically able to go home about 45 minutes after the Essure procedure, and most could resume work within 24 hours or less. The majority of women returned to normal activities within one to two days, but many women reported that they were able to resume normal physical activities the same day as the procedure.

After having the Essure procedure, women reported symptoms such as:

  • Vaginal bleeding caused by the movement of the uterus
  • Mild to moderate pain and cramping, lasting a few days
  • Temporary changes to the menstrual cycle (heavier or longer than normal periods, bleeding, or spotting between periods)
  • Pelvic, abdominal, or back pain
  • Regret

Following the Essure procedure, women could resume sexual intercourse as soon as they felt up to it. However, it was essential that they used back-up birth control methods for the first three months.

It took about three months for scar tissue to build up around the Essure inserts. It was this scar tissue, not the inserts themselves, that fully blocked the fallopian tubes and prevented pregnancy.

The Hysterosalpingogram Test

Essure diagram.

Essure

A test called a hysterosalpingogram (HSG) was performed three months after the Essure procedure to confirm whether the fallopian tubes were permanently blocked with scar tissue. This test was scheduled the week after a woman's period, to make sure she wasn't pregnant.

The HSG was performed in a radiology department using a table with an X-ray machine overhead. Patients would lie on the table and place their feet in stirrups. At this time, a dye was injected through the cervix and uterus via a thin catheter. Then, an X-ray was taken to produce pictures of the uterus and fallopian tubes.

The HSG revealed whether the coil implants were in the correct position and showed if the tubes had been successfully blocked. If they were, patients no longer had to use another birth control method.

Pros and Cons of Hysteroscopic Tubal Ligation

Essure Tissue Growth (after 3 months)

Essure

The hysteroscopic Essure method of using tubal implants offered some advantages compared to traditional, surgical methods of tubal ligation. There were no scars and women generally reported less initial discomfort.

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

Additionally, the Essure hysteroscopic sterilization procedure was 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.

Disadvantages of Hysteroscopic Tubal Ligation

Essure Birth Control insert.

Dawn Stacey

Essure Procedure Risks

Essure Inserts

Dawn Stacey

In 2019, the FDA ordered the manufacturer of Essure to recall all existing devices and halt production. The decision to do so was made after they received more than 47,865 reports of adverse events from patients between 2002 and 2019.

About 86% of these reports involved cases in which the Essure device had to be removed because of side effects and device failures. The most commonly reported issues were:

  • Chronic pain
  • Heavy bleeding
  • Irregular periods
  • Headache
  • Device break-up, fragments
  • Perforation (device punctures fallopian tube or uterus)
  • Fatigue
  • Weight fluctuations
  • Depression/anxiety
  • Hair loss
  • Rash
  • Migration (the device moves to a new location)
  • Allergic reaction to nickel in the device
  • Pregnancy
  • Miscarriage

Essure Alternatives

Closeup of a person's hand holding an IUD device

flocu / Getty Images

If you are interested in permanent birth control, the only option available to women is tubal ligation surgery. This is a very common and effective procedure, but it is more invasive than the Essure procedure was.

During tubal ligation surgery, the surgeon makes small incisions in the abdomen. They then use one of several methods to block, cut, or remove the fallopian tubes. This procedure is often done right after a woman gives birth, but it can be done at any time.

As it is a truly permanent option, this method is best suited for older women who already have children.

About 22% of women using some form of contraception choose tubal ligation.

There are a number of other long-term birth control options to consider. Many of these options are equally as effective as tubal ligation, but are much less invasive and easily reversible.

IUDs (intrauterine devices) are an excellent "set it and forget it" option. Depending on which type you choose, they can provide anywhere from three to 12 years of pregnancy prevention. They can be removed anytime you decide to become pregnant.

The birth control implant is another option. This tiny device provides up to five years of pregnancy prevention.

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Article Sources
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  1. Food and Drug Administration. Problems reported with Essure. January, 2021.

  2. Guttmacher Institute. Contraceptive use in the United States.

  3. Planned Parenthood. Birth control.

Additional Reading