ESSURE: Permanent Birth Control for Women

July 01, 2007

by Debra Ravasia, MD

Northwest Woman

Finally, for women there is an option for permanent birth control that does not involve general anesthetic or incisions, and can be done in the office. With the ESSURE procedure, your tubes are blocked without losing time off work or disrupting home life.

Women who have completed their family are candidates for the procedure. The recovery time is quick, and the procedure is generally done in the office, but can be done in the hospital outpatient setting as well. The gynecologist places a small micro-insert directly into the fallopian tubes, through a tiny camera placed through the cervix into the uterine cavity. The procedure requires only minimal sedation or local anesthetic.

In the Pivotal trial that led to FDA approval of this technique, 92% of women returned to work within 24 hours and resumed normal physical activities on the same day as the procedure. Ninety-eight percent of women rated the experience favorably as “good” or “excellent”.

There are no incisions, punctures, burning, clipping or suturing. It is a safer procedure than traditional tubal ligation (“having your tubes tied”) which must be done in the operating room. With the Essure procedure, a general anesthetic is not necessary and the abdominal cavity is not entered. The micro-inserts are made of benign material used in many other medical products and no hormones are released. In the months following the procedure, your body forms a barrier with its own natural tissue over the inserts, preventing the sperm from reaching the egg. You do need to wait three months after the procedure for this process to occur so, as with vasectomy, back-up contraception is necessary until the blockage is proven with a special X-ray test.

It is important to realize that no method of permanent contraception, whether it is tubal ligation (“having your tubes tied”), vasectomy, or the Essure procedure, is 100% effective. If you do become pregnant after tubal ligation, or after the Essure procedure, the pregnancy is more like to be an ectopic (“tubal”) pregnancy than if you conceived without one of these methods (although no ectopics have been reported to date with the Essure procedure). No permanent birth control method gives protection against HIV or sexually transmitted diseases, so barriers are still recommended for those at risk. Any of these procedures carry small risks of infection, bleeding, injury to other organs, and anesthetic reactions.

Decisions to undergo any form of permanent birth control should be made after careful consideration. All should be considered irreversible. Studies have shown that younger women who undergo permanent sterilization (any method) are more likely to regret their decision than women older than age 30. The decision to proceed with permanent sterilization should not be made under stress, such as following a divorce or miscarriage, or under pressure from a family member.

Here’s how the procedure works:

One to two hours prior to the procedure, you are given medication to reduce cramping during the procedure.

Step 1

After a local anesthetic is injected into or applied to the cervix, the doctor inserts a narrow telescope through a narrow telescope, called a hysteroscope, through your vagina and cervix (the entrance to the uterus from the vagina), and into the uterus. The hysteroscope is attached to a video camera and monitor so the doctor is able to see exactly what s/he is doing. Fluid, called saline (salt water), flows through the hysteroscope and into the uterus. The fluid is used to expand the uterus so the doctor can see the openings of the Fallopian tubes. You may feel some cramping during this part.

A narrow inserter, called a catheter is placed through the hysteroscope and into your Fallopian tube. The micro-insert is attached to the end of the inserter.

Step #2

The micro-insert is placed in the Fallopian tube and the inserter is removed. The process is repeated in the other Fallopian tube. The entire procedure should take about 35 minutes, with only 15 minutes typically required to place the micro-inserts into the Fallopian tubes. After resting about 45 minutes, you are discharged home from the clinic or medical facility.

Step #3

During the next 3 months, tissue will begin to grow into the micro-inserts, eventually blocking your Fallopian tubes. You will need to use another form of birth control during this period until your doctor confirms the procedure has worked. After 3 months, you need to have a special X-ray test, sometimes referred to as a hysterosalpingogram (HSG). This test is required before your doctor can tell you whether you may begin relying on the Essure micro-inserts for contraception. During an HSG, your doctor fills your uterus with dye and then takes and x-ray to see if the dye remained in the uterus or traveled down your fallopian tubes. The purpose of this test is to make sure that both of your tubes are blocked and that both of the micro-inserts are in the correct position.

More information about Essure