Essure is a type of tubal sterilization method also known as tubal implants, used for permanent birth control in women. It differs from tuba ligation that it does not involve any surgical intervention and anesthesia and it can be performed in doctor’s office or a surgical clinic or hospital on outpatient bases. The procedure usually takes 10-15 minutes and it has gained popularity in USA after its approval by FDA in 2002.
During the procedure metal flexible coils are inserted in the fallopian tubes. Fallopian tubes are the tubes that act as the passage for carrying egg from the ovary to uterus. Once these metal coils are inserted in the tubes, woman’s body considers it to be a foreign body and tissue start growing around the implants. This tissue known as scar tissue takes about three months to grow to the extent that it completely blocks the fallopian tube. This acts as a natural barrier inhibiting sperms from reaching the egg in fallopian tube, thus preventing pregnancy. Another important difference from tubal ligation is that Essure method can’t be reversed.
The Essure system is indicated in women who do not wish any future pregnancy and want a permanent method of contraception. It may also be advised on medical grounds if pregnancy is expected to worsen disease or disorder in a woman. However, the point can’t be stressed enough that the procedure is not likely to be reversed, and women and couples need to be absolutely sure before going ahead with this choice of female sterilization. In addition, Essure is also not recommended in ;
- women who have any structural abnormality of uterus (unicornuate uterus) or tubes( contralateral proximal tubal occlusion), these conditions interrupt visualization of fallopian tubes for insertion of tubal implants
- women who previously had tubal ligation
- women who are pregnant or they are unsure about pregnancy and who had given birth to or undergone termination of a pregnancy less than 6 weeks before Essure procedure
- presence of a pelvic infection in the recent past
- women allergic to contrast dye used in hysterosalpingogram to confirm tubal occlusion.
The procedure for Essure insertion entails following steps;
First the woman is put in a position that is usually adopted for a pelvic exam, and the doctor opens up the cervix (mouth of uterus) with the help of a speculum and a dilatation instrument. The opening up (dilatation) of cervix is necessary to avoid injury to cervix. For insertion of metal implants or coils, an instrument with a flexible tube and camera attached to it called hysteroscope (hystero means uterus or womb and scope is any instrument that helps in visualizing) is inserted through the vagina into the cervix, up till the uterus. Once the health care provider is able to visualize the opening of the fallopian tube the metal coil is inserted into the tube. The metal coil is placed in the other fallopian tube by the same procedure. It is expected to experience lower abdomen muscle cramps like menstrual cramps right after the insertion of the Essure implants.
After insertion, an X-ray is taken to make sure that the implants are in the tubes and they are blocking the tubes. As earlier said, the scar tissue takes about 3 months to fully develop and women are advised to use other method of contraception after undergoing the procedure. A special X-ray known as Hysteroselpengograph is taken after 3 months of procedure. In hysterosalpingograph a dye is injected in the uterus through an instrument inserted in to the vagina and cervix, and X-ray is taken. If X-ray confirms that tubes are fully blocked, it attests that Essure insertion is successful and the woman does not need to use other method of contraception.
The procedure usually takes about 10 minutes and most of the women can returns to usual daily activities the same day. Often women experience abdominal cramps, some vaginal bleeding and pain or discomfort in back and pelvis.
There are many benefits of the Essure system including;
- It’s a permanent method of female sterilization and woman does not have to take any other kind of contraception such as hormonal injections or contraceptive tablets
- It has proven to be Effective method for contraception in majority of women
- The method does not have significant long-term side effects
- The method can be carried out conveniently at doctor’s office, and causes no scarring or cutting of skin.
- The process has a quick recovery time and mostly women can go home within an hour and resume routine activities within a day or two.
Essure Side Effects
- The immediate side effects after procedure include abdominal pain, vaginal bleeding and back and pelvic discomfort.
- During the procedure there is a very rare chance that the Essure device may break off or it punctures the fallopian tube or uterus, which requires surgical repair.
- In the long term, people who are allergic to nickel may have a reaction due to the nickel –titanium alloy used in the metal coils. The reaction may include itching, body rash and hives.
- The metal devise may slip from its position in the fallopian tube into the abdominal cavity or pelvis.
- As no birth control method can guarantee 100% results, there is a minor chance that a woman can get pregnant even after Essure insertion, and there is greater likelihood that these pregnancies result in ectopic pregnancy(pregnancy outside the uterus, mostly in fallopian tube).This is a serious condition and require emergency treatment.
- Some women complain of a persistent lower abdomen pain and dyspareunia(pain during intercourse) for a longer period after the insertion of tubal implants.
- There is normal menstruation and sexual life after the procedure but Essure does not give any protection against STDS(sexually transmitted disease) and HIV-AIDS, thus women need to use condoms for protection against these diseases.
Cost Of The Essure Procedure
Essure is a costly procedure with its average cost reported from 2300- 7500$ depending upon the health facility and doctor and it also differs in various states. Essure is a FDA approved procedure and under the Affordable Care Act (ACA), all insurance companies are required to provide
FDA –approved birth control methods including Essure to women at no cost. Thus women with insurance coverage can have their Essure procedures without any out of pocket expenses or with most of the costs covered. Under ACA , it is possible that In case there is no insurance plan available, you can buy health insurance through marketplace with financial help to decrease the cost of coverage. The Medicaid and Family planning programs also provide comprehensive low cost insurance coverage and women eligible for these programs can avail these for Essure procedure.