Essure: non-surgical sterilization
I noticed that you have information on tubal ligation (surgical sterilization for women), but not on Essure. Can you tell me more about it? What are the risks and benefits?
Your #1 Fan
Dear Your #1 Fan,
Thanks for pointing to a gap in the Contraception category. While Essure was previously available as a form of birth control, it’s no longer on the market. In 2018, the manufacturer, Bayer, issued a ban on all Essure products in the United States after thousands of complaints from patients who’d experienced complications from the contraceptive device. Read on for information about how Essure worked, some of the concerns, and alternative contraception methods.
Essure was used to prevent pregnancies; it was similar to tubal ligation in that it physically and permanently blocked the fallopian tubes, thereby preventing sperm from fertilizing an egg. Tubal ligation is a procedure that physically ligates (ties off, staples, or clamps) the fallopian tubes via incision through the pelvis wall, whereas Essure was a product made of small coils of metal and fiber that were inserted into the fallopian tubes to create scar tissue that built up over time and blocked the tubes — thus achieving the same end result. A health care provider would insert the coils into the fallopian tubes by passing it through the vagina, cervix, and uterus using a thin tube with a camera on the end called a hysteroscope. The hysteroscope then used a catheter to insert the coils into the fallopian tubes.
There were plenty of risks involved in the procedure, many of which contributed to Bayer's eventual decision to take it off the market. These risks included:
- It was considered permanent and not reversible and therefore wasn’t recommended for those who may want to become pregnant in the future.
- Patients experienced immediate side effects such as abdominal or pelvic pain, bleeding or spotting, cramping, dizziness, nausea, or vomiting (though usually short-lived).
- Patients experienced long-term effects such as infection, persistent pelvic pain, and perforation or tearing of the uterus or fallopian tubes.
- The product was only partially effective (some people experienced pregnancy).
- The product moved, with some people finding it in other places in the body such as the pelvis or abdomen.
- The product complicated eligibility for future surgeries that involved electrosurgical procedures, as the metal coils could’ve conducted electricity and damaged tissues.
Many of the potential complications and side effects became a reality for a lot of patients using Essure, which contributed to the eventual discontinuation of the product. Since Bayer first began distributing the product in the US in 2002, thousands of patients issued complaints about adverse side effects such as persistent pelvic pain, back pain, joint pain, headaches, holes in the uterus and fallopian tubes, and migration of the device from the fallopian tubes into the pelvis or abdomen. Patient activists and safety organizations had been protesting Essure and Bayer years before the product was taken off the market.
In July, 2018, Bayer announced that at the end of the year, Essure would no longer be sold or distributed in the U.S. Though Bayer cited commercial reasons rather than safety concerns for discontinuing the sale and distribution of the device, at the time of the announcement, there were more than 16,000 lawsuits against Bayer from patients alleging harm caused by Essure.
While new Essure products were no longer sold after 2018, health care providers were permitted to continue recommending and implanting any Essure devices they had in stock up to one year after the date of the purchase. They also had a year from the date of the ban to return all unused Essure products to Bayer. As of the end of 2019, all Essure products were required to be returned to Bayer, meaning they’re no longer available for implantation. Currently, Essure isn’t available anywhere in the world, as the US was the last country to offer the device as a form of birth control. That being said, studies on Essure’s safety are ongoing.
Although Essure is officially off the market, those had it implanted and are still using it as a birth control method don’t need to worry too much. As long as you’ve never experienced issues or side effects from your Essure device, you can continue using it for pregnancy prevention. However, if you’re experiencing any side effects or have any safety concerns, it’s recommended that you consult with a health care provider. Removing your Essure device may require surgery, so it’s crucial that you seek medical attention as soon as possible.
Even though Essure may no longer be an option for pregnancy prevention, there are plenty of other birth control methods out there! They’re often categorized as hormonal and barrier, and long-acting reversible contraceptives. The hormonal methods use either progestin or a combination of estrogen and progestin. These options include injections in the butt or arm; oral contraception (referred to as “the pill”); patches worn on the lower abdomen, butt, or upper body; and rings inserted into the vagina. Barrier methods include spermicide in the form of foams, gels, creams, films, suppositories, or tablets, which are placed in the vagina to kill sperm; sponges containing spermicide, diaphragms, or cervical caps that cover the cervix; and different types of condoms that either cover the penis and prevent sperm from entering the vagina, or go inside the vagina and prevent sperm from entering. Long-acting reversible contraceptives (LARCs) such as hormonal intrauterine devices (IUDs) and implants, are inserted in the uterus and arm, respectively, and release a steady dose of hormones and can be left in place for a few years. Copper IUDs are also placed in the body like a hormonal IUD but release copper ions instead of hormones and can be left in the body for over ten years. This can be a great option for someone who wants the benefits of a LARC but don't find a hormonal contraceptive to be an appropriate fit for them. Other birth control methods include fertility awareness, which involves keeping track of your menstrual cycle and fertility patterns to understand when you’re most likely to become pregnant; and sterilization in the form of tubal ligation. Emergency contraceptives include copper IUDs or emergency contraceptive pills. Keep in mind that emergency contraceptive pills aren’t recommended as a regular or long-term method of birth control and, as the name suggests, is intended for use if no birth control method was used or the method failed (i.e., the condom broke).
As you ponder the decision to use birth control, it's wise to consider the safety, effectiveness, acceptability, and availability (including accessibility and affordability) of the contraceptive method. You can also speak to a health care professional to help you decide which method is best for you and your body.
Originally published Feb 26, 2015
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