For some women suffering complications from Essure Permanent Birth Control, the only option is to remove the device. There are several removal options to choose from. Some involve simple outpatient procedures and others may require more extensive surgery, depending on the device's location. Sometimes women need more than one surgery to remove the coils.
The Essure Permanent Birth Control System sold by Bayer is meant to be a permanent, non-hormonal method of birth control for women. Doctors insert two metal and fiber micro-coil inserts into each fallopian tube. After about three months, scar tissue develops around the inserts and blocks the fallopian tubes, preventing pregnancy.
While the coils are meant to be permanent, skilled surgeons developed techniques to remove the coils. Some women may choose to reverse the procedure because they want to welcome another baby into the family. In these cases, doctors do what they can to reconnect and repair blocked fallopian tubes.
Unfortunately, not all women who wish to have Essure reversed or removed do so to grow their families.
Thousands of women in the U.S. and all over the world have come forward to shed light on the serious side effects that come with Essure, including infections, severe pelvic pain and bleeding, painful intercourse and even the deaths of unborn children. Desperate for relief, these women simply want Essure removed, and some filed lawsuits against Bayer for not warning them of the risks.
“Typically, women will come see me with complaints of pelvic pain, heavy periods and painful sex,” Dr. Christopher Walker of UroGyn Specialists of Florida told Drugwatch. “Based upon the patient’s history of having Essure implanted and an examination in the office, we determine that it is the device causing problems.”
Walker noticed a recent surge in the number of women coming to him to have the coils removed, but was happy to report that the women who came to him for help felt relief after the coils were removed. After a simple outpatient procedure at his office, Walker said women can expect to recover in about two weeks.
There are a few different approaches to removing or reversing Essure, depending on the doctor performing the procedure. Most doctors report women find immediate relief from symptoms after removing the coils. Typically, procedures to remove Essure can cost anywhere from $4,000 to $8,000, depending on the complexity of the surgery.
Options for Essure Removal
Women who wish to remove Essure have a few options. Each surgeon has their preferred method of removal. Surgery can range from a simple outpatient procedure to extensive surgery, depending on the condition and position of the device in the woman’s body or doctor’s recommendations. Sometimes, women may need to have more than one surgery.
Essure is made up of a blend of nickel and stainless steel. It also contains Polyethylene Terephthalate (PET) fibers — small plastic fibers that cause scarring and allow Essure to block fallopian tubes. There is a chance that small piece of metal or fiber will remain in the body and continue to cause inflammation and complications. Microscopic PET fibers are impossible to detect.
When opting to remove Essure, women should get several opinions and discuss all options with doctors to reach the procedure that is best for their situation. Because removing the coils is a complex procedure, only the most experienced surgeons should attempt to remove the coils.
Generally, it is easier to remove Essure before excessive scar tissue forms around the device, usually within 3 months. Surgeons will use x-rays, ultrasounds or scopes to locate the device in the fallopian tube.
A salpingotomy is a technique where surgeons cut a small hole in the fallopian tube in order to remove the Essure coils. Surgeons leave the tubes intact. This is not to be confused with salpingectomy, which is total removal of fallopian tubes.
In Bayer’s Essure package insert, the company recommends using salpingotomy to remove the device. The insert instructs physicians to make a small cut in the tube, about 2 cm in length, directly above the device and remove the device through this opening.
In order to reach the fallopian tubes, surgeons will enter the body through the abdomen using laparoscopic surgery — a minimally invasive technique performed with very tiny incisions in the abdomen.
While this technique is feasible, some doctors caution against salpingotomy because few surgeons have extensive experience with making incisions in fallopian tubes. There is also a chance that the device may fracture during removal, leaving fragments behind.
If surgeons pull too hard on the device to remove it, it can fracture, leaving small fragments in the tubes.
A vast majority of women who chose to have Essure removed end up undergoing hysterectomy. During hysterectomy, surgeons remove the uterus, fallopian tubes and cervix. Some surgeons maintain that this minimizes the risk of leaving fragments in the body.
Surgeons can choose to perform hysterectomies laparoscopically through the abdomen or through the vagina. Many surgeons will use robotic surgery because these machines can help them make more precise cuts. Others will choose a more traditional approach to laparoscopic surgery without a robot.
Laparoscopic surgeries are minimally invasive and should allow for quicker healing times and less blood loss.
Some surgeons choose to use a power morcellator to chop up the uterus and vacuum it out of the abdominal cavity. While power morcellation requires less cutting and theoretically allows a woman to recover from the surgery faster, it may also spread undiagnosed uterine cancer in the body. In addition, some women report their doctor morcellated the uterus with coils still in the fallopian tubes, spraying bits of metal and PET fibers into the abdomen.
Hysterectomies may also cause additional health problems in the future. For example, pelvic organ prolapse and incontinence are both issues that occur after hysterectomy. Without the uterus to provide a barrier for organs, they may sink into the vagina.
To treat prolapse a number of surgeons recommend using transvaginal mesh — another device that can cause problems such as pelvic pain, infections and several other severe complications.
Uterine Preserving Surgery
Many women would prefer to keep their uterus, because it causes fewer complications and allows them to conceive a child naturally if they choose to do so. In these cases, surgeons can perform a tubal anastomosis to carefully dissect the fallopian tubes, remove Essure and reconnect the tubes to the uterus. This allows women to reverse sterilization and conceive naturally.
If they do not wish to have a baby, women can choose another type of permanent birth control that they discuss with their doctor. Without birth control, there may be a greater chance of ectopic pregnancy, a problem that occurs when an egg is fertilized inside the fallopian tube. This is a dangerous complication and needs to be corrected with surgery.
In some cases, doctor can perform Essure removal on a simple, outpatient basis if the coils are properly positioned within the tube. A portion of the coil projects into the uterus and surgeons use this piece to gently pull the device from the tubes.
Tubocornual implantation is another uterine preserving surgical technique used by some surgeons to reverse Essure. After cutting the fallopian tube, the surgeon then pulls the tube into a hole cut into the back of the uterus and reattaches it.
This can be a risky decision for women who remove Essure and choose to try and have another baby. Because of the hole cut into the uterus, it becomes weak and increases the risk of rupture during labor. The rupture can be fatal to mother and her baby.
Recovery from Essure Removal
Depending on the technique used to remove Essure and how long the device was in the body prior to removal, women can expect to have varied recovery times.
More extensive surgery such as a hysterectomy will require a longer recover time. Women who have a simple outpatient procedure to remove the device can expect to feel relief from symptoms within days.
“Once the foreign body is removed, women may expect to recover within two weeks,” Walker told Drugwatch.