Essure

Essure
Background
Birth control type	Sterilization
First use	2002
Failure rates (first year, after occlusion)
Perfect use	0.26%
Typical use	0.26%
Usage
Duration effect	Permanent
Reversibility	Irreversible
User reminders	Additional methods until 3 month check by hysterosalpingogram
Clinic review	None
Advantages and disadvantages
STD protection	No
Benefits	Permanent contraception

Essure is a permanent, non-surgical transcervical sterilization procedure for women developed by Conceptus Inc., a subsidiary of Bayer AG. It was approved for use in the United States on November 4, 2002.

Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic bilateral tubal ligation.

Since 2013, the product has been the subject of controversy with women complaining of severe side effects leading to surgical extraction, and campaigner Erin Brockovich hosting a website where women can share their stories after having the procedure.

Procedure

In one prospective study, the mean time taken for procedure was 6.8 minutes (range = 5–18 minutes). for a trained physician to perform and can be performed in a physician's office. General anesthesia is not required. Despite this, some women have reported considerable pain during the procedure.

Small, flexible inserts are placed into the fallopian tubes by a catheter passed from the vagina through the cervix and uterus. The insert contains inner polyethylene terephthalate fibers to induce inflammation, causing a benign fibrotic ingrowth, and is held in place by flexible stainless steel inner coil and a dynamic outer nickel titanium alloy coil. Once in place, the ingrowth continues over a period of three months, resulting in durable occlusion or blockage in the Fallopian tubes; the tissue barrier formed is supposed to prevent sperm from reaching an egg. During that intervening three month period, women are advised to use an alternate contraceptive method.

Unlike other forms of tubal ligation, no general anaesthetic nor incision through the abdomen is required. Similar to some other methods of birth control, initially additional forms of birth control must be continued for 3 months to prevent pregnancy until the method's effectiveness can be confirmed.

Follow-up

For the Essure method, three months after insertion a radiologist performs a fluoroscopic procedure called a hysterosalpingogram, to confirm that the fallopian tubes are completely blocked and that the patient can rely on the Essure inserts for birth control. A contrast agent (dye) is injected through the cervix, and an x-ray technologist takes photos of the Essure coils to ensure no contrast leaks past the Essure.

Efficacy

Following successful insertion and occlusional response, the Essure procedure is 99.74% effective based on 5 years of follow-up (Although one study found failure rates closer to 11%).

The reported insertional failure rates are "failure to place 2 inserts in the first procedure (5%), initial tubal patency (3.5%), expulsion (2.2%), perforation (1.8%), or other unsatisfactory device location (0.6%)". Upon follow-up, occlusion is observed to have occurred in 96.5% of patients at 3 months with the remainder occluded by 6 months.

Cautions and warnings

The inserts are made from polyester fibers, nickel-titanium and stainless steel and solder and care should be taken to notify staff before any procedures are done, such as MRI or any magnetic imaging. Unlike many temporary methods of birth control, the Essure inserts do not contain or release hormones. The inserts do not prevent the transmission of sexually transmitted diseases.

The procedure is reported to be permanent and not reversible by the manufacturing company. Notwithstanding the manufacturer's position, several Essure reversals have been performed.

Additional birth control must be used for three months after procedure until a hysterosalpingogram has been performed to confirm blockage.

Risks

• Perforation, expulsion, or other unsatisfactory location of the insert
• Punctured uterine walls
• Pregnancy and increased risk of ectopic pregnancy
• Pain, cramping, vaginal bleeding, menstrual pattern changes, light periods at first then longer, heavier periods lasting up to 6–8 weeks due to changing birth control methods to a non-hormonal solution
• Nausea/vomiting
• Vasovagal response (fainting)
• Allergic reaction to the materials
• Heightened allergic response to other allergens
• heavy metal toxicity
• itchy, raised rash
• brain fog
• autoimmune disease symptoms
• weight gain
• anxiety/depression
• hair loss
• severe anxiety
• numbness of extremities
• joint pain
• back pain
• suicidal thoughts

In 2013, the product made news in North America, with women complaining of severe side effects leading to surgical extraction. According to one article, women who have gotten pregnant are naming these children e-babies. In June 2015, the FDA reported an investigation into Essure and its over 5000 complaints, 7 reported deaths, and many additional side effects, all linked to Essure, its specific chemical composition, its improper placement and its insertion. The FDA released a statement on October 25 2013, stating that since the product was approved in 2002 that it had received 943 reports of adverse events related to Essure, mainly for pain (606 of the complaints). An additional 1,000 more complaints have been sent to the FDA in a voluntary reporting system, but physicians are not obliged to report complaints.

A Facebook group called Essure Problems has 24,953 (as of 12/26/2015) members who call the method "E-hell" and mostly complain about pain, bleeding, bloating and a host of other side effects (see above) from the device. Some say they've had coils break and perforate their internal organs, babies being stillborn with these coils imbeded in their ears, babies being born, the number of well above what Bayer is reporting. Erin Brockovich became involved in the controversy due to the laws of Federal preemption which presently stop women suing Bayer, and now hosts a website where women can share their stories after having the procedure.

Bayer has since provided two Toll-free telephone numbers for patient complaints, advises that women reporting adverse effects are "consistent with clinical trials and consistent with what the FDA is seeing", and further insists that it wants to hear from any women experiencing problems with Essure.

In April of 2015, a group of 6 delegates from the Essure Problems group, including a doctor with essure experience spoke before 36 members of the FDA and the Congressional HELP committee regarding a citizen's petition filed with the FDA. The FDA is now investigating the claims of the now over 16,000 members of the group as well as the legalities of the approval process that essure went through.

In June of 2015, the FDA announced that its Obstetrics and Gynecology Devices Panel will conduct a review of Essure's safety on September 24, 2015 due to the recent rise in adverse event reports. While the agency received only 950 reports from 2002 through October 25, 2013, they have received more than 4,150, or 81 percent of the total, since that time. As of November 24, 2015, FDA was conducting an evidence-based review of the available information data and anticipated making a public announcement of their decisions at the end of February, 2016.

On October 13, 2015, a study published in the British Medical Journal concluded that Essure did not prevent pregnancy any better than a laparoscopic procedure, but they had a "10-fold higher risk of undergoing reoperation" when compared to patients who underwent a laparoscopic sterilization procedure.

External links

• Official website
• Essure Procedure by Erin Brockovich