Should I have an Essure Removal?

The Essure device is a set of metallic coils used for female sterilization. They are placed hysteroscopically using a camera without incisions. The fallopian tubes then cause scarring around the coils, blocking the tubes. The Essure device is an effective form of contraception, and usually doesn’t cause any side effects. However, some patients have had problems with the device, and some of you are experiencing symptoms which may be attributed to the Essure coils.

Common Symptoms

The most common symptom patients report from Essure coils is pelvic pain. You may have heavy or irregular periods, cramping or pain with periods, pain with intercourse, and in some cases joint problems or systemic symptoms attributed to your Essure coils. Many of you simply describe "not feeling right." The anxiety you feel each day can't be understated.

Although most women who have Essure coils never have symptoms from them, it’s possible some of what you’re experiencing is related to the coils, especially when there is no other clear explanation for your symptoms.

An article published in the Journal of Minimally Invasive Gynecologic Surgery in 2017 surveyed patients who had their Essure coils removed. 75% of the women reported total or near total improvement in their symptoms, while 31% had ongoing symptoms even after surgery. (1)

Essure removal won’t always relieve your symptoms. However, given the limited information we have, as well as the stories of many patients, Essure removal is certainly an option for many that may improve your quality of life. For many of you, it just plain works.

What is Essure Removal?

Essure removal is done surgically. The coils are cut out of your body.

What are the Surgical Options For Removing Essure Coils?1. Laparoscopic Complete (or Total) Salpingectomy

Laparoscopic complete salpingectomy for Essure removal takes approximately 30 to 45 minutes, and is an outpatient surgery. Only three to four small puncture incisions are made, and you go home the same day. Most of the recovery happens in the first 2 to 3 days, and full recovery time is approximately 2 weeks. The key to the effectiveness of this procedure is having total or complete removal. This means your entire fallopian tube, including the portion traveling through the wall of the uterus into the uterine cavity, is removed.

This is a complicated laparoscopic procedure requiring an experienced gynecologic surgeon. The base of the tube is injected with vasopressin and desiccated with energy to limit bleeding.

Laparoscopic techniques are then used to dissect through the myometrium (wall of the uterus) to remove the entire tube and coil together as one piece. This is the safest way to remove the entire Essure coil when it is in the normal position. The incisions on the uterus are sewn shut laparoscopically in one or more layers.

I recommend cutting open and inspecting the Essure coils in the operating room once they are outside the body to ensure the leading ball tip and the distal tab are clearly visible in the removed specimen. This confirms both ends are present.

Some surgeons will perform laparoscopy and try to remove the coils by using traction or pulling on them. This may put you at higher risk of damaging the coil or leaving pieces behind. Sometimes surgeons may even cut across your coil and remove only part of the tube. I do not recommend these approaches, and routinely remove the entire tube and coil.

Hysterectomy with Bilateral Salpingectomy

The only way to guarantee the entire Essure length is removed without risk of breaking the coils is to have hysterectomy with bilateral salpingectomy. This is removal of the uterus, cervix, and both fallopian tubes together. While the vast majority of patients who have a laparoscopic complete salpingectomy are able to have the entire length of the coils removed, it may be appropriate in some circumstances to remove the entire uterus to ensure no part of the coils is left behind.

This is an option up front for some of you, and also an option during the procedure if problems arise when removing the coils. Hysterectomy with bilateral salpingectomy can be performed as an open surgery, laparoscopically, or even vaginally.

Hysteroscopic Removal

In some cases the Essure coils can be removed hysteroscopically without any incisions. This is when a camera is placed through the vagina and cervix to look at the coils within the uterus, and then the Essure coils are removed by simply pulling them out through the cervix.

This procedure is only safely done when there are certain number of coils visible within the uterine cavity and placement was not ideal. This is one reason you should seek an experienced gynecologist who is certified to read Essure placement using ultrasound. If a preoperative ultrasound suggests an abnormal position with many coils present in the uterine cavity, it would be reasonable to attempt hysteroscopy first for removal.

Common Questions

What is a common evaluation before removing Essure coils?

The initial evaluation of pain or bleeding is the same as for patients without Essure coils. Your gynecologist should do a complete evaluation to determine if there may be another cause for your pain, bleeding or other symptoms. A thorough investigation ruling out other causes will make it more likely your pain would be relieved if the coils are removed.

At a minimum, a history, physical examination and pelvic ultrasound should be done for any pelvic pain complaint. The pelvic ultrasound should be read by a surgeon who is certified to confirm Essure placement by ultrasound.

Can I get pregnant after having my Essure coils removed?

Generally speaking, after having Essure coils removed you would still be considered sterile just as you were prior to the procedure. You will not regain fertility.

How likely is it my symptoms will go away after the coils are removed?

Based on the information we have so far, the majority of you will notice improvement as long as other causes are excluded. About 1 in every 3 patients will continue to have symptoms.

What should I look for in a gynecologic surgeon who removes Essure coils?

The gynecologic surgeon you choose should be certified to verify correct Essure placement using ultrasound, and also should have advanced laparoscopic skills. Your gynecologist needs to be familiar with techniques to dissect the wall of the uterus, and have the training to sew the incisions on the uterus laparoscopically.

Don't be afraid to ask your surgeon about these skills. Remember, you are choosing someone who will operate on your body, and there is no shame in making sure you're getting the best possible care.

Do I need a hysterectomy?

Most patients do not need a hysterectomy to completely remove Essure coils. However, some patients do choose to have hysterectomy as treatment. This is usually done if you aren't comfortable with the small risk of the coil breaking, or when other pathologies such as endometriosis, fibroids or adenomyosis are present that may also be contributing to your symptoms.

I'm not having symptoms from my Essure coils. Should I have them removed anyway?

Generally speaking, if you are not having any symptoms from your Essure coils, then you don't need to have them removed. In most women, Essure coils do not cause any problems.

At TriHealth Women’s Services Advanced Gynecologic Surgery, we understand your daily life is being affected. We want you to feel normal again, as quickly as possible and can walk you through each step of the process to get you the answers you need.

Would you like a consultation to see if Essure removal may be right for you? Please reach out to Dr. Namaky at TriHealth Women's Services Advanced Gynecologic Surgery.

References
1. Clark NV et al. Essure Removal for the Treatment of Device-Attributed Symptoms: An Expanded Case Series and Follow-up Survey. J Minim Invasive Gynecol. Sept-Oct 2017;24(6):971-6.