By Mel Kurtulus, M.D., Scripps Memorial Hospital La Jolla
Until recently, women who wanted permanent sterilization had only one option: tubal ligation. This surgical procedure closes the fallopian tubes that connect the ovaries to the uterus and prevent sperm from fertilizing a woman’s eggs. Tubal ligation is commonly known as “tying the tubes” and makes a woman permanently sterile, or unable to become pregnant. Surgery is performed in a hospital or outpatient clinic under anesthesia and usually involves cutting into the belly area to burn the tubes shut (called cauterization) or close them off with a small clip. As with any surgery, tubal ligation has risks including bleeding and complications, and recovery can take several days.
However, the FDA recently approved Essure, a new procedure that gives women an alternative option for sterilization without surgery. It can be performed in an office or on an outpatient basis, and is more effective than tubal ligation in preventing pregnancy.
Essure works by blocking the Fallopian tubes and, consequently, prevent sperm from reaching her ovaries. During the procedure, small pluglike coils made of polyester fibers and metal are inserted through the cervix into each fallopian tube. Over the next few months, tissue grows over the coils, creating a permanent obstruction. The procedure is 99.8 percent effective in preventing pregnancy and is completely hormone-free, so women continue to experience their natural menstrual cycles without artificial hormones.
Unlike tubal ligation, Essure requires no cutting, hospitalization or anesthesia, and can be performed right in a doctor’s office in most cases. The procedure takes less than 30 minutes, and there is no need for pain medications or recovery time. Women can resume their normal activities the same day. Side effects are generally mild and may include cramping and spotting between menstrual periods.
Over the next three months, scar tissue forms around the inserts, creating a natural barrier in the fallopian tubes. After three months, we recommend an Essure Confirmation Test to ensure that the tubes are fully blocked. This test takes about 30 minutes; a thin tube is passed through the cervix into the uterus, and a small amount of dye is passed through the tube to the opening of the fallopian tubes. A radiologist takes an abdominal X-ray to confirm that the inserts are in the correct location and that fluid cannot flow past them. Following a positive result on this test, no further birth control will be needed. Most women receive a positive result after three months, but in some cases, it may take up to six months for the tubes to be completely blocked.
Essure is a permanent procedure, so it can be a good choice for women who are sure they will not want to become pregnant, and it is covered by most insurance plans. It is not reversible, so women who are undecided about having children should consider another form of birth control.
Mel Kurtulus, M.D., FACOG, is an OB/GYN with Scripps Memorial Hospital La Jolla. “To Your Health” is brought to you by the physicians and staff at Scripps Memorial Hospital La Jolla. For more information on staying healthy or for a physician referral, call 1-800-SCRIPPS or visit www.scripps.org.