Essure Perforation and Chronic Pelvic Pain

Abstract

Hysterosalpingography confirmed bilateral tubal occlusion, while showing the left microinsert in an abnormal configuration (Arrow). Transcervical (hysteroscopic) sterilization with Essure has become a common technique for permanent sterilization that is rapidly replacing traditional laparoscopic sterilization [1]. Performance of hysteroscopic sterilization in the office setting has been shown to be safe and feasible, with obvious advantages over laparoscopic sterilization with the patient under general anesthesia [2–7]. Evaluation of the Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE), which is a voluntary reporting database, revealed 20 reports released between January 2004 and January 2009 of pelvic pain requiring treatment after Essure placement. Most cases were related to poor placement. In 5 cases, the pain was attributed to a malpositioned device without perforation, and in 5 others, unilateral or bilateral cornual perforation was noted [8]. Other cases of tubal or cornual perforation with the Essure microinserts are reported in the literature [9,10]. Confirmation of tubal occlusion through hysterosalpingography (HSG) 3 months after insertion is still required per device labeling. Incorrect positioning of Essure has been associated with tubal patency on the 3-month HSG [11]. However, evidence of tubal occlusion on HSG does not necessarily rule out perforation or malposition. We present the case of a 37-year-old woman G4P2022 who presented with chronic pelvic pain for 1 year. The pain started after uncomplicated hysteroscopic sterilization with Essure by her primary gynecologist. The patient denied any history of pelvic pain before Essure placement. She had been on oral contraceptives (OCPs) for 10 years before Essure placement but decided to stop OCPs after a new diagnosis of