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Notes on Women's Health
Notes on Women's Health

Permanent Birth Control: Understanding Your Options

permanent birth controlOnce you decide you no longer want to become pregnant, you have several options to choose from when selecting a permanent birth control method. You may choose between non-surgical and surgical solutions, depending on your overall health and condition. Below we discuss the most commonly performed permanent birth control procedures.

Option #1: Essure Permanent Birth Control (Hysteroscopic Sterilization)

Essure is a simple, minimally invasive procedure that we often recommend because Essure has a 99.3% effective rate once tubal blockage is confirmed by a three month test. A FDA-approved birth control procedure, Essure prevents pregnancy permanently and has been used by hundreds of thousands of women.

During the procedure, the doctor inserts a flexible tube with a small camera (hysteroscope) through the vagina and cervix and up to the uterus. From here, the doctor can see the opening to the fallopian tubes and insert the soft, flexible Essure coils into each of the fallopian tubes. Over the course of about three months, the body naturally begins to form a barrier surrounding the inserts. This barrier, made up of your body’s natural scar tissue, also blocks sperm from entering the uterus, and thus prevents pregnancy.

Please note that it may take about three months for the Essure procedure to become effective and you must use an alternate form of birth control during this period. After three months, your doctor will perform an ultrasound exam to confirm blockage of the fallopian tubes.

What are the Advantages of the Essure Method?

The Essure method provides an array of advantages:

  • Essure is a non-surgical, minimally invasive procedure and requires no incisions, no anesthesia, and causes no visible scarring.
  • The procedure is performed quickly as an outpatient treatment in your doctor’s office and takes roughly 10 minutes.
  • Essure is a non-hormonal method of permanent birth control, so it will not cause side effects associated with hormonal changes, such as weight gain or mood swings.
  • About 90% of patients are able to resume normal activity immediately and 100% within 24 hours after the procedure.
  • Many insurance providers now cover the Essure procedure.
  • Never worry about birth control again once you get past the initial 3-month period.

Are There Any Risks with Essure?

While complications are extremely rare, some patients using the Essure method have experienced such adverse effects as perforation of tissue; expulsion, or shifting of location of the implant; cramping, vaginal bleeding, chronic pelvic pain, and pregnancy (including ectopic pregnancy), although the risk of this is highest during the first three months after initial placement.

Who is a Good Candidate for Essure Permanent Birth Control?

While most healthy adult women make excellent candidates for the Essure method of permanent birth control, for women with such issues as previously existing tubal blockage, fibroids that may distort the uterine cavity, or uterine septum, the procedure may not be advisable.

Option #2: Tubal Ligation

When women refer to getting their “tubes tied,” they are referencing a tubal ligation procedure. An option for female sterilization, the goal is to prevent eggs from traveling from the ovaries to the uterus to help prevent pregnancy. Tubal ligation is considered a permanent method of birth control, but may be reversible in some cases, but it’s major surgery that requires a couple of days in a hospital.

What Happens During a Tubal Ligation Procedure?

Unlike the Essure method, a tubal ligation will be performed at a hospital or outpatient surgical clinic, and the procedure requires anesthesia. The surgeon will make one or two small cuts in your abdomen and use a long, thin device similar to a small telescope (called a laparoscope) to cut, seal, clamp, or tie your fallopian tubes closed. After the procedure, you will have stitches at the point of incision, but can typically go home a few hours later.

What are the Risks with Tubal Ligation?

Tubal ligation is safe, but like any surgical procedure, there is a chance of infection, pain or bleeding from an incision or inside the abdomen. You may have other risks, depending on your specific health condition, but these will be discussed in depth with your doctor should you choose to have a tubal ligation.

How Effective is the Procedure?

Even though tubal ligation is a safe and effective form of birth control, there is a slight risk of becoming pregnant after tubal ligation. That can happen if the tubes grow back together, which is very rare.

While pregnancy is rare after any type of permanent sterilization procedure, when it does occur, the risk of an ectopic pregnancy is increased when the fallopian tubes are blocked. In extremely rare cases, some women report chronic pain after any procedure that blocks the fallopian tubes, and in those cases, the implants may be removed by means of a surgical procedure.


Option #3: Bilateral Salpingectomy

Bilateral salpingectomy (the removal of the fallopian tubes) can be considered a sterilization method that provides effective contraception, but unlike a tubal ligation, it is also believed to decrease the incidence of ovarian cancer.

Research has shown that some of the most common and aggressive ovarian cancers develop in the fallopian tubes, rather than the ovaries. So by removing the fallopian tubes during a bilateral salpingectomy, a woman’s risk of developing ovarian cancer is decreased.

The procedure takes only a short time longer to perform than a tubal ligation, and the ovaries remain, so there are no physiologic or hormonal changes after the tubes are removed. The risks and recovery time are the same as a traditional tubal ligation, but by removing both of the fallopian tubes, the risk of an ectopic pregnancy is eliminated entirely.

If you are a resident of Fairfield County in Connecticut and you are seeking a permanent birth control solution, contact Dr. Garofalo’s office today to schedule a consultation for permanent birth control.

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About the Connecticut OBGYN Practice

Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowaytan and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobygn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations and well woman exams by calling 203.803.1098.