Long-term quality of life after surgical Essure removal for device-attributed symptoms

Published:November 23, 2022DOI:



      To analyze quality of life(QoL) and symptom resolution after surgical removal of Essure devices.


      Single-center cohort study which included patients with Essure removal between February 2017 and March 2018. Surgery was performed in 65 patients by laparoscopy (Salpingectomy only or Hysterectomy). Questionnaires were used to assess QoL(SF-36), emotional disorders(HAD) and symptoms preoperatively, at 3 months and 4 years postoperatively.


      4(6,1%) and 16(24,6%) patients were lost of follow-up at three months and 4 years postoperatively respectively. Four(6,1%) intraoperative surgical complications occurred. During the three-months postoperative period, 3(4,6%) complications occurred: five Clavien Dindo Grade 1 complications (umbilical hematoma) and one Grade 2 complication (hyperthermia and digestive disorder requiring antibiotic therapy). Preoperative QoL scores were lower than those of general population. Scores were significantly improved at 3 months and 4 years postoperatively. At 4 years postoperatively, 17/49(34,7%) had a complete regression of symptoms, 21/49(42,8%) partial resolution and 11/49(22,4%) no improvement. 27/49(55,1%) patients made the connection between symptoms and ESSURE device after media coverage. 22/49(44,89 %) were influenced by media coverage in their decision of surgery. There was a higher percentage of patients with anxiety disorder before Essure removal than 4 years after [22/44 (50 %) versus 11/44 (25 %); p = 0.0045].


      Essure removal has a restorative role in terms of QoL in short and long-term. Patients should be informed about possibility of no improvement after surgery and surgical morbidity. Larger prospective cohort is needed to make a well-considered decision about risks of surgery compared with expected benefits.


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        • Dhruva S.S.
        • Ross J.S.
        • Gariepy A.M.
        Revisiting Essure – Toward safe and effective sterilization.
        N Engl J Med. 2015; 373: e17
        • Cooper J.M.
        • Carignan C.S.
        • Cher D.
        • Kerin J.F.
        Microinsert nonincisional hysteroscopic sterilization.
        Obstet Gynecol. 2003; 102: 59-67
        • Kerin J.F.
        • Cooper J.M.
        • Price T.
        • Herendael B.J.V.
        • Cayuela-Font E.
        • Cher D.
        • et al.
        Hysteroscopic sterilization using a micro-insert device: results of a multicentre Phase II study.
        Hum Reprod. 2003; 18: 1223-1230
        • Maassen L.W.
        • van Gastel D.M.
        • Haveman I.
        • Bongers M.Y.
        • Veersema S.
        Removal of essure sterilization devices: A retrospective cohort study in the Netherlands.
        J Minim Invasive Gynecol. 2019; 26: 1056-1062
        • Chene G.
        • Cerruto E.
        • Moret S.
        • Nohuz E.
        Could the anatomic location of Essure® device explain the impairment of quality of life?.
        Minerva Obstet Gynecol. 2022; 74: 123-129
        • Casey J.
        • Aguirre F.
        • Yunker A.
        Outcomes of laparoscopic removal of the Essure sterilization device for pelvic pain: A case series.
        Contraception. 2016; 94: 190-192
        • Brito L.G.O.
        • Cohen S.L.
        • Goggins E.R.
        • Wang K.C.
        • Einarsson J.I.
        Essure surgical removal and subsequent symptom resolution: Case series and follow-up survey.
        J Minimal Invasive Gynecol. 2015; 22: 910-913
        • Chene G.
        • Cerruto E.
        • Moret S.
        • Lebail-Carval K.
        • Chabert P.
        • Mellier G.
        • et al.
        Quality of life after laparoscopic removal of Essure® sterilization devices.
        Eur J Obstet Gynecol Reprod Biol. 2019; 3: 100054
        • Dindo D.
        • Demartines N.
        • Clavien P.-A.
        Classification of surgical complications.
        Ann Surg. 2004; 240: 205-213
        • Ware J.
        • Kosinski M.
        • Bjorner J.
        • TurnerBowker D.
        • Gandek B.
        • Maruish M.
        User’s manual for the SF-36v2® health survey.
        Lincoln, Quality Metric Incorporated2011
        • Bocéréan C.
        • Dupret E.
        A validation study of the Hospital Anxiety and Depression Scale (HADS) in a large sample of French employees.
        BMC Psychiatry. 2014; 14: 354
        • Le L.A.
        questionnaire MOS SF-36: manuel de l’utilisateur et guide d’interprétation des scores.
        Editions ESTEM, Paris2001
        • Leleu A.
        • Cathelain A.
        • Rubod C.
        • Vandendriessche D.
        • Cosson M.
        • Giraudet G.
        Symptom related to Essure® and evolution after removal: Outcomes of retrospective cohort.
        J Gynecol Obstet Hum Reprod. 2021; 50: 101836
        • Siemons S.E.
        • Vleugels M.P.H.
        • Veersema S.
        • Braat D.D.M.
        • Nieboer T.E.
        Long-term follow-up after successful Essure sterilization: Evaluation of patient satisfaction, symptoms, and the influence of negative publicity.
        Fertil Steril. 2019; 112: 1144-1149
        • Siemons S.
        • Vleugels M.
        • van Eijndhoven H.
        Evaluation of nickel allergic reactions to the essure micro insert: theoretical risk or daily practice?.
        J Minim Invasive Gynecol. 2017; 24: 140-144
        • Parant F.
        • Bost M.
        • Nohuz E.
        • Prost J.
        • Cerruto E.
        • Moret S.
        • et al.
        Potential release of toxic metal elements from Essure® device in symptomatic patients: First results of the French Ablimco cohort.
        Eur J Obstet Gynecol Reprod Biol. 2020; 252: 434-438
      1. Recommandations pour la pratique clinique. 2018. Available from: Essure%C2%AE. Accessed June, 2022.

        • Aarts J.W.M.
        • Nieboer T.E.
        • Johnson N.
        • Tavender E.
        • Garry R.
        • Mol B.W.J.
        • et al.
        Surgical approach to hysterectomy for benign gynaecological disease.
        Cochrane Database Syst Rev. 2015; : CD003677
        • Wartolowska K.A.
        • Gerry S.
        • Feakins B.G.
        • Collins G.S.
        • Cook J.
        • Judge A.
        • et al.
        A meta-analysis of temporal changes of response in the placebo arm of surgical randomized controlled trials: An update.
        Trials. 2017; 18: 1-7