title: Referrals for complications following hysteroscopic sterilisation: characteristics associated with symptomatic patients after the Essure procedure.
abstract: OBJECTIVE
  This report summarises recent experience with a series of symptomatic Essure® patients with an emphasis on clinical presentation, preoperative imaging, surgical intervention, and outcome.
  
  
  METHODS
  This case series presents Essure® patients (n = 7) who sought medical consultation for various complications. This retrospective analysis is based on consultations during a six-month interval beginning in April 2015.
  
  
  RESULTS
  In this sample, mean (± SD) patient age was 35.9 ± 3.4 yrs. The gravida/parity status was 3.6 ± 1.1 and 2.4 ± 1.4, respectively. Average duration of exposure to Essure® coils among these patients was 25.6 ± 24.5 (range 5-67) months. Except for one woman, these patients had hysteroscopic sterilisation (HS) either with heavy sedation or under general anaesthesia. More than two Essure® devices were implanted in two women. Complications reported after HS included device migration, coil fragmentation, tissue perforation, and vaginal expulsion of Essure® fragment. Three of seven women have required hysterectomy.
  
  
  CONCLUSIONS
  The current series offers evidence of migration of contraceptive coils as well as Essure® inserts perforating tissue and being spontaneously expelled. Evaluation of symptomatic HS patients should include determining how many devices have been implanted, as some women have more than two.
authors.affiliation: a Reproductive Research Section, Center for Advanced Genetics , Carlsbad , CA, USA ;|b Molecular and Applied Biosciences Department, Faculty of Science & Technology , University of Westminster , London , UK ;
authors.forename: E Scott
authors.initials: ES
authors.lastname: Sills
authors.affiliation: c Howard H. Baker, Jr. Center for Public Policy, Department of Political Science , University of Tennessee, Knoxville , TN, USA.
authors.forename: Marie M
authors.initials: MM
authors.lastname: Dalton
mesh_terms: D000328:Adult; D002140:California; D003274:Contraceptive Devices, Female / Q000009:adverse effects*; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D017060:Patient Satisfaction; D011374:Progesterone / Q000009:adverse effects; D011372:Progestins / Q000009:adverse effects; D012017:Referral and Consultation; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000009:adverse effects* / Q000379:methods*
chemical_list: D011372:Progestins; D011374:Progesterone
keywords: Essure; expulsion; hysterectomy; migration; perforation; sterilisation