Essure, Paragard, or other?

February 13, 2013 12:36 PM

Considering long-term, permanent birth control options.

I'm a woman in my mid-40s considering Essure or Paragard. Essure is permanent but requires nickel coils to be inserted in the Fallopian tubes permanently. I have read that some women experience crampy and heavier periods, but of course many don't. Paragard is a copper IUD, which induces an inflammation of the uterine lining, thus making it inhospitable to pregnancy. This can also lead to heavier periods.

I am nervous about the Essure due to reports of the coils coming out as well as possible nickel allergy issue. I do get very inflamed due to contact with "cheap" metal jewelry. I've seen quite a few web sites devoted to horror stories but question whether these are isolated events getting a lot of attention. I've had very, very bad experience with Cymbalta (memory loss, fatigue, weight gain). Also, I have tried the Mirena and had very bad restless leg syndrome and weight gain, likely due to the hormones. So, while I am wary of using the drug company's information as a reliable indicator of what to expect, I haven't had problems with other drugs I have taken and therefore am considering these options.

Does anyone have good or bad experience with either of these devices that they can share, or alternatives?

posted by waving to health & fitness (21 answers total)

I narrowed my choices down to Essure or tubal ligation. I ultimately chose tubal ligation because of the horror stories I heard about Essure. I was very concerned about the metal that was used to block the fallopian tubes plus the fact that an HSG would have to be performed to confirm that the coils were in place.

Of course, I had the luxury(?) of having a tubal while open already for a C-Section. Having it outside of a c-section does require surgery but all things considered, if it means a short term inconvenience versus long term possible health disadvantages due to corroding metal, I'd take the surgery option.

I'm now 3 months post-op and only have the occasional twinge from the sutures. Periods are getting back to normal, but that is more a post-pregnancy thing.

There are those who claim to have Post-tubal Ligation Syndrome caused by the tubal itself. I have not had any of these issues. I think there might be something in the theory that these issues are really due to the fact that the sufferer may not have ever been off of hormonal birth control and thus are suffering a 'crash' of the system with their withdrawal.
posted by Leezie at 12:46 PM on February 13

If you're looking for a permanent solution, I'm wondering if there's a reason that a tubal ligation isn't on your list?
posted by mireille at 12:46 PM on February 13

If you have inkling that you may have a nickel allergy for the love of god don't put nickel inside you. You could get a patch test to confirm or disconfirm the allergy, but I would just rather be safe than very, very sorry.

Seconding mireille, have you considered a very permanent, much less likely to cause issues and intolerances tubal ligation? Or hysterectomy for that matter, no periods!
posted by lydhre at 12:52 PM on February 13 [3 favorites]

I have not personally had experience with Essure, but I looked into it a couple of years ago. I saw the same horror stories that you have likely seen, and determined that even if there was a small chance that some of the same side effects could happen to me, it was in no way worth it - the stories are really awful.

In the end, we went with a vasectomy.
posted by needlegrrl at 1:19 PM on February 13 [1 favorite]

No way I would put nickel in my body with your history! And, as a former fellow Cymbalta sufferer, I agree it sucks balls.

I would go for tubal ligation if I were you.

I am extremely sensitive to hormonal changes, too, but had to take birth control pills for years since there just weren't as many options back in my twenties. I was thankful to have my tubes tied and be done with all that crap.

Now, I had the tubal with my second C-section, so I did not have to undergo invasive surgery just for that. And, in my experience, you will have heavy periods and more cramping after the tubal, yes. However, even though I was always pretty savvy about my body, after the tubal it became even more obvious to me when I was "due" to have my period (which was a big deal, actually, as I had endometriosis and issues of what they call break-through bleeding prior to that). The upside to the tubal was that, thanks to the cramping warning me, I never had to worry about accidental blood stains any more.

I don't know your situation, but of course a vasectomy is far less intrusive and just as permanent as any of your options, so if you are in a relationship and don't want kids, and you have had hormonal issues in the past, your partner should really consider stepping up. Given your other concerns, a vasectomy should be at the top off your list!
posted by misha at 1:20 PM on February 13

As a fellow nickel allergy sufferer, I perked up during my IUD research when I read that Paragard contains nickel. I never verified it on my own because I decided that an IUD wasn't a good choice for me, but if you're considering Paragard if I would definitely try to find out more about its construction before settling on it.
posted by phatkitten at 1:37 PM on February 13

lydhre: Or hysterectomy for that matter, no periods!

Dear gods, I'm sure you are only joking, but please don't even joke about having a hysterectomy for birth control! Why in the world would you consider removing a perfectly healthy organ and potentially creating more problems?

I don't know if they are covering it in Sex and Reproduction classes these days (I hope so), but the uterus does more than just hold babies in it! The ligature and muscles provide structural integrity for holding everything in place. That support helps to keep incontinence and at bay. it isn't just sitting in your body; there are complex routes of nerves, veins and arteries connecting it, some of which will have to be cut through for a hysterectomy. Those nerves in particular are pivotal for blood flow during sexual arousal. No more uterus also means no more uterine contractions, so the capacity for uterine orgasms after a hysterectomy is gone. The inconvenience of periods is a small price to pay for keeping it intact.

Not to mention that even today, doctors are still really in the dark about the precise interactions of our various hormones, even those trace amounts left after menopause. If you have any hormonal issues at all, believe me, a hysterectomy, which sends you into immediate menopause and your hormones into a plummeting nosedive, coud really screw you up.

This concludes today's edition of Your Uterus.
posted by misha at 1:46 PM on February 13 [14 favorites]

I have the Essure springs in my fallopian tubes and have never had any problems-- it's been 4 years. The procedure was easy. I chose it over a tubal ligation because I knew someone else that recommended it and because I wanted something less invasive (don't need an incision). I couldn't be happier with my choice.
posted by sadtomato at 2:08 PM on February 13

Adiana is similar to Essure, but uses silicone springs instead of nickel.

I am 32 and got Essure two years ago, and I haven't had any problems. We tried Adiana, but it didn't take.

Good luck!
posted by interiority at 2:09 PM on February 13

I opted for Essure, and have had it for 5 years this month. I would absolutely not have gotten it if I had a nickel allergy. I have been very happy with Essure overall.
posted by Nimmie Amee at 2:53 PM on February 13

Just a data point, but I had a perfectly-aligned Paragard IUD and still got pregnant. I wouldn't consider it a permanent solution.
posted by sarahsynonymous at 3:08 PM on February 13

I've had the Paragard IUD since 2009.. no pregnancies since then. No problems, even though I have a slight nickel allergy myself. The first few periods were rough but it's been smooth sailing since then.
posted by The Biggest Dreamer at 6:51 PM on February 13

I had the Paragard for a month. I had a lot of discomfort the first week, and tried to tough it out (the doctor said that would happen). Discomfort did not go away. I was taking upwards of 16 ibuprofen a day (200 mg each). Horrible cramping, so horrible it interfered with everything. It felt like little gnomes with pickaxes were trying to dig out of my body. Got it removed, and immediately felt better. I don't have any metal allergies.

In my research, and from what the doctor explained, the Paragard works better for women who have already been pregnant. I haven't. Just a data point. I opted for another form of bc.
posted by shinyshiny at 8:03 PM on February 13

IME, if you're considering Essure they'll require you to get a patch test to check for nickel allergy. In my case, I went to the dermatology department on Friday; they snipped the nickel section off a much larger, multi-substance test patch (since we only cared about nickel), taped it to the inside of my wrist, and sent me home with instructions to peel the tape off on Monday morning and check whether there was any pinkness. Unfortunately, by late Saturday it became clear I'd already developed a large, red, annoyed-looking welt (which wound up taking a full two months to completely disappear from my skin). Severe nickel allergy = no Essure for me.

I've now had a Paragard copper-T for about 6 years and love it. Love it, love it, love it. I've become a huge cheerleader for the IUD and recommend it whenever asked.

Oh, and the reason I went to the Paragard is that hormonal birth control was making me suicidally depressed. Another reason I love my IUD. Not only does it not make me suicidal, now that my hormonal cycle isn't getting squashed flat by the BCP sledgehammer, I get the fun of the mid-cycle libido surge (which my husband definitely appreciates). I can also tell when my period is about to arrive because my libido goes to sleep for 2-3 days, then wakes up again the day before Luna hits town. I've really come to appreciate being in touch with my body that way, which was most definitely not the case when I was on the Pill.
posted by Lexica at 8:05 PM on February 13 [1 favorite]

Oh, and on failure-to-preview: I've never been pregnant or given birth (nulligravida/nulliparous). It hasn't been a problem with the Paragard.

In fact, the American College of Obstetricians and Gynecologists have issued guidelines saying that IUDs are safe for teens and "should be offered as first-line contraceptive options for sexually active adolescents".

Unless they've actually done a detailed physical exam on you, any medical professional who tells you that an IUD won't work because you've never been pregnant is at best not up to date on current practice guidelines, and at worst still mired in old-fashioned paternalistic attitudes about whether women are competent to make decisions about their own sexuality. (Oops, slipped into editorializing there. Sorry.)
posted by Lexica at 8:09 PM on February 13 [3 favorites]

Paragard worked for me! I really doubted my decision the first couple months, but each month got better. And after a year, everything was back to normal. I've never been pregnant. Yes, it hurt like hell going in, but it was worth 10 years of not thinking about it!
posted by icanbreathe at 8:17 PM on February 13

In my research, and from what the doctor explained, the Paragard works better for women who have already been pregnant. I haven't.

While IUDs are generally prescribed more for women who have already had a baby (not just pregnant, but borne offspring), nulliparous women regularly use IUDs without complications. I came into the thread as a nulliparous woman to suggest the Mirena, which I have and absolutely love (2.5 years without periods!) but of course that was before I saw your note.

I think IUDs are a great, solid BC decision - I'd give Paragard a shot and see if it works better for you than Mirena.
posted by arnicae at 8:23 PM on February 13

Hysterectomy as a contraceptive is not something any responsible doctor will provide. There are many good reasons for this. However, immediate menopause is not one of them. The blood supply to the ovaries is separate to the uterus, and they can be surgically removed independently.

Tubal ligations are also an option - they be performed by laparoscopic surgery and are actually a very quick operation under general anaesthesia. The procedures I've seen were performed by a clip placed over the fallopian tube though, so I don't know if there is nickel in that that could cause you problems.
posted by chiquitita at 10:04 PM on February 13

I would look at actual rates of complications and what your doctor recommends for you specifically versus looking at random horror stories on the internet.

For example, you mentioned being worried about the coils coming out from Essure, but the Paragard IUD can fall out too. Others noted there is a failure rate with Paragard but there is a failure rate to essentially all birth control measures (including sterilization/tubal ligation), aside from hysterectomy which makes childbearing a physical impossibility, but is a major abdominal surgery versus the minor procedures you'd be looking at for the other methods.

If you do go with Essure and do your full procedural follow up with the HSG, subsequent pregnancy would be extremely unusual. For the record, I've had an HSG, it was uncomfortable but quick and not bad enough to deter me from an otherwise great permanent birth control measure, if I were interested in that.
posted by treehorn+bunny at 11:48 PM on February 13

Thanks for all of this great insight! I have decided not to do the Essure, it just sounds to permanent and risky if something does go wrong. I have inflammation to nickel and don't want to risk having chronic inflammation to the inserted coils. I don't want to have to face having them removed, if that is even possible once the scar tissue envelopes them. I'm not sure what I will do but the Paragard seems likely at this point. If I experience adverse effects, at least it is easy to take out.

I had asked my Dr. about a tubal ligation and he said they are performed with metal clips of the same material the Essure is made out of, so a reaction to the metal would be a similar risk. I don't know why he didn't mention non-metal type clips, ties or other methods of tubal ligation that seem to be available, but he didn't.
posted by waving at 8:32 AM on February 14

Update: I have had the IUD for two months now and haven't experienced anything too unusual except for a very short cycle (~3 weeks) the first month and then two pretty heavy periods, the second being less so. Otherwise I don't feel anything unusual.
posted by waving at 1:46 PM on April 22