Can Essure Cause Endometriosis and Fibroids: What to Know

Can Essure Cause Endometriosis and Fibroids: What to Know

Essure, a permanent birth control device made of small metal coils placed into the fallopian tubes, has been the focus of safety questions for years. If you have Essure or had it removed, you may wonder whether it can cause gynecologic conditions like endometriosis or uterine fibroids. Here’s what current evidence and authoritative sources suggest, how symptoms can overlap, and what to discuss with your clinician.

What is Essure and how does it work?

Essure was designed to be placed through the cervix into the openings of the fallopian tubes. The coils contain polyethylene terephthalate (PET) fibers that stimulate tissue growth, leading to scarring that blocks the tubes over several months. A confirmation test (historically a hysterosalpingogram, or HSG) was used to verify tubal occlusion. The U.S. Food and Drug Administration (FDA) has documented reported risks including pelvic pain, device migration, perforation, nickel allergy symptoms, abnormal bleeding, and unintended pregnancy, including ectopic pregnancy. Sales of Essure in the United States were discontinued in 2018, and the FDA continues to monitor safety and outcomes through postmarket studies and adverse event reports (FDA: Essure Information).

Endometriosis and fibroids: a quick primer

Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, commonly on the ovaries, peritoneum, or other pelvic structures. It can cause painful periods, chronic pelvic pain, pain with intercourse, and sometimes infertility. The exact cause is not fully understood, but proposed mechanisms include retrograde menstruation, immune and inflammatory factors, and genetic susceptibility. It affects up to about 10% of reproductive-age women (NIH/NICHD: Endometriosis).

Uterine fibroids (leiomyomas)

Fibroids are benign smooth muscle tumors of the uterus. They are extremely common and may be present in the uterine wall, within the cavity, or on the surface. Symptoms can include heavy or prolonged menstrual bleeding, pelvic pressure or pain, frequent urination, and fertility or pregnancy complications. Hormonal factors, genetics, and age influence their development. By age 50, the majority of women have fibroids, although many are asymptomatic (NIH/NICHD: Uterine Fibroids).

Can Essure cause endometriosis or fibroids?

At this time, a causal relationship between Essure and the development of endometriosis or uterine fibroids has not been established in the medical literature or by U.S. regulatory authorities. The FDA’s safety communications and postmarket surveillance focus on risks such as chronic pelvic pain, abnormal uterine bleeding, device migration, organ perforation, and hypersensitivity; they do not identify Essure as a cause of endometriosis or fibroids (FDA).

Two important nuances:

  • Symptoms overlap: Pelvic pain and heavy or irregular bleeding—reported with Essure in some patients—also occur with endometriosis and fibroids. This overlap can lead to workups that uncover previously unrecognized conditions.
  • Association is not causation: Endometriosis and fibroids are common in the same age groups that sought permanent contraception. Finding these conditions in someone with Essure doesn’t necessarily mean Essure caused them.

That said, if you experience new or worsening pelvic pain or heavy bleeding after Essure placement, you should not ignore it. Careful evaluation can identify whether symptoms are related to device position or complications, to a separate gynecologic condition, or to more than one factor.

What the FDA has reported about Essure risks

The FDA has required boxed warnings and conducted postmarket studies comparing Essure with laparoscopic tubal ligation. Interim findings have shown higher rates of chronic pelvic pain and abnormal uterine bleeding among Essure users compared with tubal ligation, as well as device-specific issues like migration and perforation. These findings support thorough counseling, individualized risk–benefit assessment, and prompt evaluation of new symptoms (FDA: Essure Safety and Studies).

Why symptoms can be confusing

Several mechanisms can produce symptoms that resemble or coexist with endometriosis or fibroids:

  • Local inflammation and scarring in the tubes can contribute to pelvic pain in some patients.
  • Device malposition, migration, or perforation may cause pain or bleeding that mimics gynecologic disorders.
  • Nickel hypersensitivity in susceptible individuals can present with systemic or pelvic symptoms.
  • Coexisting conditions such as endometriosis or fibroids may be discovered during evaluation for Essure-related symptoms simply because those conditions are common.

When to seek medical care

Contact a healthcare professional—ideally an obstetrician–gynecologist—if you experience:

  • New or worsening pelvic or lower abdominal pain
  • Heavy or prolonged menstrual bleeding or bleeding between periods
  • Pain with intercourse or persistent pelvic pressure
  • Symptoms of allergy (e.g., rash) after device placement
  • Positive pregnancy test after Essure placement, especially with pain or bleeding (seek urgent care due to ectopic pregnancy risk)

How clinicians evaluate symptoms after Essure

Your clinician may recommend:

  • Pelvic exam and transvaginal ultrasound to assess the uterus and ovaries and look for fibroids or other structural causes of bleeding and pain.
  • Imaging to check device location—pelvic X-ray, HSG, or, in selected cases, 3D ultrasound—to confirm proper positioning and look for migration or perforation (FDA guidance).
  • Evaluation for endometriosis based on symptoms and imaging; definitive diagnosis typically requires laparoscopy, though many patients are treated empirically first (NIH/NICHD).
  • Laboratory tests and pregnancy testing when indicated.

Treatment options: tailoring to the cause

Management depends on findings and your goals for symptom relief and future fertility (recognizing Essure was intended as permanent contraception):

  • For device-related issues: Options include medical therapy for pain, and when necessary, device removal. Techniques vary by timing and location—hysteroscopic removal may be considered early after placement; more commonly, laparoscopic salpingectomy with cornual resection is performed to remove the entire insert and surrounding tissue. In select cases with additional uterine pathology and no desire for future childbearing, hysterectomy may be considered. Removal should be planned with a surgeon experienced in Essure extraction due to the risk of device fragmentation.
  • For endometriosis: Nonsteroidal anti-inflammatory drugs (NSAIDs), combined hormonal contraceptives or progestins, and gonadotropin-releasing hormone (GnRH) analogs/antagonists may help pain; laparoscopic excision or ablation can be used for diagnosis and treatment. Management is individualized and often multimodal (NIH/NICHD).
  • For fibroids: Options include NSAIDs, hormonal therapies (e.g., combined pills, progestins, or levonorgestrel-releasing intrauterine system in appropriate candidates), GnRH analogs/antagonists for short-term symptom control, uterine artery embolization, myomectomy, or hysterectomy depending on size, number, symptoms, and preferences (NIH/NICHD).

Bottom line

  • Current evidence does not show that Essure causes endometriosis or uterine fibroids.
  • However, Essure can be associated with pelvic pain and abnormal bleeding, and these symptoms overlap with those of endometriosis and fibroids.
  • Thorough evaluation—including imaging to confirm device position and assessment for other gynecologic conditions—helps target treatment.
  • If you have Essure and troubling symptoms, talk with a clinician experienced in managing Essure and pelvic pain.

This article is for informational purposes and does not replace individualized medical advice.

Sources and further reading

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