Document Type : Case Report


1 College of Medicine, Florida State University, Orlando, FL, USA

2 Women’s and Maternity Care Specialists, Winter Park, FL, USA

3 Department of Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA



Introduction: Essure® device malposition is a rare, but clinically significant complication, for which management is idiosyncratic. This case report describes an unusual example of Essure® migration in order to clarify reasonable management options.
Case Presentation: A 50-year old G4P2022 underwent hysteroscopic sterilization using the Essure® device. Insertion was complicated by fragmentation of both coils. Two years later, one of the coils was incidentally discovered protruding through the cervical os. The visible portion was clipped when attempts to remove the entire coil were unsuccessful.
Conclusion: Difficult placement increases the risk of Essure® malposition. In asymptomatic patients, conservative management with removal of only a portion of the device is a rational approach.


  1. Essure®: Permanent Birth Control [package insert]. Whippany, NJ: Bayer Corporation; 2002.
  2. Munro MG, Nichols JE, Levy B, Vleugels MP, Veersema S. Hysteroscopic sterilization: 10-year retrospective analysis of worldwide pregnancy reports. J Minim Invasive Gynecol. 2014;21(2):245-251. doi:10.1016/j.jmig.2013.09.016.
  3. Mao J, Guiahi M, Chudnoff S, Schlegel P, Pfeifer S, Sedrakyan A. Seven-Year Outcomes After Hysteroscopic and Laparoscopic Sterilizations. Obstet Gynecol. 2019;133(2):323-331. doi:10.1097/AOG.0000000000003092.
  4. Brito LG, Cohen SL, Goggins ER, Wang KC, Einarsson JI. Essure surgical removal and subsequent symptom resolution: case series and follow-up survey. J Minim Invasive Gynecol. 2015;22(5):910-913. doi:10.1016/j.jmig.2015.03.018.
  5. Rezai S, LaBine M, Gomez Roberts HA, et al. Essure Microinsert Abdominal Migration after Hysteroscopic Tubal Sterilization of an Appropriately Placed Essure Device: Dual Case Reports and Review of the Literature. Case Rep Obstet Gynecol. 2015;2015:402197. doi:10.1155/2015/402197.
  6. Frietze G, Leyser-Whalen O, Rahman M, Rouhani M, Berenson AB. A Meta-Analysis of Bilateral Essure((R)) Procedural Placement Success Rates on First Attempt. J Gynecol Surg. 2015;31(6):308-317. doi:10.1089/gyn.2015.0054.
  7. Adelman MR, Dassel MW, Sharp HT. Management of complications encountered with Essure hysteroscopic sterilization: a systematic review. J Minim Invasive Gynecol. 2014;21(5):733-743. doi:10.1016/j.jmig.2014.03.019.
  8. Al-Safi ZA, Shavell VI, Hobson DT, Berman JM, Diamond MP. Analysis of adverse events with Essure hysteroscopic sterilization reported to the Manufacturer and User Facility Device Experience database. J Minim Invasive Gynecol. 2013;20(6):825-829. doi:10.1016/j.jmig.2013.05.006.
  9. Povedano B, Arjona JE, Velasco E, Monserrat JA, Lorente J, Castelo-Branco C. Complications of hysteroscopic Essure((R)) sterilisation: report on 4306 procedures performed in a single centre. BJOG. 2012;119(7):795-799. doi:10.1111/j.1471-0528.2012.03292.x.
  10. Lazarus E, Lourenco AP, Casper S, Allen RH. Necessity of hysterosalpingography after Essure microinsert placement for contraception. AJR Am J Roentgenol. 2012;198(6):1460-1463. doi:10.2214/AJR.11.7667.
  11. Gerritse MB, Veersema S, Timmermans A, Brolmann HA. Incorrect position of Essure microinserts 3 months after successful bilateral placement. Fertil Steril. 2009;91(3):930. e931-935. doi:10.1016/j.fertnstert.2008.08.013.
  12. Booker CJ, Yarwood RL, Dodson WC. Dislodged Essure microinsert. Fertil Steril. 2008;89(4):964-965. doi:10.1016/j.fertnstert.2007.08.022.