::healthy woman
Planning for Your Family
PERMANENT BIRTH CONTROL BY Sraddha Prativadi, MD
Last month we described various forms of long-acting reversible contraception. However, many women desire permanent, nonreversible contraception when they get to a point in their lives where they have made a definitive decision to have no more children and they are still have menstrual cycles. I would like to point out here that simply making the decision to not have any more children does not provide you with contraception. It seems obvious but as physicians, we very often see women who have completed childbearing that arrive pregnant and they tell us, “But I was done! I didn’t think I could get pregnant.” Yet they are still having cycles and are clearly able to get pregnant. There are minimally invasive methods of permanent contraception available to the modern day woman that require no more than a few short office visits. This is a nice fit for women who can accommodate office visits into their busy schedule but cannot take time for a hospital procedure, or the recovery time required from having abdominal incisions. Two methods that are currently available in the US and have been in use for many years outside of the United States are Essure and Adiana. In both of these methods, inserts are placed into the fallopian tubes by a catheter that is passed from the vagina through the cervix and into the uterus – no incisions. In the case of the Essure, the insert contains inner polyethylene terephthalate fibers to induce benign fibrotic reaction (scarring) and is held in place by flexible stainless steel inner coil and a dynamic outer nickel titanium alloy coil. These are highly trusted materials and are even used in medical devices for other organ systems for many years. Once in place, the device is designed to elicit tissue growth in and around the insert to form over a period of three months. This creates an occlusion or blockage in the fallopian tube that will prevent passage of an egg into the uterus and sperm into the fallopian tube. The Adiana is similar in principle. A soft, biocompatible silicone matrix is hysteroscopically positioned in the patient’s fallopian tube,
creating a permanent barrier within 3 months. The silicone matrix does not carry the risk of chronic inflammation or painful perforations. Radiofrequency energy is administered to the inner portion of the fallopian tube to make the tissue more receptive and responsive to the silicone matrix. Unlike other forms of tubal ligation, no general anesthetic nor incision through the abdomen is required for the Essure and Adiana procedures. If you choose to have this procedure performed, the uterine lining must be thin to maximize success of the procedure in the office. Your physician may choose a time of your cycle when the endometrial lining is thin or administer hormonal contraception in order to thin the uterine lining and provide you with contraception during the 3 months that you wait for the fallopian tubes to create the scar tissue. These methods can only be considered reliable forms of contraception after a confirmatory test is performed showing that dye cannot pass through the tubes. For both of these methods, three months after insertion a physician performs an x-ray test called a hysterosalpingogram to confirm that the fallopian tubes are completely blocked and that the patient can rely on the Essure or Adiana inserts for birth control. A contrast agent (dye) is injected through the cervix, and an x-ray technologist takes photos of the Essure coils to ensure that they are in place. For both procedures, blockage of the tubes must be confirmed in this test in order to rely on the method for contraception. These methods are considered to be over 99% effective. Because they are not appropriate for every woman’s situation, the final decision regarding a contraceptive method should be made between a woman and her physician. Sraddha Prativadi, MD is Clinical Instructor at the University of Rochester Medical Center and is a provider with Madonna Obgyn. www.madonnaobgyn.com rochesterWomanMag.com :: september 2011
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