Essure and Endometrial Ablation

We employ these two important services so commonly that we feel it is important to provide additional information about them. For a complete explanation and/or links to additional resources, click on the tabs below.

  • Dr. Bullaro-Anderer is an essure certified physician
  • Endometrial Ablation using Hydrothermal Ablation, Thermachoice and Novasure

Tubal Sterilization is a procedure performed to permanently prevent pregnancy.  Traditionally this has been done laproscopically in the operating room under general anesthesia.  This would require a least 2 incisions to allow burning the mid portion of the fallopian tubes.

Fortunately, I now offer the Essure procedure which is performed in my office without any incisions.  I offer this procedure with IV sedation under the care of a board certified anesthesiologist. I place a blocking device/coil through the vaginal opening and into the fallopian tubes.  Over the next 3 months the device will stimulate the tubes to scar around the coils resulting in permanent sterilization. You will need a back up birth control for 3 months to protect against pregnancy, until we can confirm your tubes are blocked.  To confirm tubal occlusion we will send you to a radiology facility to have an x-ray study.  This study consists of a dye placed through the cervix and into uterus while an x-ray is performed confirming the dye stopping at the fallopian tubes.  You may have an MRI in the future with these coils in place.  There is very low risk to the procedure and is 99.8% effective in preventing pregnancy. 

This procedure is not recommended for patients with a known nickel allergy.

Following the Essure procedure you may have some mild bleeding and cramping that can last 24-48 hours. View a brief presentation of the Essure option. You may also want to watch this interview with Dr. Bullaro-Anderer.

Our Essure-certified physician inserts soft, flexible micro-inserts into the Fallopian tubes, using IV sedation under the care of a board-certified anesthesiologist. No incision is needed because the inserts are delivered through the vagina and cervix.

Over the next several weeks a natural barrier forms by your body's natural tissue growing into the inserts. This blocks the Fallopian tubes so that sperm cannot reach the eggs, which prevents conception.

Watch a short video of the Essure procedure.


Essure tubal sterilization procedure


This is a procedure that can be performed in the operating room or less expensively, in the office.  Both are performed in the same manner with IV sedation under the care of a board certified anesthesiologist.  The procedure is used to treat heavy bleeding.  90-90% of women who undergo this procedure report satisfaction with the results.  Approximately 60-70% of women will have little to no bleeding after an ablation procedure with another 20-30% experiencing lighter periods that are markedly improved from pre-treatment.  Less than 10% of patients will fail an ablation procedure and choose to manage the bleeding with hormones or even possibly a hysterectomy.

Prior to any ablation, hysteroscopy and D&C are performed to evaluate the lining of the uterus and rule out any abnormalities.  I will then use a device (Hydro ThermAblator, Thermachoice or Novasure system.) to permanently create a scar and remove the cells that grow a lining in the uterus.  Each month during a menstrual period, the uterine lining is shed and a new lining starts to grow.  By creating a scar and preventing regrowth of this lining, we can stop periods permanently.  An ablation procedure can take anywhere from 90 seconds to 15 minutes depending on the device we choose and shape of your uterus.  You may experience some moderate to intense uterine cramps that can last 4-6 hours following the procedure.  We ask that you take your prescription pain pills upon arriving home after your procedure, so that you may go to sleep and reduce any discomfort

A brief description of each procedure is shown below:

Hydrothermal Ablation (HTA)

A small probe is inserted into the uterus, through which room-temperature saline solution is gently circulated, under carefully controlled pressure, in the uterus. The water is slowly heated to a temperature of about 90 degrees Celsius (194 degrees Farenheit) and circulated for 10 minutes. The water is then drained and the probe removed.

HTA produces results similar to that for Thermachoice (below) and the recovery period and restrictions are similar.

GYNECARE Thermachoice

A small, soft flexible silicone balloon is gently placed in the uterus via a catheter through the vagina and cervix. This method requires no incision. The balloon is then filled with fluid so that it conforms to the contours of the uterus. This fluid is gently heated while being circulated inside the balloon. This takes approximately 8 minutes.

The fluid is then removed from the balloon and the catheter and balloon is removed. Nothing remains in the uterus. Over the next 7 to 10 days, the treated endometrial tissue will shed in a manner similar to a period.

In most cases a patient can resume normal activites the next day. For more information on Thermachoice see the GYNECARE Thermachoice website.



This procedure uses radio-frequency energy to destroy the endometrium, rather than warm circulating water. A probe is inserted through the uterus and cervix, but rather than inserting water the probe end expands into a gold-plated wire mesh. When this mesh is expanded to fit the uterus, a radio-frequency current is delivered for 90 seconds to provide the energy to destroy the endometrial tissue.

A gentle vacuum is applied to the probe during the procedure and the endometrial tissue is collected on the mesh. The mesh is then pulled back into the probe and the probe is removed.

Again, the patient recovery and restrictions are similar.