4:11 pm - 10/26/2007

my HSG experience (to confirm tubal blockages due to Essure)

About three months ago, I had Essure, a less invasive method of permanent sterilization. If you want to read about my experience getting it, check out my VP post sharing my Essure story.

Essure works by inserting tiny wire implants into your fallopian tubes. Over the course of three months (sometimes six), your body gets irritated by them and builds up scar tissue that in turn completely blocks your tubes. Before you can trust that you are completely sterilized, they have to do an HSG test to make absolutely sure that both tubes are closed. I had mine today, and wanted to add this experience to the community's understanding of Essure.

The basics of the test are thus: you remove the bottom half of your clothing, get on a table and then someone sticks a tiny catheter inside your cervix. They pour radio-blocking dye (*not* radioactive, just something that will look totally black on the xray machine) through the tube and into your uterus. This test is primarily used for diagnosing infertility problems, and in the case of an HSG test done for this reason, the goal is to have the dye flow through the uterus, into both tubes, and then spill out into the abdominal cavity at the end of the fallopian tube. If anything seems blocked, a technician might put a bit of pressure on the dye to try to get a somewhat closed tube to open, or just to make sure that's as far as the block goes.

To confirm an Essure, the HSG is a little different. The goal is simply to fill the uterus with dye and press just lightly enough to confirm that the tubes are indeed blocked as they should be, and to visually verify that the inserts seem to be placed correctly.

When I was up last night reading about the procedure, I started to get really scared. HSGs can be extremely painful for some people, particularly those seeking them for infertility treatment as the doctor has to put more and more pressure on the dye sometimes. Not only that, but the fallopian tubes tend naturally to be very twitchy, and having any dye in them can send them to cramping pretty easily. Some women have tighter cervical openings than others, or vaginal angles that make insertion difficult. In short, there are a lot of scary stories about this procedure being painful and bad, and I kinda freaked myself out last night reading them. I did realize that there were several commonalities of the people who had a better time - they'd all taken painkillers ahead of time, they all had fairly normal anatomy. Still, I was worried.

Here's exactly what I did. Last night, I took 800mg Ibuprofen around 2am. Along with being a painkiller, Ibuprofen is also something of an anti-convulsant. Much of the pain assosicated with an HSG is cramping pain, so taking something that is will reduce the intensity of even likelihood of cramping is a good idea. Starting the night before lulls your uterus a bit, I guess. My procedure was set at 1:30. At 10:30, I woke up and took another Ibuprofen 800 (equivalent to 4 regular Advil) and an Ativan (anti-anxiety medication, I have a prescription for some other anxiety issues but was really really glad to have it around for this). At 12:15, I took another Ibuprofen 800 and a Vicodin and another Ativan (can you tell how worried I was?). (I did check with a doctor about whether this was advisable, and she said yes.)

On my way out the door, I printed out the HSG specs from the Essure website. (Google HSG and Essure and you'll find it.) There's a set of instructions you can bring with you to your radiology appointment to give to the techs there. Essure HSGs are done with significantly less fluid pressure than infertility HSGs, so making sure the tech knows this is definitely a good plan and you will likely have a much easier time of it if you do this. Luckily, my tech had been doing this almost 30 years and was very experienced, but this is a good step I think just in case.

I arrived, checked in, changed out of my pants and underwear and into a gown. I reminded them that I am allergic to latex - if you have this allergy, make sure to remind them! Then I got up on a table with my butt as close to the edge as possible, and my heels on the corners. I relaxed as I was fitted with a speculum. The technician showed me the cervical catheter he'd be using, a long thin blue straw. Then he slowly slid it into my cervix... and it didn't hurt! It was uncomfortable, but nothing I would describe as pain at all. Then they had me move around a little so they could position the machine above my abdomen correctly. They moved the screen, so I could watch and look at my uterus (hopefully for the last time) on the screen. During this time, the speculum moved a little and it hurt very very slightly, but still less than rough toilet paper would. They were satisfied with the images they got, so they removed the big machine, removed the speculum, removed the catheter from my cervix, and let me sit up. It was over, and I was fine.

They gave me a pad (I had meant to bring one) because the dye will be leaking out of me for a day or two, and said that if I got a fever, I needed to call in right away (there's a low chance of infection, but it can happen). The guy told me my results right then and there: my tubes are blocked! I am completely sterilized! Yay! Then I got dressed and went home.

Now I'm home and, as you might imagine, a little doped up from the pills I took, but otherwise totally fine. I had been terrified of this test because of some of the awful stories there are online, but I think most of those are for women who a) took no medication ahead of time, b) were testing for infertility and thus had more pressure and dye in their tubes, and c) may have had unusual anatomy with a smaller cervical opening or scar tissue in their cervix, etc. I am so glad that mine went this well. It was uncomfortable, but not painful at all, and fast enough that it was really no big deal.

My advice for anyone who has to go through this test either for infertility or for an Essure checkup is this: make sure you take 800mgs ibuprofen once the night before, once several hours before, and once the hour before your procedure. Don't go with a totally empty stomach, but don't eat a huge meal right before either (have a granola bar or something, something so you're not hungry but also not super full). Pee right beforehand. Bring a pad with you. Don't be too nervous or you will tense up - if this isn't something you can do on your own, ask your doctor ahead of time to give you a single Valium or Xanax pill. The Ativan I took helped a huge amount. If you have some Vicodin around, take one an hour before, too.

Good luck to everyone! I am so absolutely happy I had myself sterilized. I had been wanting to do this for years, just afraid of the procedure to do so. I needlessly worried, it all went spectacularly for me and I couldn't be happier with it.

EDIT (about 2 weeks later):
Here's info on my post-HSG experience. A couple of days after the procedure, I washed my hands and put an exploratory finger into my vagina. It was full of some sort of white nasty clumpy discharge - not like yeast infection clumpy, more like a couple of tablespoons of shredded cheese (I know, icky metaphor, but if you're reading this you are probably thinking about getting this done, and I want to prepare you). I removed it and washed my hands again. I had been bleeding lightly during this time, and on day 3 or 4 the bleeding intensified. It seems that the HSG induced my period about a week early. I was not alarmed because it was regular menstrual blood, not thinner and lighter like other kinds of blood (in which case, I'd have consulted a doctor). I had a regular (if somewhat heavy) period. I completely stopped bleeding about 8 days after the procedure itself.

I couldn't be happier with my Essure experience. I highly recommend it to anyone considering permanent sterilization.
shyshutterbug 26th-Oct-2007 11:24 pm (UTC)
Haven't had an Essure or HSG myself, but have assisted MDs with several of each, and completely agree with all your recommendations :)

Congrats on a successful sterilization!
onehundredmoons 27th-Oct-2007 01:55 am (UTC)
I'm glad you had a better HSG experience than I did. Honestly, the worst part of mine was the hapless radiology tech trying to insert the speculum... you'd think he'd never done it before. Yikes. I was on a flat table with no support for my open legs, and I find it practically impossible to "relax" when holding my knees at that angle. Someone needs to invent some kind of knee support for women having pelvic exams.

But I digress! Thanks for posting this.
tyrsalvia 27th-Oct-2007 03:42 am (UTC)
No support for your legs? Gah! Seriously.
onehundredmoons 27th-Oct-2007 03:46 am (UTC)
For real. I went back and read your original Essure post, and it sounds like you had the kind of supports I was wishing for! Too bad they're not used more frequently.
tyrsalvia 27th-Oct-2007 03:41 am (UTC)
I have Kaiser insurance, and I don't think I've paid anything for any of this. Not even a co-pay. I think I might have paid $10 for the original Essure procedure, and around $20 for all the drugs they had prescribed for me at that time.
marionravenwood 27th-Oct-2007 06:12 am (UTC)
Thanks for this. I think the idea of HSG freaks me out more than the actual Essure procedure.


I'm still angry plain pelvic x-ray isn't approved to confirm Essure in the US.
tyrsalvia 27th-Oct-2007 08:36 am (UTC)
I highly recommend pre-drugging yourself like I did and making sure the techs know that this is an Essure HSG so they should use fairly low pressure.

I swear, I was super freaked out about it, but it was really really easy.
todfox 27th-Oct-2007 01:25 pm (UTC)
Just wanted to stop by and say congrats on the sterilization. Based on my own experience, being sterile is awesome.
h0rsegurrrl 27th-Oct-2007 05:42 pm (UTC)
Congratulations!
valancy17 7th-Nov-2007 05:42 am (UTC)
super glad to hear this! I'm talking to my MD about Essure this week.

also, given the Vicodin and everything else you took, I would have been VERY surprised if it had hurt, cause that woulda been a buttload of pain for the unmedicated!
tyrsalvia 7th-Nov-2007 08:55 am (UTC)
My Essure experience has to date (about 3.5 months) been wholly wonderful and positive and almost entirely pain-free. I cannot say enough good things about it.
sauvagerie 9th-Dec-2007 05:29 pm (UTC)
I'm glad to read that the HSG made your period kick in. I had my post-Essure HSG on Wednesday and started my period (pretty heavy) last night. I suspected that the HSG plus quitting the Pill might have brought it on, but was a tad worried all the same.

YAY! for Essure. I'm such a cheerleader for this procedure that the company should probably give me some kind of rebate. Glad you had a positive experience too.
skrimple Sigh of relief12th-Jul-2010 03:29 pm (UTC)
As I have my HSG procedure scheduled for later this week and I had been steadily freaking out more and more, it was quite a relief to read your experience! I'm curious if you asked your MD or tech about the nasty clumpy discharge? My very new BF and I are very excited about getting to celebrate a successful result and am not looking forward to a 10 day period after the procedure when my norm period is only 3days.
skrimple Re: Sigh of relief19th-Jul-2010 05:37 pm (UTC)
My procedure was almost painless! No stirrups, but the tech was wonderful, and she attached little hold handles and had me spin around so I could rest me heals on them. No early period, no spotting, no cramping, no nasty clumpy discharge!! Yeah!
collectonian 2nd-Mar-2011 05:08 am (UTC)
Thank you so much for sharing this!! I've been reading some of those horror stories too and started freaking out a bit even though I'm not having it done for awhile yet (having Essure tomorrow). Will keep that in mind with the ibuprofren and vicodin :-D
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