Care Pathways and Determinants in Essure® Contraceptive Implant Use and Removal: A Qualitative Study

Introduced in 2002, the Essure® implant was promoted as a minimally invasive permanent contraceptive. After widespread use, increasing reports of adverse effects led to its global withdrawal in 2018. This study explores the experiences of women in France who chose Essure®, focusing on their motivations and the factors leading to its removal.

A qualitative descriptive study was conducted in 2024, involving 17 semi-structured interviews to document participants' clinical pathways, implantation experiences and decision-making around removal. Interviews were recorded, transcribed verbatim and analysed thematically. The study followed the COREQ checklist and received ethical approval (reference 2024-04-04-005).

All participants reported symptom onset following implantation, including chronic joint, muscle and abdominal pain. Complications such as tubal damage, device migration and breakage during removal were also described. Beyond physical symptoms, women experienced psychological distress and social consequences. Many reported inadequate pre-procedural counselling, particularly regarding the device's composition and potential risks. Participants often encountered insufficient support from healthcare providers when reporting symptoms or requesting removal.

The study highlights the broad impact of Essure®, revealing not only physical complications but also emotional and social burdens. Findings underscore the need for comprehensive informed consent, empathetic communication and responsive care in the management of contraceptive device complications.

Women with lived experience of Essure® implantation and removal were central to this study. They were involved in shaping the research question and informing the design through preliminary interviews, which contributed to refining the interview guide. Participants provided rich, first-hand narratives through semi-structured interviews, allowing for an in-depth understanding of clinical pathways, complications and the psychosocial impact of the device. Recruitment was conducted in collaboration with the RESIST patient association, whose support was instrumental in identifying eligible participants. The study thus reflects patient-led priorities and experiential knowledge, contributing to the interpretation of findings and the development of patient-centred recommendations. Their involvement did not end at the preliminary stage. The experiential input from these women was also later mobilised to reorient the interpretation of emerging findings during the thematic analysis, ensuring that analytical categories remained anchored in lived experience.