of 2018. The device is featured in the 2018 Netflix documentary The Bleeding Edge. Use A 2015 review found the effectiveness of Essure is unclear due to the low quality of evidence. With perfect use another review found evidence of a 99.8% effective based on 5 years of follow-up. The reported insertional failure rates are "failure to place 2 inserts in the first procedure (5%), initial tubal patency (3.5%), expulsion (2.2%), perforation (1.8%), or other unsatisfactory device location (0.6%)". Upon follow-up, occlusion was observed to have occurred in 96.5% of patients at 3 months with the remainder occluded by 6 months. A 2015 study published in the BMJ concluded that Essure was as efficacious as laparoscopic sterilization at preventing pregnancy, but with a "10-fold higher risk of undergoing re-operation" when compared to patients who underwent a laparoscopic sterilization procedure. Follow-up For the Essure method, three months after insertion a radiologist is supposed to perform a fluoroscopic procedure called a hysterosalpingogram, to confirm that the fallopian tubes are completely blocked and that the woman can rely on the Essure 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 no contrast leaks past the Essure. Adverse effects Serious side effects may include persistent pain, perforation of the uterus and fallopian tubes, and migration of the coils into the pelvis or abdomen. Because of the stainless steel medical staff need to be notified before magnetic resonance imaging (MRI) can be performed. However, the inserts were found to be safe with MRI using a 3-Tesla magnet and is considered MR-conditional. Risks Procedural complications Inability to place inserts (4%) Cramping (30%) Pain (13%) Nausea/vomiting (11%) Dizziness/light headed (9%) Bleeding/spotting (7%) Vasovagal response (fainting) (1.3%) Perforation, expulsion, or other unsatisfactory location of the insert Long-term complications Abdominal pain (3.8%) Back pain (9%) Menstrual cramps, severe (2.9%) Pelvic or lower abdominal pain, severe (2.5%) Gas/bloating (1.3%) Headache (2.5%) Heavier menstrual bleeding (1.9%) Vaginal discharge or infection (1.5%) Pregnancy (0.48%) and increased risk of ectopic pregnancy Allergic reaction to the materials Rash Autoimmune disease (0.99%) Weight changes Depression Hair loss Suicide attempt (0.55%) Procedure A physician places the coils into the fallopian tubes by a catheter passed from the vagina through the cervix and uterus. This occurs successfully between 63% and 100% of the time. Once in place, the ingrowth continues over