Dr. Kate,

I have three beautiful children and am at the point where I know I have all that I can handle. My husband keeps saying he will get a vasectomy--but he keeps putting it off. I am tired of taking the pill and condoms are out of the question. I was thinking about getting my tubes tied but that sounds scary and I have heard some nightmare stories about the hormone inserts. Do you have any other recommendations for long term or permanent birth control? Have you heard of something called Essure? I heard about it on the radio and it sounded intriguing.

Unsure

The three best options for long-term birth control are the IUD, tubal ligation, and tubal occlusion (with Essure):

• The IUD comes in two flavors, the Paragard (copper-based, no hormones, lasts for 10 years) and the Mirena (progesterone-based, lasts for 5 years). Both are over 99 percent effective--just like sterilization--and can be placed in your doctor's office in 3 minutes; certainly easier than surgery. Best thing about the IUD is that it's reversible, just in case you change your mind in the future.

• Tubal ligation, or "tying your tubes," is more often done now with clips or by cautery (burning). This is generally a laparoscopic surgery, performed through a small hole in your belly button and one or two other small incisions on your abdomen, and is a "same day surgery"--no overnight stay in the hospital. It has a small amount of risk (like any surgery) but is permanent.

• Essure is the latest form of permanent contraception that tries to combine the best of both the IUD and tubal ligation. Small coils are placed in your fallopian tubes through your cervix, in a procedure called hysteroscopy. Doctors can perform this procedure in the operating room, but some can now do it in the office; either way it's a one-day, no-admission-to-the-hospital procedure. The coils cause scarring in the tubes, and the tubes in essence block themselves around the coil. A special X-ray three months after the procedure confirms that the tubes are indeed blocked. So unlike tubal ligation and the IUD, Essure doesn't work right away, and you need to stay on another form of contraception until the X-ray. But it is a permanent procedure, and if your doctor can do it in the office you won't need surgery or heavy-duty anesthesia. It is a relatively new procedure, though, so you may have to call around in your area to find a gyno who can do it.

Have any of you gotten Essure? What do you think?