Everything you want to know about the coil – but are too afraid to ask
Your choice of contraception is important. It can make or break your sexual health experience – get it right and you can be a baby-less, hormonally well balanced, pain free woman. Get it wrong and you may be greeting nappy-valley! There are lots of contraceptive options, but for its effectiveness,
simplicity and longevity, your family planning practitioner will often encourage the use of the coil.
What types of coil are there?
The coil is a small T shaped device that is inserted into your womb by a specially trained doctor or nurse. There are two types of coil, one without hormones called an intrauterine device (IUD), which contains copper, stopping the sperm from surviving in the womb or fallopian tubes, and may stop a fertilised egg from implanting in the womb. The other is an intrauterine system (IUS) which releases the hormone progesterone thickening the mucus you produce, making it harder for sperm to get through to fertilise the egg. It also thins the lining of the womb to make it an inhospitable environment for implantation. In some cases it may also stop ovulation, so an egg is not even released.
How effective is the coil?
The IUD and IUS are more than 99% effective. In fact the IUD can even be used as emergency contraception if inserted up to 5 days after an episode of unprotected sex to prevent potential pregnancy. Their effectiveness is significantly better than the 82% for condoms and 91% for the contraceptive pill. These latter contraceptive options are considered less effective largely due to simple user-error, there is always the risk of missing pills or not putting the condom on properly. However, with the coil, this user error is taken out your hands, you don’t have to remember to take or use it. If you are one of the unlucky few who do fall pregnant with a coil, your coil needs to be removed immediately if you want to continue with the pregnancy. There’s also the small risk that you can have an ectopic pregnancy if you do fall pregnant whilst it is in situ.
The benefits of the coil
A major advantage of the IUD is that it contains no hormones so people who have contraindications to hormones (people with breast cancer for example) or for those in whom hormones may affect their mood, libido or acne, can still use it. Whilst the IUS does have the hormone progesterone, it is distinct from some other forms of contraception in that it does not contain oestrogen, which is the hormone that is often the culprit in increased risks of blood clots and cardiovascular disease. Further pros of the coil include that it is long acting, and depending on the brand of coil you may only have to change the IUD every 5-10 years, or every 3-5 years for the IUS. Furthermore it is a form of contraception that won’t interrupt sex and is safe to use while breastfeeding, and should you be planning on starting a family, once the coil is removed your fertility will return to normal.
Does the coil hurt?
As with all forms of contraception, forewarned is forearmed and there are some issues with the coil that need to be considered. First of all, many of us get a little squeamish at the thought of foreign bodies being inserted into us, and women often express concern about just such an operation with the coil. I’ve found that simply talking through the process with my patients can reassure them it is relatively quick (around 15 minutes) and easy. It can be uncomfortable to have inserted and for some it is painful. Various factors like the size/shape of your womb, how relaxed you are, and whether you’ve had children before, can impact your levels of discomfort. I often suggest taking a painkiller prior to the procedure and having it inserted towards the end of the menstrual period, or just after it, as this tends to make it a bit more comfortable.
What are the risks?
Physical risks are minimal however there is a chance of perforation (1 in 1000), expulsion (1 in 20) and infection (1 in 100). Perforation is when a hole is made in the womb or the neck of the womb on inserting the coil, and the main symptom experienced is a painful lower abdomen. This is unlikely to occur if the practioner is experienced, but if you do experience pain out of keeping with the procedure, then you do need to see your GP immediately. Expulsion is when the coil comes out by itself. This most commonly occurs in the first three months during your period (and even more likely in the first 72 hours after insertion), and happens more frequently with IUDs, younger patients and in those who have not had children before. As such we always bring the patient back in to the clinic 6 weeks after insertion to check it is still in place and you are happy with the experience. We will also teach you how to check it is in place yourself, by feeling for the coil threads, and we suggest in the first month you check this a few times, thereafter you may want to just check after each period.
Infection can occur in the first 3 weeks of having the coil inserted. The risk increases if the patient has a sexually transmitted disease (STD) but your nurse or doctor will aim to mitigate this risk by encouraging an STD screen prior to the coil insertion. Should you develop abdominal pain, a fever or a strong smelling discharge, it could indicate infection and you do need to see your doctor. Another side effect of the IUD can be an accompanying pain or heaviness associated with your periods. This worsening in the nature of your periods is more likely to occur if your periods were already heavy and/or painful. This is not the case on the IUS, which is even licensed as a treatment for heavy periods, though it must be noted that some people do get spotting/irregular bleeding in the first 3-6 months of having it inserted, but this tends to settle and a majority of people within the first year will actually have no periods (amenorrhoeic), which is often considered a bonus, but for some this change in period is intolerable.
Who shouldn’t have the coil?
Whilst both coils are relatively inclusive forms of contraception, there are circumstances whereby the coil cannot be used. Neither the IUS/IUD should be used if you have any structural abnormality of the womb or cervix, if you have unexplained vaginal bleeding or if you have an untreated STD or pelvic inflammatory disease (PID), or a previous ectopic pregnancy. It goes without saying if you think you are pregnant you should not have a coil, and often the practioner will expect you to use another form of reliable contraception or abstain from sex prior to insertion, to ensure you aren’t pregnant. Specific to the IUD, you should not use it if you have a known copper allergy or have had an artificial heart valve. You should not have the IUS inserted if you have or have had breast cancer in the last 5 years or if you have cervical cancer and should discuss it with your doctor if you have liver or arterial disease, or a history of significant cardiovascular disease or stroke.
Finally it is important to remind users of the coil that it doesn’t protect against STDs, so do continue to use condoms.