Coils

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The IUS & IUD is commonly referred to as a ‘coil’ due to their original shape – which is different nowadays! In both instances, this is a small plastic (or plastic and copper) device, (about the size of a match), which is placed inside the uterus (womb) to prevent pregnancy. When inserted the thread(s) hang down through the cervix. These threads are cut about 3cms from the top of the vagina and will be left there until the device is removed at a later date.

What is the difference between an IUS & IUD?

IUS (intrauterine system) contains a progestogen hormone put into the womb (uterus). The progestogen is released at a slow but constant rate.

How does the IUS work?

It makes the lining of your uterus thinner, so it is less likely to accept a fertilised egg. It also thickens the mucus in your cervix. This makes it difficult for sperm to move through it and reach an egg. In some women, it stops the ovaries releasing an egg (ovulation), but most women who use an IUS continue to ovulate.

The advantages of IUS:

• You can forget about contraception for years at a time.
• For contraception the mirena now works for 8 years, Levosert and Benilexa 6 years, Kyleena 5 years and Jaydess works for 3 (more information on the different IUS later).
• You usually experience lighter periods and may even stop completely especially with the mirena and levosert.
• The IUS is not affected by other medicines.
• The IUS can be used if you are breastfeeding.
• Once the IUS is removed, your fertility will return to normal.
• It is useful if you cannot use estrogens, like those found in the combined pill, the contraceptive patch and the contraceptive vaginal ring.
• It’s reversible, and you can have it removed at any time.

The disadvantages of an IUS:

• Changes to your menstrual cycle include irregular bleeding or spotting. In some instances, periods can stop altogether. This is nothing to worry about.
• Hormonal side effects such as acne, headaches, nausea, fluid retention and breast tenderness.
• Follicular cysts on ovaries may develop. These are not harmful and do not usually need to be treated. These cysts typically disappear without treatment.
• Initially, there may be a slightly higher risk of infection. The use of an IUS does not increase your risk of an STI, nor does it protect against sexually transmitted infections (STIs). If you get one when the IUS is in place, this could lead to a pelvic infection if it is not treated.

How does the IUD work?

IUD (intrauterine device) do not use hormones, so there are no side-effects due to hormonal changes in your body.

The copper in the IUD acts as a contraceptive immediately and will last for up to 10 years.

How does it work?

The copper in the IUD prevents sperm from surviving and alters your cervical mucus to prevent sperm from reaching an egg. An IUD may also help to stop a fertilised egg from implanting in the uterus.

The advantages of an IUD:

• It is effective immediately. 
• Depending on the type, it works for 5 or 10 years.
• You can breastfeed.
• It’s not affected by other medicines.
• Once the IUD is removed, your fertility returns to normal.
• It doesn’t require you to remember to take it daily/weekly.

The disadvantages of an IUD:

• Your periods may be heavier, longer or more painful but this may improve after a few months. 
• You’ll need an internal examination when the IUD is fitted.
• The IUD will not protect you from sexually transmitted infections, so you may need to use condoms as well.
• While an IUD does not increase your risk of infection, if you get an infection while an IUD is in place, this may lead to a pelvic infection if not treated.

Potential risks involved in IUS & IUD:

• Although small, there’s a possibility of you getting an infection in the first three weeks after an IUS/IUD is inserted.
• If you get an infection, this could lead to a pelvic infection if it is not treated.
• You may be advised either before or at the time an IUD if fitted, to have a check for sexually transmitted infections.
• The IUS/IUD can be pushed out (expulsion) by your uterus (womb), or it can move. While uncommon, it’s more likely to happen soon after the IUS/IUD’s been inserted. Your doctor or nurse will teach you how to check the threads in place.
• A very small risk the IUS/IUD might perforate your uterus or cervix when inserted. There is an increased risk if you’ve recently given birth or are breastfeeding. This may cause pain but often there are no symptoms, and the uterus or cervix will heal by itself. The risk of perforation is low when an experienced doctor or nurse fit an IUS/IUD. If it does happen, the IUS/IUD may have to be removed by surgery.
• You're unlikely to get pregnant while using an IUS/IUD but if you do, there’s a risk of having an ectopic pregnancy. You’re less likely to have an ectopic pregnancy while you’re using an IUS/IUD than when you’re not using any contraception.

There are some conditions which may mean you shouldn’t use an IUD, these include:

• Think you might already be pregnant, have had a baby <4 weeks ago or still being monitored after a molar pregnancy.
• Have an untreated sexually transmitted infection or pelvic infection
• Have problems with your uterus or cervix
• Have or being treated for breast cancer or malignant liver cancer (IUS).
• Have or being treated for cervical or endometrial cancer (IUS and IUD).
• Have a serious heart condition.
• Have unexplained bleeding from your vagina (for example, between periods or after sex)?

Is an IUD or IUS the right form of contraception for you?

The right form of contraception for you will depend on several factors, e.g., age, medical history, whether you smoke, etc. Not all woman have an IUS or IUD fitted for contraceptive purposes. If this applies to you, please ensure you have discussed this with your medical practitioner or GP.

Help to decide which form of contraception is right for you, can be found by visiting the Family Planning Association (FPA)

More information on long-acting reversible contraceptives can be found here

The Procedure

On The Day

We recommended you eat a light meal and take 400mg of ibuprofen before your appointment; unless contraindications or you are allergic to ibuprofen, please take 1g of paracetamol.

Your appointment will last around 20–30 minutes and a doctor or nurse will perform the procedure. Inserting the IUS/IUD usually takes approximately 5 minutes, and some woman may experience some discomfort or pain. In some instances, a woman may be offered a local anaesthetic.

After the procedure you may experience some discomfort or bleeding; therefore it’s a good idea to rest afterwards.

More information on post-insertion can be found here and your doctor or nurse will discuss this with you on the day of your appointment.

Listen to this contraception podcast for more information

Learn more about the four types of IUS

• Mirena - Approximately 20mcg of progesterone is released every day and it lasts 8 years for contraception and is licenced for HMB (heavy menstrual bleeding).
• For HRT - The Mirena, Levosert and Benelixa can all be used,  in conjunction with oestrogen gel, patches or tablets, as the progesterone component of combined HRT regimens. If using the LNG-IUD or IUS for this purpose it can only be used up to 5 years maximum no matter how old you are or which of the 3 devices you are using. The Mirena is the only device that has a licence for this purpose but Levosert and Benelixa have been approved for this use in line with Mirena use. In this situation therefore,  the device must be refitted by 5 years. If the device is removed and not refitted the oestrogen only HRT must be changed to a combined regimen.
• Levosert - Can be used for 6 years for contraception and 5 years as HRT.
• Benilexa - is the same as Levosert.
• Kyleena - Has a slightly smaller frame than Mirena and Levosert and releases less hormones (around 17.5 mcg daily) it lasts 5 years but only licenced for contraception.
• Jaydesse (likely to be discontinued) - Less hormone release than the others, approximately 14mcg per day, but only lasts 3years, same size as the Kyleena and more likely to get irregular bleeding.

If after reading this you have any questions regarding the coil please complete a Patient Triage

Coil appointment request/review

If your coil has expired and you rely on it for contraception please contact us for alternative contraception whilst you wait on our waiting list. Our current waiting list is approximately 3 months, you will be seen in 2 weeks if you are happy to travel to the contraception clinic in Exeter, they offer an initial telephone consultation and then an appointment for the procedure so you only have to travel there once. Please call them on 0300 303 3989 or visit their website.