Dr Bella

Contraception - The Coil

written by Dr Bella Smith

  1. #womens health
  2. #contraception
  3. #coil
  4. #dr bella
  5. #advice
  6. #expert

We recently posed the question to the Up All Hours community 'Who uses the coil?' asking people to share their experiences with the increasingly popular contraceptive.

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The feedback was really very interesting. What struck us was the almost 50/50 split between people who frankly loved it or hated it. It really seems as though you either get on with it or you really don’t. There were horror stories and there were love stories but what there was were a lot of questions about what it actually is, what it does and the procedure involved with popping it in. We turned to the brilliant Dr Bella Smith to pick her brains on it all…

Dr Bella

The Mirena Coil? The Pill? The Implant? The Injection? Contraception is a huge, important topic and we have so many options to choose from. The Coil is one of 'Long Acting Reversible Contraceptions' and is proving very popular among women.

1) What is The Coil?

The Coil is a small T-shaped plastic device that is inserted into the uterus of a woman. There are 2 main types: the Intra-uterine Device (IUD) which is otherwise known as the Copper Coil. And the Intra-uterine System (IUS) that contains a hormone and goes by the names of The Mirena Coil, Levosert and Jaydess. For this article we are focussing on the IUS or otherwise known as the Hormone Coil.

2) Why is it called The Coil?

Historically the Coil was literally a large coil of metal that was inserted into the uterus to stop implantation of the fertilised egg. Things are a lot more sophisticated now but the name has stuck for all these years.

3) How does The Coil work?

The IUS (Hormone Coil) - releases a small amount of levonorgestrel (progestogen) every day, this hormone tells the lining of the uterus to shed so for the first 3 months or so you may notice daily spotting. This bleeding slowly thins the lining of the uterus until there is no more lining to come away and it holds it in a very thin, very healthy state. Most women find they have either very light infrequent periods or no periods at all. But it can take 3-6 months of vaginal spotting or bleeding to get to this state of no periods. The hormone causes a 'Mucus Plug' in the cervix that stops sperm being able to get through into the uterus to fertilise the egg, and therefore prevents pregnancy.

4) How is The Coil inserted?

You will either have your coil inserted by your GP, a gynaecologist or in a sexual health clinic. If there is a risk of infection you may need to have vaginal swabs prior to insertion. The coil does not cause infections but if you have an infection in your vagina already it could 'jazz it up'. The procedure itself usually takes about 5 mins but we allow 30 mins for prep, discussion, the procedure itself and recovery time. You lie on a couch with your legs in stirrups and a speculum is inserted into your vagina, just like when you have a smear. The cervix sits at the top of your vagina and is a natural opening to your uterus so there are no injections, no cutting and no stitches. You may feel something go through your cervix twice - first to measure the size of the uterus and second to put the actual coil in. Then if its all in correctly the Coil threads are cut, the speculum is removed and it is all done.

5) Is The Coil painful to have put in? Be honest Dr!

It really depends. If you find your smear tests painful then your cervix may be sensitive and so you may find this procedure painful. The cervix is often numbed with a local anaesthetic gel to help this. But some women don't feel a thing. The most painful part of the coil insertion is when the coil goes through the internal opening of the cervix. This is a 'deep intense period-like pain' that lasts for a few seconds and can make you 'catch your breath' and then quickly improves. You may feel a slight period-like ache after the procedure which you can take pain relief for if necessary. We always advise patients to take ibuprofen and paracetamol about 30 mins before the procedure to help with pain relief and to make sure you have eaten breakfast or lunch, depending on the time of day.

6) Can it have a greater hormonal effect as some of the pills do? 

It has less hormonal effect than pills. Some pills contain both oestrogen and progestogen, the mirena coil only had progestogen (called Levonorgestrel) and this is at a lower dose as it is sitting right where it needs to be – next to the uterus lining - so there is less hormone in your blood stream.

7) What are risks when having The Coil inserted?

The Doctor inserting your coil will go through all the risks and benefits with you prior to insertion. A few risks that are important to mention are a) expulsion - if you have a heavy bleed after insertion your coil could come out b) perforation - this is rare but there is a risk of perforating the back of the uterus when inserting the coil which is why it is important that we measure the size of the uterus first c) sometimes you can be at risk of feeling faint when you have the Coil put in and that is why we always do the procedure with 2 people present so that one person is always checking on how you feel.

8) Who can have The Coil? Is there any different advice given pre or post children?

Most women can have the coil. It does not matter if you have never had children, are breast feeding or are on any other medication. The Jaydess Coil is also known as the 'Mini-Mirena' as it is smaller, and easier to put in and so aimed at young women who have never had a baby. Jaydess only stays in for 3 years compared to 5 years for the Mirena or Levosert.

Currently the Coil seems to be used more for women who have had children, partly due to increased awareness and partly as it seems more acceptable to them. It is really important to say that the Coil can be used for women of ANY AGE, pre or post children.

9) What are the benefits for having The Coil?

The Hormone Coil is very popular and can be used for 3 things: a) contraception, b) treating heavy periods and c) as the progestogen component of HRT (Hormone Replacement Therapy). A lot of women have very light very infrequent periods, if any periods at all with this coil which can be a huge relief for some women. You can also 'fit and forget' and not have to think about contraception for 5 years and you are less likely to have an unintended pregnancy with the Coil. Real life data shows that a woman using short acting contraception such as The Pill are 21 times more likely to have an unintended pregnancy over 3 years compared to a woman with a LARC. If it is used as part of HRT you can feel reassured that your uterus is protected by the progestogen and can happily have oestrogen for your menopausal symptoms in the form of pills, patches or creams.

10) What are the side effects?

There is a very slight increase risk of Ectopic Pregnancy with this coil so this needs to be discussed with your Dr beforehand. Other side effects are spots, breast tenderness and mood changes, but these tend to settle with time as the hormone changes lessen. Some Coil users have reported weight gain and mood changes. There may be other side effects experienced but these are much less common. From chatting with patients the coil can be a bit like 'Marmite', in that you 'either love it or you hate it'. We recommend trying the coil as for the majority of women its a really improved their quality of life.

11) Can I get pregnant with the Coil?

Failure rate of the hormone coil is less than 1% in 5 years, so yes it can happen, but it is rare. As I mentioned above, if you did get pregnant with this coil in you are more likely than normal to have an ectopic pregnancy (when the pregnancy sits in a fallopian tube instead of in the uterus), but the rates are still very low.

12) How is it removed?

Removal is much easier than the insertion. You have a speculum inserted again and we pull the threads at the base of Coil to gently pull it out. It is actually extremely easy to remove the coil and takes just a few seconds. These threads are like 'nylon' when they are inserted, then as time goes on they soften and become more like 'cotton' and with time they tend to tuck themselves up around the cervix.

13) Being honest, we found in response to us asking our community for their thoughts and experiences, it felt like it either works for you or it doesn’t. Its almost 50/50! That’s not something that doctors really say? Why is that? Why wouldn’t it work for one women but be perfect for another?

Recent studies have shown that out of all the available contraception options the Mirena Coil has the highest satisfaction rate, so although from the online questions it sounds as if it is ’50:50 love:hate’ actually the majority of women who have the coil are very satisfied with it.

It is so important to have a consultation with the Doctor who is inserting the Coil to go through all the pros and cons and all the possible side effects. Understanding how it works really helps with expectations. The constant exposure to hormone causes the lining of the uterus to shed (studies show it decreases menstrual blood loss by 90% at 3 cycles and 96% at 6 cycles) so by 3-6 months the spotting should stop and women should start to feel the benefits.

As Doctors we can’t predict how each individual is going to react to the coil as everyone is different but we can discuss the common and rare side effects. The bottom line is if you try it and don’t like it then it is very easy to remove.

Summary

Contraception is absolutely your choice and it is about finding the right contraception for you. It must be something that you find acceptable, with the least side effects. Have a chat with your Dr about all your options or have a look at the www.iCaSH.nhs.uk for more information.

We also spoke to Dr Bella on camera about the coil and the other forms of contraception available to you. These can be found in the video section of the website right here.

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