Intrauterine Device (IUD) or ‘coil’ insertion clinic

This leaflet is for patients who have an appointment to have an insertion of an intrauterine contraceptive device in the Gynaecology outpatient clinic here at CUH. This will either be a non-hormonal or hormonal device. The leaflet will refer to both devices as a ‘coil’.

If you do not currently have a coil fitted, or your current coil is out of date and you are of child bearing age, please ensure you use alternative methods of contraception such as condoms, the combined oral contraceptive pill, the progesterone only pill, the injection, the implant or the patch or abstain from sexual intercourse from the date of your last menstrual period.

What is a coil?

A coil is usually a T-shaped device that is inserted into the womb. It offers more than 99% effective reliable contraception (this means less than 1 in 100 people will fall pregnant with this method of contraception). The coil is part of a group of contraceptives called long-acting reversible contraception (LARC). There are two type of coil – a hormonal coil and a non-hormonal coil. The effects are quickly reversible on removal of the device and there are no long lasting effects on fertility.

Hormonal coil

The hormonal coil works by thickening cervical mucus and thinning the lining of the womb. Depending on the brand of coil, they can last 3, 5 or 6 years. Your periods will usually become lighter and for most women, periods stop. It can be used as contraception, part of hormone replacement therapy (HRT) and for the management of heavy menstrual bleeding and pelvic pain.

Side effects include:

• Headaches
• Breast tenderness
• Irregular bleeding for 3-6 months or longer
• Recurrent thrush

Non-hormonal coil

The non-hormonal coil, also known as the ‘copper’ coil works by releasing copper which is toxic to sperm and eggs. It can last for 5 or 10 years depending on the brand used. It can sometimes be used as emergency contraception. There are no hormonal side effects

Side effects include:

• Your periods may become heavier, prolonged and more painful.
• Bleeding between periods
• Recurrent thrush

What to expect at the appointment

The appointment will assess if a coil is the best choice for you. We will discuss the different types of devices. You will be able to ask any questions at this time, please do not hesitate to discuss your concerns and we will try our best to reassure you.

The coil will be fitted by a trained Doctor or a Nurse, there will be an assistant present. The fitting takes around 5-10 minutes using a speculum in a similar way to how cervical smears are taken. If you are due a smear test, this can usually be done at the same time. We may take some vaginal swabs to check for infection. You may feel some period cramp discomfort when the coil is being inserted and afterward. The Doctor or Nurse may use local anaesthetic to numb the area if needed. There will also be Entonox (gas and air) available if required, please ask your Doctor or Nurse if you feel you will need this.

Please remember that you are in control of the consultation, we can stop at any time if you want us to.

How to prepare

We ask that you make sure you eat and drink before your fitting appointment.

Please take simple painkillers like paracetamol and ibuprofen (if tolerated) an hour before the appointment

Allow plenty of time for the appointment and avoid strenuous activity after fitting.

Timing

The coil can be inserted at any time as long as there is no risk of pregnancy.

It is best fitted at the end of your period as we can then be sure that you are not pregnant and your cervix is more relaxed.

It can also be fitted from 4 weeks after giving birth and does not affect breast feeding.

New Fitting

We ask that you avoid unprotected intercourse or abstain from sex after your last period to ensure there is no risk of pregnancy (unless you are using a reliable method of contraception such as condoms, the pill, implant, and injection).

If you have unprotected intercourse in the 3 weeks before your appointment then the coil fitting will be delayed until we can reliably exclude a pregnancy.

A non-hormonal IUD (copper coil) can be used as emergency contraception if specific criteria are met.

Removal and refit

For a removal and refit, please avoid unprotected sexual intercourse or abstain within 7 days before your appointment. Occasionally a new coil cannot be refitted on the same day it has been removed due to cervical tightening on removal of the existing coil.

We will arrange a further date for the coil to be refitted.

Switching contraception

If you are already using the combined oral contraceptive pill, patch or ring or the progesterone only pill, implant or injection, please continue to use these until the appointment date. You may be advised to continue these for a short time afterwards too. A coil can be fitted at any time if these methods are used consistently beforehand.

Suitability

Please speak to your healthcare professional is you have any of the following conditions:

• Any irregular bleeding
• Symptoms of an untreated STI or pelvic infection
• Womb/cervical problems or a previous endometrial ablation
• Known heart rhythm problems

Risks

• Infection: There is a slight increased risk of pelvic infection in the first few weeks after insertion. This affected less than 1 in 1000 people.
• Perforation: This rare complication affects less than 1 in 1000 people fitted with a coil and is when the device goes through the womb. This risk is minimised by techniques used during fitting but is increased in women who have recently given birth or are breastfeeding.
• Expulsion: The coil can sometimes be expelled, most commonly during a heavy period. This affects approximcoi1 in 20 people. (FSRH, 2023).
• Ectopic pregnancy: The risk of pregnancy is low (1 in 1,000) but if the method fails then there is a higher risk that the pregnancy will be ectopic (where a pregnancy implants outside of the womb for example, in the fallopian tube). If you do fall pregnant with the coil inserted, please contact Clinic 24 (the early pregnancy and emergency gynaecology unit) on the contact telephone numbers provided at the end of this leaflet.

What to expect after the appointment?

Bring a sanitary pad as some vaginal bleeding is common afterward and for the following days. You may experience some abdominal cramp-like pain for a few days after the fitting, simple pain relief will help.

If a hormonal coil is inserted, you might experience irregular bleeding for the first 3-6 months, this will settle over time.

If you have had a non-hormonal coil inserted, your periods may be heavier and longer.

Alternatives

Alternative contraceptives are available, you can find out more information from the NHS 'choosing a method of contraception' webpage (opens in a new tab).

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart

Contacts/further information

• Reproductive Medicine Clinical Nurse Specialist

01223 808240

Tuesday – Friday – 08:30 – 17:00

Please note the phone number is not manned daily, you will have the opportunity to leave a voicemail and someone will get back to you. If your query is urgent, please call Clinic 24.

• Clinic 24 (the Early Pregnancy and Emergency Gynaecology unit)
  01223 217636
  08:00 to 20:00 Monday to Friday
  08:30 to 14:00 at weekends
  Closed: Bank holidays

References/sources of evidence

Faculty of Sexual and Reproductive healthcare, 2023. FSRH Guideline Intrauterine contraception. Online. Available at: Guideline intrauterine contraception (opens in a new tab)