Intrauterine contraception (coils)

Copper coils and hormonal coils are very similar in many ways but the way they stop you getting pregnant is very different.

The decision to have a copper coil or a hormonal coil is very individual and depends on many things such as if you want to have periods and want or don’t want hormones for example.

The fitting and removal of both types of coils is very similar.

Before you have a coil fitted, you may be offered testing for sexually transmitted infections.

Coils can be fitted at any time in your monthly cycle if there are no pregnancy risks. The risks and benefits of a coil will be discussed with you before the procedure.

To have a coil fitted you will need to lie down and have an internal examination, using a speculum to hold open the vagina (this is the same instrument used when having smear). The doctor or nurse will measure your womb using a thin plastic measuring device into your vagina, through your cervix (neck of your womb) and into your uterus (womb). The coil device is in an inserter which is like a straw. This will be placed into your womb to insert the coil and leaves the coil in place when removed.

The common risks of a coil include:

• Potential cramps and spotting/bleeding for a few days after fitting

The rare risks of a coil include:

• A small risk of infection within 20 days of fitting (for approximately one in 100 people)
  • If you have any of the following symptoms after a coil fitting you must return to where fitted or seek assessment: persistent pain in lower abdomen, high temperature, smelly discharge, increased bleeding
• The risk of pregnancy is less than one in every 100 people fitted with a coil, in the first year
  • However, if you do get pregnant with a coil, there is a chance that it could be in the tubes and not in the main part of your womb
  • This is called an ectopic pregnancy and it can be dangerous
  • Therefore, if you have a coil and suspect you are pregnant, do a pregnancy test
  • If your test is positive, you must attend an emergency gynaecology service for assessment
• There is a very rare risk (for about one in 1000 people) that the coil may make a tiny hole in the womb, or neck of your womb (also known as a perforation)
  • This may cause pain, but often there are no symptoms
  • Pain for a few days after fitting is normal, but if you are experiencing a lot of pain in your lower abdomen, return for a check
  • If perforation occurs, you may need surgery to remove the coil
  • You are encouraged to check the threads of your coil to check it is still in place.

Everybody is very different in how they experience pain during a coil fitting.

Some people experience cramping during and following the procedure. Normal pain killers can help with this, which you can take before or after your appointment.

The fitting may be uncomfortable, but you will be offered pain relief during the procedure. There are three main types of pain relief or local anaesthetic that you may be offered for the coil fitting:

• Local anaesthetic injection into your cervix (neck of the womb) which numbs the area immediately
• Local anaesthetic spray which is sprayed onto your cervix (neck of the womb) which works after about three minutes
• Local anaesthetic gel over and into your cervix (neck of the womb) which takes a couple of minutes to work.

It is quite common for people to experience some bleeding or spotting and period-like pain for a few days after having a coil fitted.

Regular over-the-counter pain killers should be enough for this pain. Some people prefer to not have any plans immediately after their fitting, so they can relax if needed.

Not necessarily. You will be advised of when to attend clinic for a check if needed.

You will be taught how to check for the threads yourself and when you should seek further assessment.

The removal of both types of coil is very similar.

This is usually quite a quick and easy procedure that is done by a trained doctor or nurse.

It can be removed at any time, but you should use condoms or not have sex for seven days before the removal, or there could be a risk of pregnancy.

If the threads cannot be seen at the neck of the womb, it may not be possible to remove the coil at that point, and a scan may be needed.

A coil has two thin threads that hang through the neck of your womb (cervix) into the very top of your vagina.

You will be taught how to feel for the threads and check the coil is still in place.

This can take practice, so don’t worry if you cannot feel it straight away.

If you can't feel the threads, or if you think the coil has moved, you may not be fully protected against pregnancy.

See your doctor or nurse straight away and use extra contraception, such as condoms, until your coil has been checked.

It is unlikely that your coil will come out.

This is most common in the first three months after fitting (though it can happen at any time) and happens in one out of 20 cases.

This is why it is important for you to feel for the threads every month and if you cannot feel them, use extra contraception, such as condoms, until your coil has been checked.

There is no evidence that a copper or hormonal coil will affect your weight.

There is no evidence that a copper or hormonal coil increases the risk of cancer of the womb, neck of the womb or ovaries.

Not usually. If this is an issue, you can get your doctor or nurse to check your coil is in place.

If your partner puts fingers inside your vagina, they should be able to feel the threads. This is often useful for a thread check if you are unable to feel them for yourself.

Generally, none of these are a problem with either type of coil. However, there is some evidence that moon cups can slightly increase the risk of your coil coming out.

No, neither coil will do this.

A coil can be fitted in the first 48 hours after giving birth. This is offered in some maternity units.

This can be done even if you have had a Caesarean birth.

After 48 hours post-natal, it is recommended that you wait until you are four weeks post-natal before you have a coil fitted. This is because of the slightly increased risk of perforation of the womb until then.

Generally, yes. Many years ago, coils were only fitted in those who had given birth previously, but as coils are now much smaller and easier to fit, it usually does not matter if you have had a baby or not.

An STI needs treating as soon as possible, or this could lead to a pelvic infection.

Though a coil can stop you from getting pregnant, it does not protect you against STI’s.

You may wish to also use condoms.