Intrauterine contraception
The terms used to describe the two different forms of Intrauterine Contraception (IUC) have recently changed. A copper intrauterine device (Cu-IUD) is the term used for what is commonly referred to as a ‘copper coil’, and levonorgestrel intrauterine device (LNG-IUD) is now the term used for what was previously referred to as an Intrauterine system (IUS) and commonly known as a ‘hormonal coil’. In the information that follows we are using ‘device’ instead of ‘coil’ to reflect this new guidance.
What happens during a device fitting procedure?
The nurse or doctor will call you through and ask you some questions. This is to check that it is safe to fit the device, and to answer any questions you have. If you haven’t already had a full sexual health screen you will be offered one. We offer all of our patients a blood test for HIV and syphilis, and a swab for chlamydia and gonorrhoea.
The fitting procedure is explained in this short video:
Intrauterine contraception
Intrauterine contraception, known as the coil, is a popular form of long acting reversible contraception. It’s chosen more and more by women of any age, whether or not they’ve been pregnant before. It’s over 99 percent effective, more effective than condoms or even the pill. It doesn’t get in the way of sex, unlike condoms.
Once fitted, you can forget about contraception for 3, 5 or 10 years. Once removed, your fertility will return to whatever is normal for you within days. Importantly, IUD or IUS devices do not protect you against sexually transmitted infections. We recommend using condoms until both you and your partner have had an STI screen.
There are two types, the hormonal intrauterine system, or IUS, and the copper intrauterine device, or IUD. Both are small and flexible, with two threads at one end. The hormonal IUS works by releasing a tiny amount of a hormone called progesterone, much less than the pill releases. The progesterone thins the lining of the womb, which prevents a pregnancy from settling there.
It also thickens the mucus in the cervix, stopping sperm getting in. The hormonal IUS takes 7 days to be effective, and lasts up to 5 years, or longer if you’re over 45. The copper IUD contains no hormones. The copper kills sperm and eggs, which prevents fertilisation, and it stops a pregnancy implanting if fertilisation has already happened.
It’s effective as soon as it’s been fitted, and it lasts for 5 or 10 years. It can also be used for emergency contraception.
Before the procedure
Both types can be fitted at any point in your cycle, provided there’s no chance you could be pregnant. We ask that you don’t have unprotected sex for at least three weeks before fitting.
This includes sex when your method of contraception has passed its expiry date, or using withdrawal or natural methods of contraception. Women with irregular bleeding may require extra tests. If this is the case, speak to your GP first. It’s a good idea to have a light meal and to take your usual pain relief to reduce possible discomfort an hour or two before the procedure.
How is the procedure done?
The appointment lasts about 30 minutes, with the device fitting usually only taking 5 to 10 minutes. You’ll meet the clinician who’s fitting your device. An assistant will also be there to support and reassure you. We’ll ask about your medical history, do a pregnancy test, an STI test if needed, and answer any questions.
Then we’ll carry out an internal vaginal examination to check the entrance to the womb or cervix before fitting your chosen device. The procedure can be uncomfortable, but half of women experience little or no pain. We’ll provide extra pain relief if you need it.
After the procedure.
Most women feel well enough to leave the clinic straight away and can travel home by bus, taxi or car.
You may like to bring someone with you to take you home. We’ll explain how to check the threads that show the device is in the correct position. You will need to check this once a month and we’ll give you a card with the expiry date written on it. Keep this safe. We’ll give you an information sheet to remind you about post fit advice and how to check for problems.
Most women don’t need a follow up appointment, but you must come back if you’re concerned about anything. For example, lost threads or pain. The device can be removed at any time. This process is much easier than having it fitted. If you want it removed and still don’t wish to be pregnant, you must use condoms or avoid sex for seven days before removal.
Side effects.
Most women have some period like discomfort afterwards, but this usually settles after a few hours. You can use your usual pain relief. In the first three to six months, the hormone or IUS can result in lighter, unpredictable bleeds known as spotting. This usually settles into infrequent, lighter bleeds, or no periods.
If spotting persists, we might suggest you also take the contraceptive pill for a while. Some women notice hormonal side effects in the first few months, such as headaches or spottier skin, breast tenderness or weight gain. But as the womb lining thins, less hormone is absorbed, so these symptoms often settle.
Conversely, the copper IUD can cause heavier periods, but this may improve with time. Less commonly, there can be painless ovarian cysts, which often disappear within months.
Risks
Most women have no problems. Occasionally, the device can be pushed out of the womb. This is most common in the first year of having the device. There’s a small risk of infection. This is most common in the first three weeks, after which the risk becomes much lower. Very rarely, the device can go through the wall of the womb during insertion.
If this is recognised at the time, the device will be removed. Otherwise, it will have to be removed later with keyhole surgery. In the extremely unlikely event that you fall pregnant with a device in place, there’s a slightly higher risk of a pregnancy outside the womb, an ectopic pregnancy. If you think you’ve become pregnant with a device in, you should seek medical help urgently.
If you have any concerns about your device fitting or if after reading through this information you have further questions about the procedure you can book a telephone appointment with a nurse by ringing 01273 523 388. There are many things we can do to help make the whole process easier for you.
Phone line opening times
Phone lines are closed on Bank Holidays.
- Monday:
- 9.15am to 4.30pm
- Tuesday:
- 9.15am to 4.30pm
- Wednesday:
- 12.30pm to 4.30pm
- Thursday:
- 9.15am to 4.30pm
- Friday:
- 9.15am to 4.30pm
Things to remember on the day of the procedure
- Eat! You do not need to avoid food before the procedure, and it is best to have had a light meal and a drink 1-2 hours before your appointment, as this can help to reduce the likelihood of feeling unwell after your device is fitted
- Please make a note of the start date of your last period, or where you are in your contraception pack and bring this with you to the appointment
- Please wear “sensible” underwear (big and stretchy!) and bring a sanitary pad to wear afterwards, as often there is some bleeding and/or discharge after the procedure
- If you have or care for small children or babies, please arrange for childcare to avoid bringing them to your appointment. We will need you to lie still and relax. This can be hard to do when you are trying to look after children too
- Please allow 1-2 hours for your appointment. Although the procedure does not take long some people can feel faint afterwards and need a little time to recover
- Please be aware that we have health care professionals of all genders who fit the devices and help with the procedure. An assistant is needed to ensure your safety and to help the person fitting your IUD. We will do our best to accommodate you if you would prefer to have a clinician or assistant of a specific gender, but please be aware that this may not be possible and therefore may delay your procedure.
- We recommend that you avoid driving immediately after your fitting as you may feel some cramping post procedure
- Try to ensure you have no major commitments for the rest of the day as you may feel a little uncomfortable and need to take it easy afterwards. We recommend sweatpants, a box set and lots of your favourite snacks
Is the device fitting painful? What pain relief do you offer?
Everyone has a different experience when having their device fitted, some have very little discomfort, and others can find it painful. We will do our best to support and reassure you. Please remember you are in control of the procedure, and you can ask us to stop or pause at any time.
We usually use a numbing spray on the cervix to help reduce any pain. As a result, you may notice some jelly-like discharge from the vagina after the procedure. Occasionally we may also need to use a cervical ‘block’ (anaesthetic injection into the cervix) to anaesthetise the cervix. If we do, this will be discussed with you at your appointment. It is only the cervix that will be numbed, so you will be able to move around as normal immediately afterwards.
We recommend you take an anti-inflammatory painkiller such as Ibuprofen 400mg about 1 hour before your appointment unless you know you are unable to take this type of medication. Alternatively, a paracetamol-based pain killer can be used, or whatever you would usually take to manage period cramps. This is to help with discomfort after the procedure.
Our service offers Entonox, also known as ‘Gas and Air’ or ‘Laughing Gas’ for a short-term pain relief and calming of anxiety during a device fitting. The effects of Entonox usually start within a few breaths, and clear from the body within a few minutes once you have stopped using the Entonox, although some people can feel sick and dizzy for a while after using it. Entonox is not suitable for everyone and should not be used if you:
- Have recently had a ‘burst eardrum’
- Are within 48 hours of scuba diving
- Have had a recent head injury
- Have a lung condition called a ‘pneumothorax’
- If you are driving yourself home you should make sure you feel competent to drive and that it is at least 30 minutes since you stopped using the Entonox.
- Entonox can be used in conjunction with numbing gels and sprays and/ or injections. Your pain relief will be discussed on the day to help you decide which form of pain relief is best for you.
Mindful breathing can be very effective as a method of remaining calm during the procedure, and this can help reduce pain. A simple example can be found here:
Square breathing
Starting on one side of the square.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way, 3, 4. And hold your breath, 2, 3, 4.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way, 3, 4. And hold your breath, 2, 3, 4.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way, 3, 4. And hold your breath, 2, 3, 4.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Three, four. Breathe out all the way. Three, four. And hold your breath. 2, 3, 4.
Breathe in. 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way. Three, four. And hold your breath. 2, 3, 4.
Breathe in. 2, 3, 4. Hold. 2, 3, 4. Breathe out all the way. Three. Four. And hold your breath. Two. Three. Four.
In
And hold.
Breathe out.
And hold.
Breathe in.
If you’d like to keep going, keep pressing repeat.
Now let’s go back to breathing naturally. You can put your hand on your tummy or over your heart to feel your breath move in and out.
Remember – you can always do square breathing whenever you need help to focus or calm down.
After the procedure you may need to continue to take over-the-counter pain relief for the next 24 hours to help relieve any cramps.
If your pain continues to worsen, please contact us on 01273 523 388.
When is the best time to have an IUD fitted?
A device can be fitted at any time during your menstrual cycle, but we need to make sure that you are not at risk of pregnancy when you attend for a device fitting.
If there is any risk that you might be pregnant, we will have to reschedule your fitting
You may be offered a copper intrauterine device as emergency contraception. This can be fitted up to 120 hours after unprotected sex, or within 5 days of your expected date of ovulation. If you need emergency contraception, please contact us on 01273 523 388.
You may book your appointment at any convenient time providing you are using one of the methods of contraception reliably until your fitting:
- The combined pill, patch or vaginal ring
- The progesterone-only pill (mini-pill)
- Depo-Provera injection within 14 weeks of the last injection
- Implant (Nexplanon) within 3 years of its insertion
- A copper or hormonal device prior to its expiry date
- Condoms used consistently and perfectly (used for the whole period of sexual contact, no breakages or slippage)
If you are currently using the diaphragm or natural family planning (including period tracking apps) OR you are having unprotected sex, you have these options depending on what type of device you are having fitted:
- If you have chosen a copper device you may be able to continue to have unprotected sex until your appointment, but this depends on your menstrual cycle, and you will need to discuss this with a contraception-trained doctor or nurse first.
- If you are having a hormonal device fitted, please abstain from sex from the first day of your period (Day 1) until your appointment (a hormonal device is preferably fitted between Day 1 and Day 7 of your cycle).
- Alternatively, you can arrange a more reliable form of contraception (from the list above) to be used for more than 3 weeks prior to your fitting appointment.
If you have just had a baby, are still breastfeeding or not having periods for any other reason, you will need to discuss the best time to fit your IUD with a contraception trained doctor or nurse.
Which type of device should I choose?
We offer different types of device at SHAC:
Levonorgestrel intrauterine device (LNG-IUD or ‘hormonal coil’)
It releases a small amount of hormone into the womb, which thins the lining of the uterus to prevent a fertilised egg implanting and thickens the cervical mucus which makes it difficult for sperm to reach an egg. Depending on the type it can last for 3-8 years. The hormonal device can also help relieve symptoms of heavy menstrual bleeding and period pain, as it can thin the womb lining.
For the first few months after fitting, some people experience hormonal side effects (Mood changes, breast tenderness, acne) and a change to their bleeding pattern (usually lighter and less frequent bleeding). These side effects usually settle within a few months, but if you have any concerns, we are happy to talk to you about any side effects you are experiencing.
Hormonal devices commonly used in the UK & how long they can be used for contraception if you are under age 45:
- Mirena – 8 years
- Levosert – 8 years
- Benilexa – 8 years
- Kyleena – 5 years
- Jaydess – 3 years
If you are 45 years or older and have any 52mg levonorgestrel hormonal device (Mirena, Levosert and Benilexa) inserted for contraception then this can be used up until age 55 when contraception is no longer required.
If you use a 52mg levonorgestrel hormonal device as part of hormone replacement therapy (HRT) this will need to be changed 5 yearly at your GP.
Copper intrauterine device (Cu- IUD or ‘copper coil’)
There is a copper thread woven around the T-shaped device. Copper is toxic to sperm and stops it from reaching an egg and it may also stop a fertilised egg implanting in the uterus. Depending on the type it can last between 5-10 years.
As there are no hormones in a copper device, you will not experience any hormonal side effects. Some people experience heavier menstrual periods with a copper device.
Copper devices used at SHAC and how long they can be used for contraception if you are under age 40:
- NOVA T 380 – 5 years
- T-Safe 380A QL – 10 years
If you are 40 years or older any copper device fitted in the UK can be relied on for contraception until age 55 when contraception is no longer needed, or you have menopause diagnosed if this is sooner.
Both devices can also be fitted at some GP practices in Brighton and Hove.
What are the risks of having a device fitted?
Infection
Although we will do our best to minimise the risk of infection, some people develop an infection after their device fitting procedure. To reduce the risk of this, we advise:
Having a sexual health screen before the device is fitted, even if you have a regular long-term partner
Avoid sexual intercourse for the first 4-5 days following in order to let the device settle in and minimise the risk of getting infection
If you develop any offensive discharge, lower abdominal pain that is worse than period pain, or feel feverish or unwell, please contact us or your GP for advice
Bleeding
Even if the device is not inserted during your period you may have some bleeding for a few days. The local anaesthetic gel used during the procedure may make this look worse.
The device may also cause some unpredictable bleeding over the first 3-6 months after insertion, especially if you have a hormonal IUD fitted. This usually settles down on its own.
If you have prolonged or heavy bleeding (soaking through a sanitary towel every hour) please contact your doctor. If you have had a copper device inserted, heavier periods may be normal.
The use of tampons or moon cups could also disturb the device, so we suggest avoiding using these for 6 weeks following the procedure.
Expulsion
Rarely, the device may come out without you noticing. This is most common in the first three months after fitting. It is a good idea to check you can feel the threads of the device after your period. If you can’t feel the threads, please contact us. You should use extra precautions such as a condom, until a doctor or nurse has checked it is still there.
If your device has come out in the last few days you may need emergency contraception. If it could have come out more than a few days ago, and you are sexually active, we will need to make sure you are not already pregnant before fitting another one or starting alternative contraception.
Damage to the womb
The fitting of a device can, very rarely, become embedded into or perforate (make a small hole in) the womb lining. This happens in less than 2 per 1,000 fittings, often at the time of fitting. It can cause pain, but this is not usually severe and for some people there is no pain. The main symptom is not being able to feel the threads.
If you are unable to feel your threads, please contact us. It may mean that perforation has occurred, but more commonly it means either that the threads are tucked up inside the cervix or (less commonly) the threads have come off the device. If a clinician cannot find your threads, we will carry out an ultrasound scan to check the position of your device. This may require a further appointment. You will be offered another form of contraception until we are sure the device is in the right place.
Ectopic pregnancy
Although your overall risk of becoming pregnant with a device in place is very small (0.2 % with the hormonal device, and 0.6% with a copper device), if you should become pregnant, there is a risk of the embryo developing outside the uterus, usually in one of the fallopian tubes. This is called an ectopic pregnancy and is considered a medical emergency.