Coil Fitting

‘Hormonal coils’ as the name implies have a hormone (progesterone) that is released slowly over the lifetime of the coil into the inner lining of the womb (called the endometrium). The hormone keeps the lining thin all the time so it can’t support a pregnancy. Also, the hormone thickens the mucus around the neck of the womb so sperm can’t get in. Now, because the lining is thinner, there is much less blood to lose each month, so women tend to have much lighter periods and, in some cases, periods can stop altogether (called amenorrhoea).

‘Hormone-free’ coils work by the effects of copper which lines the stem and sometimes arms of the device. The copper is directly toxic to sperm and the egg. It also causes an inflammatory reaction in the lining of the womb that makes it difficult to support a pregnancy. Furthermore, the presence of copper in the mucus around the neck of the womb, makes it difficult for sperm to get in.

Are there any additional benefits to having a coil fitted ?
The Mirena hormonal coil can be used as part of Menopause Hormonal Therapy. It may also reduce the pain associated with period-pain, endometriosis and adenomyosis. Hormonal coils are generally effective at reducing blood loss and so can be used to treat heavy menstrual bleeding.

The copper coil may protect against cancer of the womb and cancer of the cervix.

This can be a difficult decision, and it’s important to consider your immediate and long-term contraceptive needs, bleeding patterns, medical history, and past contraceptive experiences. You may have done your own research and have already made a decision about a coil.

We find it helpful to have some understanding of how the different coils work. They can be broadly divided up into ‘hormone’ and ‘hormone-free.’

As previously mentioned, the hormonal coil works locally on the lining of the womb and the neck of the womb, but small amounts of hormone can sometimes get into the bloodstream from the blood vessels in the lining of the womb and women can experience side effects of acne, headache, breast tenderness, mood changes, bloating, fluid retention, and abdominal cramping. This is called progesterone intolerance. Those symptoms can happen at start and get better or persist and it is a common request for discontinuation.
In the first 3-6 months after the fitting of a hormonal coil, women may experience Irregular, prolonged, or frequent bleeding, but bleeding patterns usually improve with time.

The copper coils can cause heavy painful periods and is a common reason for discontinuation.

A coil can be inserted at any time in your cycle, if it is reasonably certain that you are not pregnant. The deal time is between Day 1 and 5 of a natural period, ideally towards the end of your period. This is because we can be sure you are not pregnant at this time, and the fitting itself is more comfortable for you, as the hole in the neck of the womb, the cervical canal (through which the coil is inserted) is wider. It doesn’t matter if you are still bleeding (unless it is very heavy).

After Day 5, you can still have a coil fitted if you have not had any unprotected vaginal intercourse since the start of your period. If you have had unprotected vaginal intercourse after day 5, you may be at risk of pregnancy so you will need to speak to a doctor.
If you have been using a hormonal method (the Combined Contraceptive Pill, Ring, Patches, Progesterone-Only-Pill, injection method or implant), consistently and correctly (with no missed pills / ring/patch and your injection or implant is not overdue), the coil can be fitted at any convenient time, and you do not need to abstain from sex before your fitting.
If you are having a coil replaced, this can be done on any day except a day of heavy bleeding. You should not have sexual intercourse for the SEVEN days before the fitting. This is to ensure that there is no sperm in your body that could result in a pregnancy.

We recommend having something to eat and drinking plenty of fluids before your coil fitting. Try to avoid drinking excessive amounts of alcohol or having an alcoholic ‘binge’ the night before. Take 1g of paracetamol and 400mg of ibuprofen at least half an hour before your coil fitting if you are not allergic to these medications.
Please allow at least an hour for the appointment. Although the procedure does not take this long, a few women feel faint afterwards and need some time to recover. It is recommended that you have someone you can contact by phone, who would be able to collect you, in case you feel unwell.
You will be asked to pass urine on arrival for a pregnancy test.
Please ensure that you have no major commitments afterwards, as you may need to take it easy and relax for the rest of the day.
Some sanitary protection may be required afterwards. You may wish to bring your own sanitary pad or panty liner with you.

Having a coil fitted can be uncomfortable. We recommend ‘painkillers’ at least half an hour before the fitting, 1g of paracetamol and 400mg of ibuprofen, if there are no contraindications to taking these medications. We use local anaesthetic lidocaine gel on and inside the neck of the womb prior to a fitting. In our experience, creating a warm, friendly, relaxed and safe environment goes a long way! Some women experience lower abdominal cramping after the procedure, and we recommend taking a further dose of ibuprofen 400mg and paracetamol 1g at the recommended time interval.

A coil should only be fitted by a Healthcare Professional trained in this procedure. A urine pregnancy test is always done prior to a fitting.

An internal examination is carried out to determine the location of the neck of the womb (the cervix), as well as the position and size of the womb. A plastic speculum is inserted into the vagina which brings the cervix into view. Local anaesthetic gel is squirted onto and inside the cervix. The cervix is stabilised using a plastic clamp whilst a bendy plastic measuring rod (‘sound’) is passed through the cervix to measure the length (or depth) of the womb. Once the length of the womb is marked, the rod is removed, and the coil is then inserted. The threads attached to the coil are then cut to about 3 to 4 cm from the cervix.. The clamp and then the speculum are removed. That’s it!

It may not always be possible to fit a coil. There can be limitations or barriers encountered at different stages of the procedure. For example, it may be difficult to pass the Sound through the neck of the womb, it may be difficult to pass the coil through the neck of the womb after using the Sound, or it may be difficult to pass the coil along the full length of the womb. Where it is not possible to fit a coil, you will be referred to a ‘Complex Coil’ service where a scan may be used to guide insertion. Pain can sometimes be a limiting factor and in this case, an anaesthetic injection into the cervix may be required or the procedure may need to be carried out under a general anaesthetic. In the event that a coil cannot be fitted and you need contraception, you will be offered an alternative, usually contraceptive pills taken by mouth, until the coil is inserted.

Yes, the copper coil can be fitted as emergency contraception if you have had unprotected sex within the past 5 days or if you are within 19 days from the first day of your last period (of a 28-day cycle). This is the most effective form of emergency contraception and the only one that is effective up to 5 days after you have released an egg (or ovulated).

You will receive an aftercare sheet after your procedure for your reference. Tampons should not be used for the first two days after the fitting. We advise not to have penetrative sex for 24 hours after your coil fitting. You can eat and drink normally. Some women experience lower abdominal cramping after the procedure, and we recommend taking a further dose of ibuprofen 400mg and paracetamol 1g at the recommended time interval. Cramping can persist for 2-7 days after the procedure, sometimes longer but it should decrease in intensity.

If you have a hormonal coil fitted, you will need to wait 7 days to use it as your sole form of contraception, so you will need to abstain from penetrative sex or use condoms during the waiting time. If you have a copper coil fitted, you can rely on it immediately as your sole form of contraception.

Studies have shown that the use of the Mooncup and tampon are not associated with an increased risk of expulsion of a coil, however the manufacturers of the Mooncup recommend waiting for 6 weeks following the insertion of a coil before using the cup and it should be placed low in the vagina with an adequate seal, which should be broken before the cup is removed.

No… The contraceptive coils do not interact with other medications.

Yes… .The hormonal and copper coils can safely be inserted in the first 48 hours of delivery in non-breastfeeding women. If you are breastfeeding, only the copper coil can be inserted within 48 hours of delivery. After week 4 of delivery, the coils can be inserted at any time if it is reasonably certain you are not pregnant or at risk of pregnancy.

YES……After a surgical abortion, copper and hormonal coils should ideally be inserted at the end of the procedure and no additional precautions are required. If a hormonal coil is fitted after Day 7 of an abortion, additional precautions are required for 7 days.

After a medical abortion, a coil can be fitted at any time after completion of the second part of the abortion (i.e. passage of products of the pregnancy).