Contraceptive Coil: An expert's guide

In her latest online article, Dr Georgina Forbes gives us her expert insight into the contraceptive coil. She explains the benefits, side effects and the procedure for inserting and removing the contraceptive coil.

What are the benefits of using contraceptive coils?

Contraceptive coils are an excellent form of long-acting reversible contraception. They are also known as intrauterine devices and intrauterine systems. There are two kinds of contraceptive coils, non-hormonal coils and hormonal coils.

Non hormonal coils are a plastic t shaped device with copper wire wound around it. The typical failure rate with this method is 0.8%.

Hormonal coils are plastic t shaped devices around which there is a sheath containing a reservoir of hormones. The hormone is Levonorgestrel (a progesterone) which is released daily. There are several different strengths of hormonal coil and they have a failure rate of 0.2-0.3%.
 

How long does it take for contraceptive coils to start working?

The copper coil begins working immediately. It can also be fitted for emergency contraception and is 10 times more effective than emergency hormonal contraception (also known as the morning after pill).

The hormonal coils begin working immediately, if fitted within the first 5 days of your menstrual cycle. Outside of this time, it will take up to 7 days to be effective. 
 

What are the side effects of using contraceptive coils?

Copper coils have no hormonal side effects however your periods may become heavier, more painful or longer. This sometimes improves over time. 

Hormonal coils can be used to manage period pain, heavy periods and pre-menstrual symptoms. The hormonal coil works by thinning the lining of the womb (the endometrium). This means that most users with notice a lightening of their periods and some will not have any bleeding. For the first 3-6 months it is common to have erratic bleeding which settles over time.  

As with any hormonal method there is a risk of hormonal side effects such as on mood, libido or skin. However, the risk is lower than other hormonal methods due to it being a relatively low dose that is delivered directly to the uterus. 

How long can contraceptive coils be used for?

Depending on the coil type and brand they can last up to 3-10 years for contraception. 

The most commonly fitted copper coil (Tsafe 380A) lasts for 10 years and the most common hormonal coil (52mg Levonorgestrel IUS) lasts for 6 years. If a coil is fitted over the age of 40-45 years it may last longer. 

Be sure to clarify with your healthcare provider which coil you have and how long it lasts. 

Your hormonal coil may last less time if you are also using it as part of hormone replacement therapy. 
 

What is the procedure for inserting and removing contraceptive coils?

Having a coil fitted is an outpatient procedure. A swab may be offered to check for sexually transmitted infections and minimise infection risk from the procedure. The clinician will need to assess the position and size of your uterus by gently examining inside your vagina and feeling your abdomen at the same time. This is to reduce the risk of perforating (making a hole) in your uterus during the procedure. 

Next a speculum is inserted into your vagina and gently stretched open. This is the same as any gynaecological examination or smear test. 

Anaesthetic options should be discussed prior to the fit and are applied at this point. That may involve a gel, spray, cream or a small injection into the cervix. Be sure to ask your clinician what is available and right for you. 

Once the anaesthetic has been applied and is working the procedure can continue. 

A small clip is applied to the cervix and many women describe this as a pinching sensation. 

Your uterus is then measured and this may give you a cramping sensation. The coil is then set up and adjusted to the size of your uterus. The clinician should double check at this point that they have the correct type of coil and that it is in date. 

The coil is then fitted into the uterus and this will cause a second cramping sensation. 

The clip can then be removed from the cervix and the threads of the coil trimmed to 2-3cm long. 

Finally, the speculum is removed and the procedure is complete. Many women feel well after this but be sure to let your clinician or their assistant know if you feel unwell or it has been painful. 

The pain should gradually get better and be gone within 7 days. Simple measures such as paracetamol and ibuprofen are appropriate. If the pain does not settle or is severe, please contact your healthcare provider. You will be asked to feel for the threads in 4-6 weeks to check the coil has remained in place. 
 

Dr Georgina Forbes is a highly respected specialist doctor in sexual and reproductive healthcare with over 10 years of experience in her field. You can schedule an appointment with Dr Forbes today on her top doctor’s profile.