Contraceptive coils

Intrauterine devices (IUDs) have remained quite popular during the 21st century, especially among women who have had babies. The word ‘intrauterine’ means ‘inside the womb’.
IUDs are not so easy to insert in young women who have not had children. Also, official advice is that young, sexually active women must be carefully screened for sexually transmitted diseases (STDs) before having an IUD put in.

Names

You may hear the IUD referred to by any of these names:

• the IUCD – short for intra-uterine contraceptive device
• the coil – because in the early days of IUDs, back in the 1960s, some devices were coil shaped (they aren’t now)
• the loop – because a lot of the IUDs of 45 years ago were loop shaped (again, they aren’t now)
• the copper T – because many of today’s devices contain some copper (to make them more effective ) and are T shaped
• various brand names – see below.

Please do not get confused between the IUD and the IUS. The IUS isn’t the same thing at all. It’s a hormone-containing contraceptive device that’s also good for treating period problems.

What is an IUD like?

It’s very small – not much longer than a matchstick. Indeed, any IUD could comfortably sit in the palm of your hand.
Your womb (uterus) is actually about the size of your clenched fist. So if you close your hand round a matchstick, you’ll have a rough idea of how an IUD sits inside your womb.
As I’ve just said, most IUDs are now T shaped. They’re made of plastic and copper, sometimes with a little silver inside. (But the silver is of no real financial value – so it’s not worth saving your old IUDs.)
All IUDs have either one or two little threads that hang down a short distance into your vagina. These are useful when you (or a doctor or nurse) are checking to see that the device is still in place.
Also, most importantly, the threads are used when it’s time to remove the IUD; the nurse or doctor just grasp a thread with a surgical ‘clip’ and pull the device out.

How do IUDs work?

They sit in your womb and prevent you from getting pregnant. They do this in three main ways:

• they prevent your partner’s sperm from getting through your womb and into your tubes
• they alter the secretions (mucus) in your cervix, creating a further barrier for sperm
• they affect your womb lining – making it less likely to ‘accept’ an egg.

Pretty well all family planning doctors and nurses say that the IUD does not work by ‘causing an abortion', as some people have alleged.

Do a lot of women use them?

Yes. In the UK about 4 per cent of all sexually active women are using IUDs.
But, in some other countries they’re much more popular: in Scandinavia, around one in five of all women of reproductive age have IUDs.
However, it’s unlikely that IUDs will ever be as popular as the Pill or the condom.

How well do they protect you against pregnancy?

Today’s IUDs are almost 98 per cent effective, which makes them not all that far off being as good as the Pill (and about as good as the the mini-Pill).
What this means is that if 100 women use IUDs for a year, then only about two of them would become pregnant. This isn’t very much when you consider that if they used nothing, then up to 20 of them would get pregnant.

Are there any side-effects?

There are a number of side-effects and you must be aware of these before you decide to have an IUD.
These devices generally:

• make your periods heavier
• make them longer
• may make them more painful.

Furthermore, because of the increase in menstrual flow, it’s possible that you might become anaemic.
So the IUD is not usually the best choice of contraceptive for a woman who already has heavy or prolonged periods. She might well do better with another method, such as the Pill or the IUS.

Can anybody use an IUD?

No. Most women can use them, but not all. You shouldn’t have an IUD if:

• you have some structural abnormality of the womb or cervix
• you have a pelvic infection, for instance an STD
• you have unexplained vaginal bleeding
• you have heart valve problems (unless a heart specialist thinks you should go ahead)
• you have an allergy to copper (which is rare)
• you’ve previously had an ectopic pregnancy
• you think you might already be pregnant.

The doctor will advise you if you have any other condition that makes using a ‘coil’ inadvisable.

How do I get myself an IUD?

Start by going to a family planning clinic, or to one of the minority of GPs who have experience of fitting IUDs. Also, a few women have their devices fitted by gynaecologists – either under the NHS or privately.
Please make sure that whoever puts it in is properly trained! In the past, a few doctors who had little or no experience of IUDs ‘tried their hands’ at inserting them – often with poor results for the unfortunate patient.

What happens when you have an IUD insertion?

Once you’re fully informed about having a ‘coil’ (and happy with the idea), you’ll be asked to come to the clinic/surgery on a specific date. This is often at the end of your period (when the flow should be light) or just after it.
Current advice is that device should not be fitted during the ‘heavy’ days of the period. You must make sure you haven’t run any risk of pregnancy.
You’ll be asked to take off your pants and tights, and to lie on the examination couch. The doctor will insert the little device called a ‘speculum’ which lets them see your cervix.
They’ll then check the length of your womb with an instrument called a ‘sound'. This might hurt slightly.
All IUDs fold up so that they can go inside a medical instrument that looks like a drinking straw. The doctor or nurse pushes this ‘straw’ into your vagina and then through your cervix – and so into your womb. Finally, they eject the IUD from the ‘drinking straw’ - and it’s in!.
This whole process usually takes about 10 minutes.

Is it painful?

Yes it is – a bit. Of course, it’s easy for me – as a man – to say that it’s only ‘a bit’ painful. But in practice, most women say that it’s much less unpleasant than a visit to the dentist. Others exclaim in a surprised way: ‘Is that it? I thought it would be much worse than that.’
A small proportion of women do find it very painful. The amount of pain you feel depends on various factors, like:

• how relaxed you are
• how skilled the doctor is
• the size and shape of your womb
• whether you’ve ever been pregnant – insertions in women who’ve had babies are usually not very uncomfortable at all.

You can take a painkiller an hour or two before the insertion if you like to decrease any discomfort.

What happens after the insertion?

After the device has been put in, you should rest in the clinic or surgery for a good half-hour. Don’t drive yourself home – just in case you feel faint.
You may well need to take aspirin (eg Aspro clear) or paracetamol (eg Panadol) during the next few hours, because you’ll probably experience some crampy pain.
Have some pads available, as it's likely you'll lose a little blood that night and over the next few days. (Personally, I advise against using tampons until you have your next period.)

What about love-making?

I have known one or two highly sexed women who went out and had intercourse immediately after an IUD insertion, but I feel that commonsense suggests that you should give the device 24 hours to settle down before having sex.

Are there any other drawbacks with the IUD?

Yes, a few.

Expulsion

Surprisingly few people realise that IUDs are often ‘expelled’ - that is, they can come out! (In a few clinics, the expulsion rate is as high as 10 per cent.)
This is why it’s a good idea to check your vagina regularly with your fingertips, to make sure that your IUD is not ‘coming down'. All you should be able to feel are the threads – not the device itself, which would feel hard to the touch.

Perforation

Rarely, the device goes through (‘perforates’) the wall of the womb. Usually, it’s at insertion that this happens.
Perforation is an emergency, so if you ever get a great deal of pain in the lower part of your tummy, contact a doctor at once.

Infection

Infections are a little more common in IUD users, and are most likely to cause symptoms in the three weeks following insertion.
It’s now thought that often the woman is ‘carrying’ a sex infection, such as chlamydia, and the insertion makes it flare up.
If you get a smelly discharge, pain or a fever, consult a doctor urgently.

Ectopic pregnancy

The IUD is very good at preventing normally located pregnancies – ie in the womb. So if a pregnancy does occur, there’s an above-average chance that it might be ectopic (outside the womb).
Symptoms are lower abdominal pain and bleeding; contact a doctor urgently if these occur.

Fertility problems

These are unlikely to occur unless you are unlucky enough to catch an infection.

How often should I have check-ups?

In the UK, it’s common to have a check-up by a doctor or nurse at about six weeks after insertion. Thereafter, a yearly check is sufficient.
But don’t hesitate to go back to the clinic earlier if you’re having problems – for instance, if your periods are driving you crazy!

How long will the IUD last me?

Some of the original coils and loops were designed to last ‘forever', and a few women are still using these devices.
But all of today’s British IUDs have a lifetime of between five and 10 years, because they gradually ‘wear out'. At the end of that time, you need to have the IUD changed - or if you prefer, you can switch to another method.

What types of IUD are available – and how can I choose?

To be honest, it’s very rare for a woman to pick her own IUD, unless she’s a nurse or doctor and knows a lot about these devices. But the following list of ‘coils’ may well be of help to you in discussing the choice with the clinic staff.

Important

Make sure you know what brand you’ve been fitted with, so that in years to come you will be able to tell any doctor or nurse you consult.

In 2008, there are ten types of IUD available in Britain.

• The Flexi-T 300. T shaped. Lasts five years.
• The Flexi-T +380. Similar to the one above, but for slightly larger wombs. Lasts five years.
• The GyneFix. Different from the rest, because it isn’t T-shaped, and just consists of six copper tubes on a polypropylene thread. Lasts five years.
• Load 375. U-shaped. Lasts five years.
• The Multiload Cu 375. Lasts five years.
• The Nova-T 380. Copper and silver. Lasts five years.
• The T-Safe Cu 380A. Yet another T shape. Manufacturers say it lasts 10 years.
• TT380 Slimline. Currently intended to last 10 years.
• UT 380 Short. For the shorter womb. Lasts five years.
• UT 380 Standard. For the larger womb. Lasts five years.

Some women are still ‘wearing’ brands that are not on the above list, because they’re no longer manufactured, notably the Gyne-T 380. To find out when yours needs to be changed, check with the clinic that fitted it.

Emergency post-coital contraception with an IUD

The morning-after pill (which should really be called ‘the post-coital pill’) can be used up to three days after sex. The IUD can also be used post-coitally.
A ‘coil’ can be inserted as emergency contraception, up to five days after unprotected sex. It works well, but isn’t 100 per cent effective.
Unfortunately, it’s a lot more difficult to obtain than the morning-after pill. If you’re in difficulties, try calling a family planning clinic