Which contraceptive coil is right for me?

Having control over our fertility is one of the biggest triumphs of modern gynaecology. However, there are now such a huge range of options available that it is almost less empowering because it can be so confusing to know what contraceptive is best! I get asked all the time about what I recommend, and the short answer is it very much depends on your own wishes.

Here are some things to ask yourself to begin:

1. Are your periods an issue?
2. How soon do you want to conceive
3. Do you have PCOS or endometriosis and any of the side effects that accompany that?
4. Do you have an issue with taking hormones
5. How old are you, and how far are you away from the menopause?

As a general rule, I think that the coil devices are brilliant, and can be an excellent choice for almost any woman. There are different versions available and these are likely to change over time. As of now, here are the important facts to help you choose which is right for you!

What are my options?

There coils currently on offer fall into 2 main categories; IUD (intrauterine devices) and IUS (Intrauterine Systems).

The IUD (or copper coil) is made of plastic and copper. It has no hormones.

The IUS (hormonal coil) is made of plastic and releases a small amount of progesterone hormone locally into the uterus.

How are the coils inserted?

Both the IUD and IUS are put in by a doctor or nurse at a GP surgery, sexual health clinic or family planning clinic.  They may also be inserted by a gynaecologist at the hospital during other procedures.

Before your IUD is fitted, the fitter will check inside your vagina for the position and size of your womb. You may be tested for any existing infections, such as STIs and for pregnancy.

The appointment takes about 20 to 30 minutes, and fitting the IUD should take no longer than 5 minutes:

• The vagina is held open using a speculum similar to a smear test
• The IUD is inserted through the cervix and into the womb

Having an IUD fitted can be uncomfortable, but you can have a local anaesthetic to help. Discuss this with your GP or nurse beforehand.

You may get period-type cramps afterwards, but painkillers can ease the cramps. You may also bleed for a few days after having an IUD fitted.

Once an IUD has been fitted, it’ll need to be checked by a GP after 3 to 6 weeks to make sure everything is fine. Tell the GP if you have any problems after this initial check or if you want the IUD removed.

How soon does it work?
• Copper coil (IUD)- immediate
• Mirena / Jaydess (IUS) fitted before day 5 of menstrual cycle – immediate
• Mirena / Jaydess (IUS) fitted after day 5 of menstrual cycle – 7 days after insertion
(Day 1 is the first day of your period)

They can be taken out very easily by a doctor or nurse whenever you decide you no longer want the device, or wish to conceive.

The coils are great if you forget to take pills

They last 5-10 years, and are not affected by other medicines, vomiting or diarrhoea.

Partners won’t feel the coil during sex

Some men do notice the threads during sex, but the threads can be trimmed so they are out of the way.

You can safely use a coil with a menstrual cup

Check out this blog post for more information.

When can it be used after birth?

An IUD or IUS can usually be fitted 4 weeks after giving birth (vaginal or caesarean). You’ll need to use alternative contraception from 3 weeks (21 days) after the birth until the IUD/IUS is put in.

In some cases, an IUD/IUS can be fitted within 48 hours of giving birth. It’s safe to use an IUD/IUS when you’re breastfeeding, and it will not affect your milk supply.

Non-hormonal (Copper) coil

Many women these days are very concerned about the effect of taking extrinsic hormones for contraception over long periods of time. If you would rather avoid hormones then the copper IUD is a fantastic option as a very reliable form of contraception.

As it contains no hormones, it wont have any beneficial effects for your periods. Some women, especially if you have previously been on hormonal contraception for many years and therefore don’t know what your natural cycles are like, may find their periods are heavier than before. You may also experience spotting during your cycle but most women find these side effects all improve after the first 6 months of use.

The IUD lasts for 5 to 10 years (depending on the type). 

1. Are your periods an issue? – if yes then the copper coil may not be best for you.
2. How soon do you want to conceive? – if you know you plan to conceive in the near future eg 1-2 years, this is a great option because it shouldnt have any lasting effects.
3. Do you have PCOS or endometriosis and any of the side effects that accompany that? If yes, the copper coil wont help with this.
4. Do you have an issue with taking hormones? If you would rather not take hormones, the copper coil is a great option
5. How old are you, and how far are you away from the menopause? The copper coil can be used in any age group

How effective is the IUD?

The IUD is more than 99% effective – if 100 women use the IUD for a year, less than one will have an unplanned pregnancy. 

How does it work?

The IUD is made of plastic and copper. The copper alters the cervical mucus, which makes it more difficult for sperm to reach an egg and survive. It can also stop a fertilised egg from being able to implant itself.

When the IUD is removed, a woman can get pregnant immediately as it should not have any lasting impact on her fertility. 

What are the main disadvantages?

• Your periods may become heavier, longer or more painful, though this may improve after a few months.
• It does not protect against STIs, so you may need to use condoms as well.
• If you get an infection when you have an IUD fitted, it could lead to a pelvic infection if not treated.
• Most women who stop using an IUD do so because of vaginal bleeding and pain, although these side effects are uncommon.

Hormonal (Eg Mirena, Jaydess) coil

The IUS is something we as gynaecologists recommend on an almost daily basis. The key benefits are that they usually make periods lighter, shorter and less painful. Some women will have no periods at all, especially if they have been using it for a while. 

Some women get irregular bleeding which is not harmful but can be a nuisance – it’s worth seeking advice if this happens.

1. Are your periods an issue? – If heavy or painful periods, the mirena may be a great choice for you!
2. How soon do you want to conceive? They are easily reversible but it may take time for your hormones to regulate. If you want to conceive very soon it may be best to avoid hormonal contraception
3. Do you have PCOS or endometriosis and any of the side effects that accompany that? If you would rather not have any periods then the IUS could be a great choice.
4. Do you have an issue with taking hormones? The IUS contains the hormone progesterone
5. How old are you, and how far are you away from the menopause? If you are over 45 you may experience worsening periods near the menopause and the IUS can really help to ease this. It can also remain in situ if you choose to take HRT and protect you from endometrial cancer.

How effective is the IUS?

The IUS is more than 99% effective – if 100 women use it for a year, less than one will have an unplanned pregnancy.

How does it work?

The IUS releases a small amount of progestogen hormone which thickens the fluid around the cervix and prevents sperm getting to an egg. It also makes the lining of the womb thin so that a fertilised egg can’t settle and grow. 

As the lining of the womb doesn’t grow and thicken each month, you do not need to have a period to shed and replenish the lining.

The IUS contains a lower level of hormones

The IUS has the lowest level of hormone of all the hormonal methods of contraception. The hormones are focused in the womb rather than having generalised effects around your whole body. This can mean less side effects than other forms of contraception such as bloating or weight gain.

The IUS does not cause infertility

Fertility returns to normal after having the IUS taken out.  It may take some time for periods to return, and to become regular, especially if they stopped whilst the coil was in place. If your periods are not regular again by 6 months of trying to conceive then you should see your GP to discuss further.

Women don’t need a period once a month

As mentioned above, in the way that the mirena works it keeps the lining of the womb thin so there is no need for a period. This can have the additional benefit of protecting the womb from endometrial cancer which can arise when the lining of the womb becomes excessively thick.

What are the main disadvantages?

• Your periods may become irregular or stop completely, which may not be suitable for some women.
• Some women experience headaches, acne and breast tenderness after having the IUS fitted.
• Some women experience changes in mood and libido, but these changes are very small.
• Rarely women can develop small ovarian cysts which disappear without treatment.
• An IUS doesn’t protect you against STIs, so you may need to use condoms as well.
• If you get an infection when you have an IUS fitted, it could lead to a pelvic infection if it’s not treated.
• Most women who stop using an IUS do so because of vaginal bleeding and pain, although this is less common.

What are the different types of IUS?

There are 2 types currently available in the UK; The Mirena and the Jaydess

The Mirena IUS is licensed for contraception, menorrhagia (heavy periods) and as part of hormone replacement therapy (HRT). It protects against endometrial cancer when combined with HRT. It may be used for 4-5 years.

The Jaydess IUS is licensed only for contraception. It is physically smaller than Mirena with a lower dose of the dose. It may be used for up to 3 years.

Many women use the IUS for its benefits even if they don’t need it for contraception

It can be fantastic for period pain, lighter periods, and to level out the moodiness of premenstrual tension. It can be also used to protect women taking HRT from endometrial cancer.