Timing of Coil Fit:
- Before a coil can be fitted it is important that there is no chance you are pregnant.
- Continue regular, effective contraception up until your coil fitting.
- The ideal time to fit a coil is when we can be sure there is no risk of pregnancy; it is fine to fit a coil whilst you are on your period. The insertion procedure may be easier at this time in your cycle, however it can be fitted at other times in your menstrual cycle as long as you are not pregnant.
- If you are using condoms, it may be best to try to abstain, as if you have a burst condom and take emergency contraception in the 7 days before fitting, we may not be able to fit the coil. We do not accept the withdrawal method as a way of preventing pregnancy as there is always a risk.
- If you don’t have periods at present (e.g. during breastfeeding or whilst using other methods of contraception), a coil fit can be arranged at any time providing there is no chance of pregnancy. In some circumstances a negative pregnancy test may be needed before a coil can be fitted. To rely on a negative result, effective contraception, or abstinence from sex (having no sex) is required for the 3 weeks before the pregnancy test.
- After having a baby, it is advisable to wait 4 weeks before a coil is fitted (unless it is fitted in the 1st 48hrs after giving birth). There are other appropriate forms of contraception available to use before this time (see https://www.nhs.uk/conditions/baby/support-and-services/sex-and-contraception-after-birth/ https://www.contraceptionchoices.org/ or discuss with a nurse/GP).
- Coil Replacement:
- If you already have a coil in place, please either abstain from sexual intercourse or use a condom carefully in the 7 days before you attend. Sperm can live in the pelvis for 7 days, so there is a theoretical chance of pregnancy if this advice is not followed, as, on rare occasions it may not be possible to fit the replacement coil successfully.
- If you are attending for a replacement coil and your coil change is overdue, you are advised to use an alternative form of contraception. In some cases, a negative pregnancy test, after at least 3 weeks of contraception/abstinence may be required before the coil can be
- changed.
Before the Fitting:
You should have had an appointment with one of the practice nurses to go through the coil procedure and risks, and the options of coils will be mentioned. They will have sent you a couple of texts:
- One text includes a video about the coil fitting and some written information on both coil options (hormonal and non-hormonal)
- The other text reminds you to watch the video, to read the attached consent form, and to respond to the text to confirm you have read the consent form and agree to the coil fitting.
You can change your mind at any time about the coil fitting even if you have responded to say Yes. It is important though if you do want to have the coil fitting that you respond to the text. You will still be able to ask any questions before the appointment via the nurses, or with the coil fitter on the day of the appointment.
- Please take some painkillers an hour before the procedure (either ibuprofen 400mg (with or after food) or paracetamol 1g, or both, as long as you are not allergic to these) as some people can experience discomfort, like period cramps, during coil insertions.
- Some people can feel a little faint during and after the fitting. It is therefore advisable to have someone with you or someone you can
contact by telephone in case you feel unwell. - If possible, ask a friend to drive you or accompany you home.
- Please ensure to arrange for someone else to look after any children/dependents during a coil fit.
- It is usual practice to offer a chlamydia test before fitting an IUD/IUS to all our patients. This should have been done in the few weeks before fitting, but if for some reason this hasn’t happened, the swab may be taken at the time of the coil insertion.
- In some rare circumstances where we may be concerned about a high risk of infection, we will offer antibiotics to take prior to the coil fitting, whilst awaiting the results of the swab.
- Please wear loose, comfortable clothes and footwear on the day of fitting, ensure to be hydrated and have eaten.
- You can change your mind about having a coil fitted at ANY time.
The Fitting Process:
- Please allow up to an hour for the appointment. You are welcome to bring someone to support you, but please be aware that you will be asked some personal questions. You may have some music on during the procedure from your own device.
- The doctor will ask questions to check the coil is suitable for you and which coil you have chosen. You will have the opportunity to ask any questions, before giving your verbal consent to proceed with the fitting. If at any stage you change your mind about the fitting, the procedure can be stopped. This is your body, and you are in control, so please say if you would like to pause the procedure, or if you want to stop.
- A vaginal examination will be undertaken to check which way your womb lies (every woman is different), a speculum (a plastic device) inserted into your vagina to see the cervix (like what happens with a smear test), and then the coil fitted.
- Most people describe having a coil fitted as a mild to moderate, deep cramping discomfort. Every person’s body is different, some will hardly feel a coil being fitted, whilst others may find it more painful. For most people, the part that causes the deep cramping will only last a few minutes and then your coil will be in.
- The doctor and nurse will do their best to reassure you and make the procedure as pleasant as it can be, talk to your coil fitter if you have concerns. Every clinic can offer a local numbing gel or spray which we can apply to your cervix, this may help with discomfort, but it won’t take it away completely.
- You will be given advice after fitting about what to expect and when to come back.
- Please ensure you have no major commitments afterwards as you may need to take it easy and relax for the rest of the day.
Possible Risks:
- Discomfort – v mild to severe pain/dizziness/fainting on insertion/shock
- Infection – highest in 1st 3 weeks after fitting (test advised before fitting)
- Expulsion or change of position (up to 1 in 20 – highest in 1st year)
- Failure (<1 in 100 in 1 year)
- Ectopic pregnancy if pregnancy occurs
- Damage to cervix or womb including perforation (up to 1 in 500: risk 6x higher if breastfeeding) during insertion or after the procedure
- Altered vaginal bleeding (IUS: spotting or irregular/prolonged bleeding 3-6 months; IUD: heavier/more painful/prolonged periods)
- Hormonal effects with IUS – greasy skin, mood changes, weight change
After the Fitting:
You will be provided with further information and guidance after a fitting:
Advice following insertion of your Intrauterine Contraceptive Device (IUCD)
How should I feel afterwards?
Most women experience some period-like discomfort/cramps for 24-72 hours after fitting, which then usually settles. For some people there can be mild intermittent cramps continue for 1-2 weeks.
There may be some bleeding or spotting for a few days. If an IUCD is fitted during a period, the period may be heavier and last slightly longer than usual.
If the pain is severe, is not being relieved by simple painkillers, gets worse, does not settle fully after 1 week or you are bleeding heavily, you should contact your GP or Practice Nurse (or call 111 if the Practice is closed).
What should I do afterwards?
Avoid using tampons and menstrual/moon cups for 7 days after the coil fit, just use pads. You can use tampons again if needed after 7 days, but please be aware menstrual cups can dislodge the coil if the threads are caught and can be pulled out with the cup – ensure the seal is fully released.
Take simple painkillers such as Paracetamol and/or Ibuprofen (as long as you are not allergic to these products). Take what you usually would to manage period pains.
Rest for several hours after fitting and avoid strenuous activity for the rest of the day.
Using a hot water bottle and sometimes gentle walking might help.
When can I resume sex?
A copper IUCD is effective straight away as contraception.
An IUS (Mirena/Levosert/Kyleena or Jaydess) will not work as contraception for the first 7 days and you should abstain from sex or use another contraceptive method at the same time.
Otherwise, you can resume sexually activity whenever you feel comfortable. IUCDs do not protect you against sexually transmitted infections so additional barrier protection such as condoms may still be advisable, especially in the 1st week due to the higher infection risk and with any new sexual partner (it would be advised they have an infection screen prior to unprotected sex).
Is there anything I should look out for?
A change in bleeding pattern occurs frequently after your coil insertion, you can bleed lightly for a few days, sometimes up to 1 week. With a new copper coil, you will likely have heavier and more painful bleeding. Irregular bleeding and a dark brown ‘stringy’ discharge is particularly common with an IUS device but should settle after 3-6 months to possibly no period or a light period most months. The hormonal side effects such as headaches, breast tenderness, oily skin or mood changes are rare and may settle within 8 weeks (this is as slightly more hormone is released in the 1st 6-8 weeks after it is fitted). See your GP if the side effects are persisting and bothering you.
With a copper IUCD periods can become heavier, longer and more painful but then often improve after the first 3 months, you can also get a small light bleed in the middle of your cycle, after sex and exercise for the first 3 months. If you are concerned about bleeding, please speak to your Practice Nurse or GP.
If you think you may have an infection, please contact the GP Practice as soon as possible.
Symptoms of an infection may include:
- Persistent or worsening lower abdominal pain
- Abnormal vaginal discharge
- Fever
- Pain during sexual intercourse
When does the coil need changing?
All intrauterine devices are effective for at least 5 years (except Jaydess which is 3 years) and some for up to 10 years. You should have been advised of the date for replacement at the time of fitting; if not, please ask. It is then your responsibility to attend your GP or local sexual health clinic before this date to have your coil removed or changed.
If you have had an IUS (Mirena or Levosert) fitted after the age of 45, (or a copper IUCD fitted after the age of 40), you can continue to use the same device for contraception until no longer required (usually at age 55).
Removing a coil
A coil can be removed at any time by a trained nurse or doctor gently pulling on the threads, this can cause some very brief cramps. We recommend trying the method for at least 3 to 6 months to see if it suits you before having it removed. If irregular or heavy bleeding is a problem, there are medication options that can be prescribed for a few months which may help. If you don’t want to be pregnant, avoid sex or make sure to use a condom in the 7 days before your coil is removed or changed for another coil. This is to avoid any risk of unintended pregnancy.
If you are planning for a pregnancy, please speak to your GP, it is advised to start folic acid and vitamin D 3 months prior to trying for a baby. You may also find the following information useful: https://www.nhs.uk/pregnancy/trying-for-a-baby/planning-your-pregnancy/
Checking your threads
We recommend that you check for your coil threads ideally once a month (after your period if you have them) – some people do not want to feel for the threads, or simply cannot ever feel them – we would advise you to seek a review if your bleeding pattern changes, you are having new abdominal pains or discharge so your coil can be checked.
- Wash your hands and sit or squat down.
- Gently put your finger inside your vagina (as if inserting a tampon).
- Feel for your cervix (which feels firm, like the end of your nose).
- Gently roll your finger over your cervix and you should feel your threads. (Although there are two threads they usually stick together and you will only be able to identify them as one thread; this is fine).
- It is unlikely that your coil will fall out, but if you cannot feel your threads or if you feel something hard and plastic other than the threads, please abstain from sex or use condoms, check a pregnancy test and make an appointment to have the device checked.
If you think you may have had sex since the coil has moved, you may need emergency contraception. Please check a pregnancy test and seek advice as soon as possible from your GP or 111. If the threads cause discomfort to you or your partner, they can be trimmed, please contact the practice for a routine appointment.
Additional advice
We do not routinely see patients for follow up after a coil fit, but we are always very happy to see you if you have any concerns. Please contact the Practice for an appointment.
If you are aged 25 or over, make sure you have regular cervical smears as part of the National Cervical Screening Programme (you will receive a letter about this about 6 months before your 25th birthday).
We recommend regular sexual health checks for everyone (check if you are eligible for the free postal kits https://sh24.org.uk/ ), but especially if you have a new partner or believe you may be at risk.
Please contact your GP or the local sexual health clinic if requiring sexual health testing https://www.nuh.nhs.uk/sexual-health-clinics
Coil removal
- Prior to removal please either abstain from sexual intercourse or use a condom carefully in the 7 days before you attend for the coil removal.
- As long as there is no risk of pregnancy (by avoiding sex 7 days prior to removal), a coil can be removed at any time by a trained nurse or doctor gently pulling on the threads. We recommend trying the method for at least 3-6 months to see if it suits you before having it removed, you can see a nurse if requiring a trial of oral hormone contraception alongside to help with irregular bleeding patterns (this will be checked if a safe option).