Contraceptive coils (IUDs) - Lloydspharmacy.com Health

Written by Dr David Delvin, GP and family planning specialist

The IUD or 'coil' is a small plastic device, not much longer than a match, which is placed inside the womb, where it prevents you from getting pregnant.

In Britain, intrauterine devices (IUDs) have remained fairly popular during the 21st century, especially among women who have had babies.

But they're very unpopular in some other countries, particularly the USA, where IUD use remains quite rare. This is largely because of the fact that many American women have memories of the disastrous side-effects of a particular type of IUD (the Dalkon Shield), now long withdrawn from sale.

The word 'intrauterine' just means 'inside the womb'. Far back in the 20th century, it was found that if an object, such as a short strip of plastic, was placed inside the womb, its presence would prevent most pregnancies.

About 40 years ago, it was discovered that such devices worked better if they had a length of thin copper wire wrapped round them. So today, most IUDs contain copper.

Most women who have had a child can use an IUD, though the device isn't usually a good choice for anyone who has heavy periods because it may make them worse.

IUDs are not so easy to insert in young women who haven't had children. Also, official advice is that young, sexually-active women should 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 intrauterine 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 50 years ago were loop shaped (again, they aren't now)
the copper T – because many of today’s devices 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, marketed under the brand-name Mirena, which is also good for treating period problems.

However, in America the term 'IUD' is generally used to cover ordinary coils AND Mirena.

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 match, 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.)

Also, most importantly, the threads are used by the nurse or doctor when it's time to take the IUD out (see below).

Many women check the threads themselves with their fingertips, to make sure the device is in the right place.

You may find that your partner can feel the threads during intercourse or love play, but this is not usually a problem. If your man is being 'jabbed', ask the doctor to shorten the thread slightly.

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.

How well do they protect you against pregnancy?

Today's IUDs are about 98 per cent effective, which makes them not all that far off being as good as the Pill (and about as good as 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, at least 20 of them would get pregnant.

Please note that if you do become pregnant while using an IUD, there's a chance that the pregnancy might be ectopic (in the Fallopian tube).

This is because these devices are good at preventing pregnancies in the womb, but not in the tube.

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.

Also, IUDs can sometimes be associated with womb and tube infections, particularly in the three weeks after insertion.

Quite a lot of IUDs actually fall out ('expulsion'), which is why it is worth checking inside your vagina with your fingertips from time to time, to make sure that the device hasn't been expelled.

Finally, it's an unfortunate fact that IUDs do occasionally go through the wall of the womb ('perforation'), particularly if they have been put in by an inexperienced operator.

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 or nurse 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 the device should not be fitted during the 'heavy' days of the period. Also, you must make sure you haven’t run any risk of pregnancy.

You'll be asked to take off your underwear and to lie on the examination couch. The doctor or nurse 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.

A very few doctors then inject some local anaesthetic to make the coil insertion less painful. But at the present time, most doctors in the UK feel that this is unnecessary.

All IUDs fold up so they can go inside a medical instrument, which 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.'

However, a small proportion of women do find it very painful indeed. 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, in order 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. If you do feel 'woozy', please tell the doctor or nurse immediately. They will check your pulse and get you to lie down for a while.

After an insertion, you may well need to take aspirin, ibuprofen or paracetamol because you'll probably experience some cramping 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 – but after that, tampon use is OK.)

What about love-making?

I have known one or two 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.

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 very few women may still be 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.

The Family Planning Association currently advises that women who have an IUD put in at the age of 40-plus can continue using it till after the menopause.

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

To be honest, it's rare for a woman to pick her own IUD, unless she's a nurse or doctor or perhaps a scientist who knows a lot about these devices.

So in practice, the IUD which you are given will depend very much on which brands the clinic or surgery currently has available and also on which types the doctor has been trained to insert.

But the following list of 'coils' may well be of help to you in discussing the choice with the clinic staff.

In the USA, the choice is very simple because there's only currently one brand of IUD which is licensed. This is the copper-containing Paragard.

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.

But in Britain, there are currently 13 types of IUD available.

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.
The 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 380A QL. Yet another T shape. Manufacturers say it lasts 10 years.
The TT380 Slimline. Currently intended to last 10 years.
The Mini TT380 Slimline. For smaller wombs. Lasts five years
The UT 380 Short. For the shorter womb. Lasts five years.
The UT 380 Standard. For the larger womb. Lasts five years.
The Multi-Safe 375. Lasts five years.
The Neo-Safe T380. Last 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 your device 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 after sex to prevent pregnancy. 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 harder to obtain than the morning-after pill. If you're in difficulties, try calling a family planning clinic.

How is the IUD removed?

There will probably come a time when you want to have your IUD taken out. This could happen if:

you get fed up with side-effects, like heavy periods
you want to have a baby
the 'shelf-life' of the IUD has run out.

It can easily be removed by a IUD-trained nurse or doctor, who will put a small surgical clip on the string, and gently draw the device out. This could hurt a bit, and there may be a little bleeding.

I'd suggest that you get someone else to drive you home afterwards.

In recent times, I've encountered several instances in which doctors who weren't trained in IUDs have decided to pull out a device out and indeed received an NHS fee for doing so. This isn't something I would recommend.

If you want your device removed, find yourself a family planning-trained nurse or doctor.

Current FPA advice is that if you don't want to get pregnant, you should start using condoms (or some other contraception) seven days BEFORE IUD removal.

Please don't try and remove your IUD yourself.

Useful numbers for IUD information

Sexual Health Direct (FPA): 0845 122 8690

Northern Ireland FPA: 0845 122 8687.

Other people also read:

Choosing a contraceptive: the most popular types of contraception.

Contraceptive injections: how do contraceptive jabs work?

Contraception – chemical methods: how do you use them?

Contraceptive implants: what are the side-effects?

Last updated 09.05.2011

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