Contraception - Copper Coil information leaflet

 

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The Copper Coil (IUD)

 

Are you able to have a copper coil?

We cannot fit a copper coil if any of the following apply:

  • You are pregnant
  • You have a past history of the serious pelvic infection called Pelvic Inflammatory Disease (PID) - unless you have had a normal pregnancy since the infection
  • You have an untreated pelvic infection now
  • You have cancer of the uterus, cervix or breast
  • You have unexplained bleeding from the vagina
  • You have liver disease or a liver tumour
  • You have a known condition that has changed the shape of the uterine cavity, such as large fibroids

Are you aware of the potential risks and complications?

As with any medical device, there are risks associated with the use of the copper coil. These are outlined below and revisited at the end of this information sheet.

  • Ectopic pregnancy: Very few pregnancies overall occur with a copper coil in place. This means that the OVERALL risk of ectopic pregnancy is reduced compared to using no contraception. However if a pregnancy does occur with a copper coil in situ up to half of those pregnancies will be ectopic. This is why it is very important to alert the doctor immediately if you think you may be pregnant.
  • Pregnancy: A copper coil is an extremely effective method of contraception. If pregnancy does occur with acopper coil in place, A copper coil should be removed; and this removal or manipulation may cause pregnancy loss. It can cause complications if it remains in place throughout a pregnancy, for example by increasing the risk of septic miscarriage (miscarriage where the mother becomes ill from infection).
  • Pelvic Inflammatory Disease: There is a risk of introducing any pre-existing or new infection into the uterus when a copper coil is inserted, or if you have a copper coil in place. PID can cause tubal damage leading to ectopic pregnancy or infertility or hysterectomy.
  • Perforation: May occur during insertion and not be detected until some time later. Risk is about 1-2 per 1000 insertions. Perforation may allow a pregnancy to occur. You may require surgery to remove the coil. Delayed detection may result in migration outside the uterine cavity, with a risk of adhesions, internal infection, and/or perforation of intestine.
  • Expulsion: May occur without you noticing. The risk is around 1 in 20 and is most common in the first year of use, particularly within the first three months after insertion.
  • Heavier and / or more painful periods

Do you need a swab before fitting?

The Faculty of Sexual and Reproductive Health states that any woman with the following risk factors must have a swab to check for sexually-transmitted infection prior to fitting a coil:

  • Being sexually active and aged under 25
  • Having a new sexual partner in the last three months
  • Having more than one sexual partner in the last year
  • Having a regular sexual partner who has other sexual partners
  • A history of sexually-transmitted infections

If any of these apply to you, please request a self-test swab for chlamydia and gonorrhea from Bridge Street reception a week before your fitting is scheduled. Ask reception for a QUICK CHECK TEST. This is a simple vaginal swab, the instructions are in the packet. Drop it back to reception when you are done. (You are very welcome to pick up this test anyway if you would like, even if you don’t fit into any of the suggested categories).

Scheduling

We can fit a copper coil at any time in your cycle, including during menstruation as long as your bleeding is not too heavy. However it is vital you are not pregnant at the time of fitting.

To ensure you are not pregnant the FSRH suggests either:

  • abstaining from intercourse from your last period until fitting or;
  • correctly and consistently using a reliable method of contraception until the copper coil can be fitted

See information at end for more detail re this.

Fitting

Please ensure you have eaten prior to your appointment (ie, do not skip breakfast). We would recommend taking an anti-inflammatory painkiller, such as ibuprofen, about an hour before your appointment (as long as you are able to take this medication usually).

There will be a GP and an assistant present at your appointment. We will first review what we’re going to do and go through the consent form.

The GP will then do a pelvic examination to assess the size and shape of your uterus. The rest of the procedure is carried out using a speculum (the device that is used during a smear test). The fitting can cause some discomfort – the sensation has been described as like a sharp pinch, or a strong period cramp.

Fitting usually takes half an hour or less. Very rarely, some women can experience a vasovagal reaction during or after fitting and can faint. If this occurs we will ask you to stay on the premises until we are sure you are feeling well enough to go home.

Follow up

Please book an appointment with the nurse at 3-6 weeks after insertion for follow up and a thread check (this is carried out by performing an examination with a speculum – it is quick!). If you don’t feel you want a vaginal examination please feel free to request a nurse phone call instead to go through any questions or concerns.

If any of the following occurs please contact the GP urgently:

  • pain or discomfort after 48 hours have passed since fitting
  • severe pain or concerning bleeding at any time
  • an unusual or odorous vaginal discharge or fever
  • if you cannot feel your threads or if you think the copper coil has been expelled for any reason (use contraception until you can see the doctor or nurse in case the device has been expelled or perforated)
  • if you have a positive pregnancy test

Removal

You can have a coil removed at any time. Taking it out is usually quick and easy (five minutes or less) and can be performed by the nurse. Occasionally we are unable to remove a coil at the surgery, in which case we will refer you to the gynaecology department at Addenbrookes. Please be aware you need to have abstained from sex for a week prior to removal as otherwise there is a risk of pregnancy.

In summary

We are keen to make your clinic visit as straightforward and streamlined as possible. We will try to insert an IUD / IUS for you at our contraception clinic therefore it is important that you have read all the information and are suitable for the procedure on the day you come. You can also discuss other methods with us as well and ask any questions.

  1. I have read the IUD/IUS leaflet or I already have an IUD/IUS and am familiar with the method
  2. I have abstained or am using an effective method of contraception (if condoms are used they have been used consistently and correctly on every incidence of intercourse) & have not had any problems (e.g. missed pills, IUD overdue for change) or unprotected sex (or withdrawal) since my last period.
  3. I understand that it is not safe to insert an IUD/IUS if I might be pregnant.
  4. I will make sure that I have had breakfast/lunch on the day of the appointment. A painkiller can be taken around an hour in advance.
  5. I am not at risk of sexually transmitted infection (e.g. I do not have a new partner) or I have been tested recently for chlamydia / gonorrhoea.
  6. I understand that no method is 100% effective and that the IUD/IUS has a very small risk of failure (less than 1 in 100 chance of pregnancy).
  7. I understand there is a 1 in 1000 risk of perforation of the womb at the time of insertion of the IUD/IUS, and that this risk increases to approximately 2/100 if breastfeeding.
  8. I understand there is a 1 in 20 chance of the device falling out.
  9. I understand the IUD/IUS will not protect against sexually transmitted infections and condoms in addition are recommended for this if for example I have a new partner.
  10. I understand there is a small risk of infection (1 in 100) in the first few weeks after insertion of the device.
  11. I know that a copper IUD might make my periods slightly heavier, longer and more painful.
  12. I know that an IUS will make my periods much lighter but is likely to cause erratic bleeding and spotting in the first few months of use.

Precautions before your appointment

  • I am not using any contraception or am only using condoms: Do not have sex (even using condoms) from when your period starts until the fitting.
  • I take the contraceptive pill or have a contraceptive implant or injection: Make sure you continue to use your current method of contraception.
  • I have just had a baby: Book an appointment from 4 weeks afterwards providing there is no risk of pregnancy (i.e. no sex since delivery or your last period, or already taking the contraceptive pill or injection).
  • I am having the intra-uterine device removed or replaced: Do not have sex for 10 days before the fitting. This is to ensure there are no live sperm in your uterus, in case the new coil cannot be fitted once the old one has been removed.

Find out more about other contraceptive options on our Sexual Health page here