Coils Flashcards
(26 cards)
What are coils?
Coils are devices inserted into the uterus that provide contraception.
What type of contraception are coils?
long-acting reversible contraception
Once the coil is removed, fertility is restored. True/false?
True
What is the 2 main types of coil (IUD)?
Copper coil (Cu-IUD): contains copper and creates a hostile environment for pregnancy
Levonorgestrel intrauterine system (LNG-IUS): contains progestogen that is slowly released into the uterus
What is the effectiveness of the coils?
Both 99% effective when fitted properly.
What is difference between IUD (intra-uterine device) and IUS (intra-uterine) system?
Often, the two types of coils are referred to as IUD and IUS.
The intrauterine device (IUD) refers to the copper coil, and the intrauterine system (IUS) refers to the levonorgestrel (e.g. Mirena) coil.
The copper coil is just a “device”, whereas the hormones in the Mirena make it a “system”.
Contraindications to contraceptive coils?
- Pelvic inflammatory disease or infection
- Immunosuppression
- Pregnancy
- Unexplained bleeding
- Pelvic cancer
- Uterine cavity distortion (e.g. by fibroids)
In women at increased risk of sexually transmitted infections (e.g. under 25 years old), screening for chlamydia and gonorrhoea is performed before insertion of a coil.
True/false?
True
What risks can occur on insertion of a coil?
- Bleeding
- Pain on insertion
- Vasovagal reactions (dizziness, bradycardia and arrhythmias)
- Uterine perforation (1 in 1000, higher in breastfeeding women)
- Pelvic inflammatory disease (particularly in the first 20 days)
- The expulsion rate is highest in the first three months
What does the women need to do before removal of the coil?
Before the coil is removed, women need to abstain from sex or use condoms for 7 days, or there is a risk of pregnancy.
When the threads of the coil cannot be seen, what 3 things should be excluded?
Expulsion
Pregnancy
Uterine perforation
If the location of the coil is undetermined, what may be required until coil is located?
Extra contraception (i.e. condoms) is required until the coil is located.
What is a copper coil (IUD) and how long is it suitable for after insertion?
The copper coil (IUD) is a long-acting reversible contraception licensed for 5 – 10 years after insertion (depending on the device).
Can a copper coil be used as emergency contraception and how long after unprotected sex is it used?
Can be used as emergency contraception, inserted up to 5 days after an episode of unprotected intercourse.
What is a notable contraindication to copper coil use?
Wilson’s disease
How does copper coil prevent pregnancy?
Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation.
Benefits of copper coil?
Reliable contraception
It can be inserted at any time in the menstrual cycle and is effective immediately
It contains no hormones, so it is safe for women at risk of VTE or with a history of hormone-related cancers
It may reduce the risk of endometrial and cervical cancer
Drawbacks of copper coil?
A procedure is required to insert and remove the coil, with associated risks
It can cause heavy or intermenstrual bleeding (this often settles)
Some women experience pelvic pain
It does not protect against sexually transmitted infections
Increased risk of ectopic pregnancies
Intrauterine devices can occasionally fall out (around 5%)
How many types of IUS are there?
4 types of IUS (all containing levonorgestrel)
What are the 4 types of IUS and how long are they licensed for use?
Mirena: effective for 5 years for contraception, and also licensed for menorrhagia and HRT
Levosert: effective for 5 years, and also licensed for menorrhagia
Kyleena: effective for 5 years
Jaydess: effective for 3 years
Most commonly used levonorgestrel IUS?
Mirena coil this is due to it being effective for 5 years for contraception, and also licensed for menorrhagia and HRT
How does the LNG-IUS prevent pregnancy?
The LNG-IUS works by releasing levonorgestrel (progestogen) into the local area:
- Thickening cervical mucus
- Altering the endometrium and making it less accepting of implantation
- Inhibiting ovulation in a small number of women
Benefits of LNG-IUS?
It can make periods lighter or stop altogether
It may improve dysmenorrhoea or pelvic pain related to endometriosis
No effect on bone mineral density (unlike the depo injection)
No increase in thrombosis risk (unlike the COCP)
No restrictions for use in obese patients (unlike the COCP)
The Mirena has additional uses (i.e. HRT and menorrhagia)
Drawbacks of LNG-IUS?
A procedure is required to insert and remove the coil, with associated risks
It can cause spotting or irregular bleeding
Some women experience pelvic pain
It does not protect against sexually transmitted infections
Increased risk of ectopic pregnancies
Increased incidence of ovarian cysts
There can be systemic absorption causing side effects of acne, headaches, or breast tenderness
Intrauterine devices can occasionally fall out (around 5%)
