Coils

Question 1

What are the two types of coils?

Answer 1

Copper coil - contains copper and is toxic to sperm.

Levonorgestrel intrauterine system (Mirena) - contains progesterone which is slowly released into uterus.

Question 2

What are the contraindications for using a coil?

Answer 2

PID or infection, Immunosuppression, Pregnancy, Unexplained bleeding, Pelvic cancer, Uterine cavity distortion (e.g., by fibroids), Wilson’s disease (copper coil).

Question 3

What are the risks relating to coil insertion?

Answer 3

Bleeding & pain on insertion, Uterine perforation - rare, PID, Expulsion rate highest in first 3 months.

Question 4

What advice should be given to women before coil removal?

Answer 4

Abstain from sex or use condoms for 7 days or there is a risk of pregnancy.

Question 5

What should be excluded if threads can’t be seen or felt?

Answer 5

-Expulsion,
- Pregnancy
- Uterine perforation
- Use condoms until coil is located

Question 6

What investigations are done if you can’t feel/see threads?

Answer 6

• First investigation is USS
• Abdominal/pelvic X-ray can be used to check
• Hysteroscopy or laparoscopic
• surgery depending on coil location

Question 7

What is the copper coil?

Answer 7

A long acting reversible contraception licensed for 5-10 years after insertion and can be used as emergency contraception if inserted up to 5 days after an episode of unprotected sex.

Question 8

What are the benefits of the copper coil?

Answer 8

• Reliable contraception
• can be inserted at any time in the menstrual cycle and is effective immediately
• contains no hormones (safe for women at risk of VTE or with a history of hormone-related cancers)
• may reduce the risk of endometrial and cervical cancer.

Question 9

What are the risks associated with the copper coil?

Answer 9

A procedure is required to insert and remove the coil (with associated risks), can cause heavy or IMB (often settles), some women experience pelvic pain, doesn’t protect against STIs, increased risk of ectopic pregnancies, IUD can occasionally fall out.

Question 10

What are the 4 types of IUS?

Answer 10

1. Mirena → effective for 5 years (also licensed for menorrhagia and HRT as endometrial protection).
2. Levosert → 5 years (also licensed for menorrhagia).
3. Kyleena → 5 years.
4. Jaydess → 3 years.

Question 11

What is the mechanism of action for IUS?

Answer 11

Thickens cervical mucus, Alters endometrium and makes it less accepting of implantation, Inhibits ovulation.

Question 12

When can an IUS be inserted?

Answer 12

Up to day 7 of the menstrual cycle, without any need for additional contraception. If inserted after day 7, pregnancy needs to be reasonably excluded and extra protection is needed for 7 days.

Question 13

What are the benefits associated with IUS?

Answer 13

• May make periods lighter or stop altogether
• may improve dysmenorrhoea or pelvic pain related to endometriosis
• no effect on bone mineral density (unlike depo injection)
• no increased risk of VTE (like the COCP)
• no restriction for use in obese patients (like COCP), the Mirena has additional uses (e.g., HRT and menorrhagia).

Question 14

What are the risks of IUS?

Answer 14

• A procedure is required to insert and remove the coil (with associated risks)
• can cause spotting or irregular bleeding, some women experience pelvic pain
• doesn’t protect against STIs, increased risk of ectopic pregnancies
• increased incidence of ovarian cysts
• there can be systemically absorption (causing side effects of acne
  headaches or breast tenderness)
• IUD can occasionally fall out.