Hormone Coil Counselling

 

Hello, I’m Dr Brun. If you don’t know me, I’m one of the GPs at Elmham surgery and one of the Drs who fits coils. 

This short video is about the Hormone coil. Otherwise know as the Intra uterine system (or IUS for short). There are a few different makes of hormonal coils, the commonest one is the Mirena Coil which is the one we tend to use, so the information following is about the mirena coil. 

Hormonal coils are different to copper coils. Though they are fitted in the same way, they have differences. I’ll talk about copper coils in a separate video. 

You may be watching this because you’ve been asked to by one us before having a coil fitted. This is to make sure you understand before your procedure, what it is, how it works and the advantages and disadvantages of having one

The Mirena Coil

The mirena coil is a small plastic T shaped device which is inserted into the womb. Here’s a demo one so you can see the size and shape of it. It contains a form of the hormone Progestogen which is gradually released into the womb. It’s safe for most people to use, even those who have never had a baby. There are a few health conditions where we need to avoid using a mirena coil. These include breast cancer, cervical cancer awaiting treatment, endometrial (womb) cancer, current sexually transmitted infections (STI), Pelvic inflammatory disease, severe infection post childbirth or abortion, liver disease, HIV infection and Pelvic Tuberculosis. Some of these are rare but the commonest one to consider is an STI, more on that shortly. 

The hormonal coil has 3 main uses: 

Firstly it is a form of long-acting reversible contraception. It’s very effective at preventing pregnancy, over 99% effective. For contraceptive purposes it lasts for 8 years. Once it’s removed, your fertility returns. You can keep having hormonal coils fitted every 8 years for as long as you want or need them. 

Secondly it’s a very effective treatment for heavy periods. While it can take a few months to settle down, by 12 months many women will only have a day or 2 of spotting a month. 1 in 5 will have no bleeding. Some may get slightly more frequent spotting but it is usually very light. Because it reduces blood loss dramatically, it also helps reduce painful periods too. 

Thirdly, it can be used as part of HRT. For heavy bleeding and HRT it lasts for 5 years. 

The hormone coil works in a few ways. It thins the lining of the womb. This reduces bleeding and it also prevents a fertilised egg implanting. Secondly it thickens the mucous at the entrance of the womb to prevent sperm entering the womb. Thirdly, in some cases it prevents ovulation (an egg being released). 
 

The benefits of the hormonal coil

It’s very effective, there’s no need to remember to take a pill everyday for contraception. It reduces heavy bleeding. It releases hormones locally, directly into the womb. Because of this, there are less side effects than oral contraceptives. Side effects can happen, particularly in the first 2 or 3 months, but they tend to quickly settle and be mild. For any contraceptive containing this hormone, including the hormone coil, they include headaches, breast tenderness, acne, low mood and ovarian cysts. 
While the coil is excellent at preventing pregnancy, on the rare occasion it fails and pregnancy occurs, there is a slightly higher than normal risk of that pregnancy being ectopic. This means it doesn’t grow in the correct place, in the womb. This can be very dangerous so it’s vitally important any pregnancies associated with a coil are reported to us straight away as an urgent scan needs to be arranged. 
Because the coil sits inside the womb, a small procedure is needed to fit it. This is a little bit like having a smear test but it lasts a bit longer and can cause some tummy cramps. It involves passing the coil, in it’s inserting tube, up through the vagina and into the womb. We use an instrument called a speculum to allow us to gently open up the vagina enough to see. This is the same instrument that is used during a smear. We use a local anaesthetic spray to numb the entrance to the womb to help reduce pain. We then measure the size of the womb with a special thin ruler before inserting the coil. This process takes approximately 15 minutes. While most people tolerate the procedure very well without problems there are a few potential complications to be aware of.

Firstly, in approximately 1/20 cases, the womb sees the coil as a foreign body and pushes it out. This tends to happen in the first few months of fitting if its going to happen. 

Secondly, 1/100 will get a infection as a result of the coil fitting. This can happen if there is infection sitting in the vaginal canal, which is then pushed up, with the coil, into the womb. Because of this we ask all women to do a self taken vaginal swab to check for chlamydia before the time of fitting. You can collect a swab kit from reception desk. Please read the leaflet and return it once completed. Do write your name and DOB on the label. This must be done well before fitting to give us a chance to get the results. The sooner you do this the better.

Thirdly there is a 1/500 risk that when we introduce the coil into the womb, instead of sitting nicely inside the womb, it pushes through the muscular wall of the womb and falls down into the pelvis. This is called a perforation. It usually happens at the time of insertion or within the first few days. It usually causes pain and bleeding. This needs key hole surgery to remove it. It is more common in women who have recently had a baby and are breast feeding. Because of this we never fit a coil shortly after a baby has been born. We prefer to wait until 6 months after delivery and use another form of contraception to cover until then. 

The coil has very fine threads that hang out of the bottom of it into the vaginal canal. (Show on the demo coil). You’ll just be able to feel these with your finger if you insert it up into your vagina. They shouldn’t interfere with sex. You’ll be shown at the time of your fitting how to feel for your own threads. You’ll also be told what to do if you can’t find them. It’s important to check your threads so you know the coil is sitting in the correct place, in the womb, and that it hasn’t been expelled. Sometimes the threads can wiggle up inside the entrance to the womb and be hard to feel. This can sometimes make removing a coil tricky too. We have different ways of trying to retrieve threads if this happens. You mustn’t use tampons for 7 days after insertion as they can catch the threads and pull the coil out before it’s settled down.

We recommend that you take a painkiller of your choice such as paracetamol or ibuprofen before the fitting. Also do bring a sanitary towel as its common to get some light bleeding and cramps afterwards. 

The coil will be effective as a contraceptive after 7 days. If it is inserted in the first 7 days of your period it will be effective straight away. We can fit a coil anytime in your cycle, as long as any bleeding is light. 
If you’d like any more information, do have a look at the websites listed below.

Thank you for listening and goodbye.