5.7 Coils

Question 1

What are the two types of coil?

Answer 1

Copper coil (Cu-IUD)

Levonorgestrel intrauterine system (LNG-IUS)

Question 2

What are the names of different IUS?

Answer 2

Levonorgestrel intrauterine system or LNG-IUS:
Mirena
Levosert
Kyleena
Jaydess
(system for hormones, IUD for copper)

Question 3

Effectiveness of coils?

Answer 3

99% and fertility returns immediately once removed.(use condoms for 7 days prior to removal)

Question 4

What are the contraindications to the coil?

Answer 4

• PID or infection
• immunosuppression
• pregnancy
• unexplained bleeding
• pelvic cancer
• uterine cavity distortion (ie submucosal fibroids)

Question 5

How is the coil inserted?

Answer 5

Bimanual, then speculum, then special device.

Record BP and HR before and after.

Question 6

Risks of coil insertion?

Answer 6

• bleeding
• pain
• vasovagal (dizziness, bradycardia, arrhythmias)
• uterine perforation 1 in 1000
• PID
• high expulsion rate in first 3 months

Question 7

What 3 possibilities need to be excluded when the threads aren’t visible?

Answer 7

• pregnancy
• expulsion
• uterine perforation

(condoms needed until coil located)

Question 8

How do you locate the coil if the threads are missing?

Answer 8

First ultrasound.
Xray if perforation and its in the peritoneal cavity.
Hysteroscopy or laparoscopy depending on location.

Question 9

How long is the copper coil licensed for?

Answer 9

5-10 years depending on device.

Question 10

On which days can the Cu-IUD be inserted?

Answer 10

Up to 5 days after an episode of UPSI (so long as not pregnant before that)
So can be used as emergency contraception.

Question 11

What is the mechanism of the Cu-IUD?

Answer 11

Copper is toxic to ovum and sperm

Alters endometrium making less accepting to implantation

Question 12

When is the Cu-IUD contraindicated?

Answer 12

Wilsons Disease (excessive accumulation of copper)

Question 13

What cancer is reduced with Cu-IUD?

Answer 13

may reduce the risk of endometrial and cervical cancer

Question 14

6 drawbacks of the Cu-IUD?

Answer 14

• procedure to insert and remove and these have risks
• can cause heavy or intermnestural bleeding (often settles)
• some women get pelvic pain
• no STI protection
• increased risk of ECTOPICS
• can sometimes fall out (5%)

Question 15

What is Mirena licensed for?

Answer 15

5 years contraception
menorrhagia
HRT (4 years license)

Question 16

What are the names and licenses of the LNG-IUS?

Answer 16

Mirena (5 years contraception, menorrhagia, HRT)

Levosert (5 years contraception, menorrhagia)

Kyleena (5 years contraception)

Jaydess (3 years contraception)

Question 17

Mechanism of LNG-IUS?

Answer 17

Release levonorgestrel (progestogen) locally causing:

• thick cervical mucous
• alter endometrium for implantation
• in some women it inhibits ovulation

Question 18

On what days can LNG-IUS be inserted?

Answer 18

Up to day 7 on menstrual cycle without extra condoms.

After day 7 then exclude pregnancy and condoms for 7 days.

Question 19

Benefits of LNG-IUS?

Answer 19

• periods are lighter or stop
• improves dysmenorrhoea or pain from endometriosis
• no effect on BMD
• not VTE risk
• no obese restriction

Question 20

Side effects of LNG-IUS

Answer 20

• increased incidence of ovarian cysts

- can have systemic absorption causing headaches, breast tenderness, acne

Question 21

What can be seen on a smear test on someone with and IUD?

Answer 21

Actinomyces-like organisms (ALOs)

Does not require treatment, if symptomatic of pelvic pain then remove the device.