Coils

Question 1

What are coils?

Answer 1

Coils are devices inserted into the uterus that provide contraception.

Question 2

What type of contraception are coils?

Answer 2

long-acting reversible contraception

Question 3

Once the coil is removed, fertility is restored. True/false?

Answer 3

True

Question 4

What is the 2 main types of coil (IUD)?

Answer 4

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

Question 5

What is the effectiveness of the coils?

Answer 5

Both 99% effective when fitted properly.

Question 6

What is difference between IUD (intra-uterine device) and IUS (intra-uterine) system?

Answer 6

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”.

Question 7

Contraindications to contraceptive coils?

Answer 7

• Pelvic inflammatory disease or infection
• Immunosuppression
• Pregnancy
• Unexplained bleeding
• Pelvic cancer
• Uterine cavity distortion (e.g. by fibroids)

Question 8

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?

Answer 8

True

Question 9

What risks can occur on insertion of a coil?

Answer 9

• 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

Question 10

What does the women need to do before removal of the coil?

Answer 10

Before the coil is removed, women need to abstain from sex or use condoms for 7 days, or there is a risk of pregnancy.

Question 11

When the threads of the coil cannot be seen, what 3 things should be excluded?

Answer 11

Expulsion

Pregnancy

Uterine perforation

Question 12

If the location of the coil is undetermined, what may be required until coil is located?

Answer 12

Extra contraception (i.e. condoms) is required until the coil is located.

Question 13

What is a copper coil (IUD) and how long is it suitable for after insertion?

Answer 13

The copper coil (IUD) is a long-acting reversible contraception licensed for 5 – 10 years after insertion (depending on the device).

Question 14

Can a copper coil be used as emergency contraception and how long after unprotected sex is it used?

Answer 14

Can be used as emergency contraception, inserted up to 5 days after an episode of unprotected intercourse.

Question 15

What is a notable contraindication to copper coil use?

Answer 15

Wilson’s disease

Question 16

How does copper coil prevent pregnancy?

Answer 16

Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation.

Question 17

Benefits of copper coil?

Answer 17

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

Question 18

Drawbacks of copper coil?

Answer 18

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%)

Question 19

How many types of IUS are there?

Answer 19

4 types of IUS (all containing levonorgestrel)

Question 20

What are the 4 types of IUS and how long are they licensed for use?

Answer 20

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

Question 21

Most commonly used levonorgestrel IUS?

Answer 21

Mirena coil this is due to it being effective for 5 years for contraception, and also licensed for menorrhagia and HRT

Question 22

How does the LNG-IUS prevent pregnancy?

Answer 22

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

Question 23

Benefits of LNG-IUS?

Answer 23

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)

Question 24

Drawbacks of LNG-IUS?

Answer 24

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%)

Question 25

Irregular bleeding is common in the first 6 months of LNG-IUS. True/false?

Answer 25

True

Usually settles with time. COCP can used alongside LNG-IUS if bleeding problematic.

Question 26

Progesterone IUS is completely contraindicated in women with fibroids. True/false?

Answer 26

False

Progesterone-releasing IUS is first line in fibroid-associated menorrhagia in fibroids smaller than 3cm and that doesn’t distort uterine cavity.