Fertility Control - Coils

Question 1

What is a Coil?

Answer 1

A device inserted into the uterus that provides contraception (long-acting and reversible). Removing it will restore fertility.

Question 2

Contraindications of a Coil (7).

Answer 2

1. Pelvic Inflammatory Disease.
2. Infection.
3. Immunosuppression.
4. Pregnancy/28 Days Postpartum.
5. Unexplained Bleeding.
6. Pelvic Cancer.
7. Uterine Cavity Distortion (e.g. Fibroids).

Question 3

Main Contraindication of Cu-IUD.

Answer 3

Wilson’s disease.

Question 4

Mechanism of Action of Cu-IUD (2).

Answer 4

1. Copper is toxic to ovum and sperm.

2. Alters endometrium to make it less accepting of implantation.

Question 5

Indications of Cu-IUD (2).

Answer 5

1. Licensed for 5-10 years after insertion.

2. Emergency contraception (up to 5 days after UPSI).

Question 6

Mechanism of Action of LNG-IUS (3).

Answer 6

Releases Levonorgestrel into local area :

1. Thickens Cervical Mucus.
2. Alters endometrium to make it less accepting of implantation.
3. Inhibits ovulation (quite rare though).

Question 7

Protection of LNG-IUS (2).

Answer 7

1. Up to day 6 of menstrual cycle, no protection required.

2. After, requires extra protection for 7 days.

Question 8

Types of Coils (2).

Answer 8

1. Cu-IUD (Copper Intrauterine Device).

2. LNG-IUS (Levonorgestrol/Mirena) Intrauterine System.

Question 9

Prior to Insertion (4).

Answer 9

1. Women at risk of STI e.g. under 25, screened for Chlamydia and Gonorrhoea.
2. Bimanual examination (size and position of uterus).
3. Speculum and specialised equipment.
4. Forceps to stabilise cervix maybe.

Question 10

Post-Insertion (2).

Answer 10

1. Seen 3-6 Weeks After to check threads.

2. Teach lady to feel strings to ensure coil remains in place.

Question 11

What happens if the threads cannot be seen or palpated? (4)

Answer 11

1. Exclude expulsion, pregnancy, uterine perforation.
2. Extra contraception until located.
3. US used to check for it (or AXR/PXR).
4. Hysteroscopy/Laparoscopy may be required.

Question 12

Removal of Coils (3).

Answer 12

1. Abstain from sex or use condoms for 7 days to prevent pregnancy.
2. Locate and slowly pull strings to remove device.
3. If fitted after 40, it can stay in place until after menopause.

Question 13

Adverse Effects of Coil Insertion (6).

Answer 13

1. Temporary Crampy-Period Pain (NSAID).
2. Bleeding.
3. Vasovagal Reaction.
4. Uterine Perforation (higher risk in breastfeeding women).
5. PID (in the 1st 20 days).
6. Expulsion (in 1st 3 months).

Question 14

Adverse Effect of LNG-IUS (1).

Answer 14

Irregular Bleeding.

Question 15

Adverse Effect of Cu-IUD (1).

Answer 15

ALO (Actinomyces-Like Organisms) discovered as incidental finding in smear tests. No management unless symptomatic.