Sexual Health - Coils Flashcards
What are the two types of IUD?
Copper
Levonorgestrel IUS
Both more than 99% effective
How long does it take for fertility to return after removal of coils?
Immediate return
Why is the Mirena coil called the IUS?
Intra-uterine system
Contains hormones which make it a system
Copper doesn’t so just a device
What are the contraindications of coil use?
PID
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Fibroids
Who is screened for chlamydia and gonorrhoea before coil insertion?
Women at increased risk
e.g. under 25 years old
What is required before coil insertion?
Bimanual to check position and size of the uterus
Speculum inserted and device then used to fit coil
What should women be made aware of after insertion?
May be temporary crampy period type pain
NSAID use
Need to be seen after 3-6 weeks to check threads, should be taught to feel to ensure coil is in place
What are the risks of coil insertion?
Bleeding
Insertional pain
Vasovagal reactions
Uterine perforation (1/1k higher in breastfeeding women)
PID (especially in first 20 days)
Expulsion rate highest in first 3 months
What advice is given before removal?
Women need to abstain from sex or use condoms for 7 days
Pregnancy risk
Strings located and slowly pulled to remove device
What needs to be excluded when threads are not seen or palpated?
Expulsion
Pregnancy
Uterine perforation
Extra contraception must be used until coil located
Pelvic USS first line
Abdominal and pelvic x-ray
Hysteroscopy or laparoscopic surgery needed depending on coil location
How long does the copper coil last?
Long-acting reversible contraception
5-10 years
What is the period that the copper coil can be used as emergency contraception for?
5 days
When is the copper coil contraindicated?
Wilson’s disease
How does the IUD work?
Copper is toxic to the ovum and sperm
Alters endometrium and less receptive
What are the benefits of the IUD?
Reliable
Inserted at any time in cycle and effective
No hormones, so safe for women with VTE risk or hormonal cancers
Reduces risk of endometrial and cervical cancer
What are the drawbacks of the copper IUD?
Procedure required
Can cause heavy or intermenstrual bleeding
Some women get pelvic pain
No STI protection
Increased risk of ectopic pregnancy
IUDs can fall out (5%)
What is the Mirena coil used for?
Contraception
Menorrhagia
Endometrial protection for women on HRT
How long does the Mirena coil last?
5 years
What IUS can be given for a shorter period of time than the Mirena coil?
Jaydess
3 years
How does the IUS work?
Releases levonorgestrel (progestogen)
- Thickens cervical mucus
- Reduces endometrium receptiveness
- Inhibits ovulation in small number of women
When can the LNG-IUS be inserted?
Up to day 7 with no additional contraceptive need
After day 7, need to exclude pregnancy and used additional contraception for next 7 days
What are the benefits of the IUS?
Makes periods lighter or stop
Improves dysmenorrhoea
No effect on bone mineral density
No increase in thrombosis risk
No restrictions for use in obese patients
Can be used for HRT and menorrhagia
What are the drawbacks of the IUS?
Procedure
Can cause spotting or irregular bleeding
Some women get pelvic pain
No STI protection
Increased ectopic pregnancy risk
Increased ovarian cysts
Can be systemic absorption, acne, headaches or breast tenderness
Expulsion (5%)
What can be used for problematic bleeding in the LNG-IUS?
COCP for 3 months
What are actinomyces-like organisms?
Often discovered incidentally during smears in women with IUD
Do not need treating if asymptomatic
May get pelvic pain or abnormal bleeding
Device removal may be considered
