Contraceptive coil fitting advice

Advice BEFORE a contraceptive coil fitting

Timing of coil fit

• Before a coil can be fitted it is important that there is no chance you are pregnant.• Continue regular, effective contraception up until your coil fitting
• The ideal time to fit a coil is in the first 7 days of your cycle (day 1 is the day your period starts). The insertion procedure may be easier at this time in your cycle, however it can be fitted at other times in your menstrual cycle
• If you are using condoms, it may be best to try to abstain, as if you have a burst condom and take emergency contraception in the 7 days before fitting, we may not be able to fit the coil
• If you don’t have periods at present (eg during breastfeeding or whilst using other methods of contraception), a coil fit can be arranged at any time providing there is no chance of pregnancy. In some circumstances a negative pregnancy test may be needed before a coil can be fitted. To rely on a negative result, effective contraception or abstinence from sex is required for the 3 weeks before the pregnancy test
• After having a baby it is advisable to wait 4 weeks before a coil is fitted. There are other appropriate forms of contraception available to use before this time. Visit the NHS Sex and contraception after birth webpage for more information, or discuss with a nurse/GP

Coil replacement

• If you already have a coil in place, please either abstain from sexual intercourse or use a condom carefully in the 7 days before you attend. Sperm can live in the pelvis for 7 days, so there is a theoretical chance of pregnancy if this advice is not followed, as, on rare occasions it may not be possible to fit the replacement coil successfully
• If you are attending for a replacement coil and your coil change is overdue, you are advised to use an alternative form of contraception eg condoms. In some cases a negative pregnancy test, after at least 3 weeks of contraception/abstinence may be required before the coil can be changed

Before the fitting

• Please take some painkillers an hour before the procedure (either ibuprofen 400mg (with or after food) or paracetamol 1g- or both-as long as you are not allergic to these) as some ladies experience discomfort, like period cramps, during coil insertions
• Some ladies can feel a little faint during and after the fitting. It is therefore advisable to have someone with you or someone you can contact by telephone in case you feel unwell
• If possible, ask a friend to accompany you to drive you home
• If you can arrange childcare and come without children this may be helpful for you. If you can’t do this then don’t worry
• It is usual practice to offer a chlamydia test before fitting an IUD/IUS to all our patients. This should have been done in the few weeks before fitting, but if for some reason this hasn’t happened, the swab may be taken at the time of the coil insertion
• Please wear loose, comfortable clothes and footwear for your appointment
• Remember, you can change your mind about having a coil fitted at any time

The fitting process

• Please allow an hour for the appointment
• The doctor will ask questions to check the coil is suitable for you. You will have the opportunity to ask any questions, before giving your consent to proceed with the fitting. If at any stage you change your mind about the fitting, the procedure can be stopped
• The process of fitting a coil is similar to what happens with a smear test. A vaginal examination will be undertaken and then the coil fitted. You may feel some discomfort, but this varies from person to person. The doctor and nurse will do their best to reassure you and make the procedure as pleasant as it can be
• You will be given advice after fitting about what to expect and when to come back
• Please ensure you have no major commitments afterwards as you may need to take it easy and relax for the rest of the day

After the fitting

• Use condoms for 7 days and consider using additional contraception
• You may experience bleeding or cramping. Continue with regular painkillers if required. If the pain is more uncomfortable than a period, talk to a doctor
• Avoid tampons for the first week, but thereafter it is ok to use them
• If you have any concerns after your coil fitting please do not hesitate to contact the surgery for advice

Possible risks

• Discomfort/dizziness/fainting on insertion
• Infection
• Expulsion or change of position (up to 1 in 20)
• Failure (IUD- up to 1 in 100 at 1 year, up to 2 in 100 at 12 years, IUS- up to 1 in 100 at 5 years)
• Ectopic pregnancy (if pregnancy occurs)
• Damage to cervix or womb including perforation ( up to 1 in 500)
• Altered vaginal bleeding (IUD- heavier, more painful or prolonged periods, IUS- erratic bleeding up to 6 months)
• IUS- hormonal effects- greasy skin. Mood changes, weight change

Advice AFTER a contraceptive coil fitting

• Copper IUCD (CuIUCD) eg NovaT380, TSafe380 - information
• Intrauterine system (IUS) eg Mirena, Levosert, Kyleena, Jaydess – information

How should I feel afterwards?

Most women experience some period-like discomfort/cramps for 24-72 hours after fitting, which then usually settles. For some people there can be mild intermittent cramps continue for 1-2 weeks.

There may be some bleeding or spotting for a few days. If an IUCD is fitted during a period, the period may be heavier and last slightly longer than usual.

If the pain is severe, is not being relieved by simple painkillers, gets worse, does not settle fully after 1 week or you are bleeding heavily, you should contact your GP or Practice Nurse (or call 111 if the Practice is closed).

What should I do afterwards?

Avoid using tampons and menstrual/moon cups for 7 days after the coil fit, just use pads. You can use tampons again if needed after 7 days, but please be aware menstrual cups can dislodge the coil if the threads are caught and can be pulled out with the cup – ensure the seal is fully released.

Take simple painkillers such as Paracetamol and/or Ibuprofen (as long as you are not allergic to these products). Take what you usually would to manage period pains.
Rest for several hours after fitting and avoid strenuous activity for the rest of the day.
Using a hot water bottle and sometimes gentle walking might help.

When can I resume sex?

A copper IUCD is effective straight away as contraception.

An IUS (Mirena/Levosert/Kyleena or Jaydess) will not work as contraception for the first 7 days and you should abstain from sex or use another contraceptive method at the same time.

Otherwise, you can resume sexually activity whenever you feel comfortable. IUCDs do not protect you against sexually transmitted infections so additional barrier protection such as condoms may still be advisable, especially in the 1st week due to the higher infection risk and with any new sexual partner (it would be advised they have an infection screen prior to unprotected sex).

Is there anything I should look out for?

A change in bleeding pattern occurs frequently after your coil insertion, you can bleed lightly for a few days, sometimes up to 1 week. With a new copper coil, you will likely have heavier and more painful bleeding. Irregular bleeding and a dark brown ‘stringy’ discharge is particularly common with an IUS device but should settle after 3-6 months to possibly no period or a light period most months. The hormonal side effects such as headaches, breast tenderness, oily skin or mood changes are rare and may settle within 8 weeks (this is as slightly more hormone is released in the 1st 6-8 weeks after it is fitted). See your GP if the side effects are persisting and bothering you.

With a copper IUCD periods can become heavier, longer and more painful but then often improve after the first 3 months, you can also get a small light bleed in the middle of your cycle, after sex and exercise for the first 3 months. If you are concerned about bleeding, please speak to your Practice Nurse or GP.

If you think you may have an infection, please contact the GP Practice as soon as possible.

Symptoms of an infection may include:

• Persistent or worsening lower abdominal pain
• Abnormal vaginal discharge
• Fever
• Pain during sexual intercourse

When does the coil need changing?

All intrauterine devices are effective for at least 5 years (except Jaydess which is 3 years) and some for up to 10 years. You should have been advised of the date for replacement at the time of fitting; if not, please ask. It is then your responsibility to attend your GP or local sexual health clinic before this date to have your coil removed or changed.

If you have had an IUS (Mirena or Levosert) fitted after the age of 45, (or a copper IUCD fitted after the age of 40), you can continue to use the same device for contraception until no longer required (usually at age 55).

Removing a coil

A coil can be removed at any time by a trained nurse or doctor gently pulling on the threads, this can cause some very brief cramps. We recommend trying the method for at least 3 to 6 months to see if it suits you before having it removed. If irregular or heavy bleeding is a problem, there are medication options that can be prescribed for a few months which may help. If you don’t want to be pregnant, avoid sex or make sure to use a condom in the 7 days before your coil is removed or changed for another coil. This is to avoid any risk of unintended pregnancy.

If you are planning for a pregnancy, please speak to your GP, it is advised to start folic acid and vitamin D 3 months prior to trying for a baby. Visit the NHS Planning your pregnancy webpage for more information.

Checking your threads

We recommend that you check for your coil threads ideally once a month (after your period if you have them) – some people do not want to feel for the threads, or simply cannot ever feel them – we would advise you to seek a review if your bleeding pattern changes, you are having new abdominal pains or discharge so your coil can be checked.

• Wash your hands and sit or squat down.
• Gently put your finger inside your vagina (as if inserting a tampon).
• Feel for your cervix (which feels firm, like the end of your nose).
• Gently roll your finger over your cervix and you should feel your threads. (Although there are two threads they usually stick together and you will only be able to identify them as one thread; this is fine).
• It is unlikely that your coil will fall out, but if you cannot feel your threads or if you feel something hard and plastic other than the threads, please abstain from sex or use condoms, check a pregnancy test and make an appointment to have the device checked.

If you think you may have had sex since the coil has moved, you may need emergency contraception. Please check a pregnancy test and seek advice as soon as possible from your GP or 111. If the threads cause discomfort to you or your partner, they can be trimmed, please contact the practice for a routine appointment.

Additional advice

We do not routinely see patients for follow up after a coil fit, but we are always very happy to see you if you have any concerns. Please contact the Practice for an appointment.

If you are aged 25 or over, make sure you have regular cervical smears as part of the National Cervical Screening Programme (you will receive a letter about this about 6 months before your 25th birthday).

We recommend regular sexual health checks for everyone, but especially if you have a new partner or believe you may be at risk.

UHS offers a self-swab walk-in service for STI screening which you can request at reception. You can also check online if you're eligible for free postal kits.

If you have questions or concerns about sexual health testing you can submit an online request or contact Sexual Health Sheffield.

contact your GP or the local sexual health clinic if requiring sexual health testing.

Post-coil fitting - removal and pain management advice

“Will fitting or removing the coil be painful?”

Although some women may feel nervous before, and some find a coil insertion painful, studies suggest the majority of women experience only mild or moderate pain/discomfort (rather than severe) during coil fitting, even without pain relief.

Pain from a coil fitting usually feels like lower abdominal cramps with some having lower back ache too, this can sometimes last hours to days.

Women who reported greater pain were often those who have never given birth, who have delivered only by Caesarean section, or those who regularly experience painful periods.

It is impossible to predict how each person will feel during the procedure, but the team will do their absolute best to ensure you feel relaxed, supported, fully informed and that you are in control every step of the way.

Make sure you have these ‘over the counter’ painkillers at home

We recommend you take the following painkillers one hour before your procedure to provide you with pain relief during, and to take after the insertion or removal for a few days (following packet instructions).

You can take (as long as you are not allergic to any of the ingredients):

• Two 500mg tablets of paracetamol AND/OR
• One 400mg (OR Two 200mg tablets) tablet of Ibuprofen,
• OR One 500mg tablet naproxen

During the procedure in the GP practice

We want you to feel as relaxed as you possibly can, and if it helps to bring along a friend/partner (who may be asked to wait for you outside the room during the actual fitting), or even listen to some music, then that’s fine with us. Some feel that chatting helps to distract, others prefer to meditate.

In addition to the recommended regular painkillers, the following pain relief methods are offered from the healthcare professional fitting the coil (each clinician may have their own preference from experience):

• Local anaesthetic gel can be applied to the neck of the womb; this may potentially cause mild cramping

The healthcare professional will discuss these options with you if further pain relief is necessary and check for any allergies. A trained health care assistant will also be present to help and support you throughout.

Removal in the GP practice

People usually do not find the removal of a coil uncomfortable; it is much quicker than insertion. If a new coil is wanted (as long as you have not had sex without a condom 7 days before an appointment) this can be inserted immediately after the previous coil is removed. The experience of the insertion of a new coil may be similar to the last coil but it also may be different.

(Adapted from FSRH statement: Pain associated with insertion of intrauterine contraception June 2021)