Expert / 1 July, 2021 / Ellie Thompson
Are coil fittings painful? Following recent press coverage surrounding the coil and most notably, Naga Munchetty’s harrowing experience, Dr Rebecca Gibbs, Consultant Gynaecologist, at The Portland Hospital (part of HCA Healthcare UK) joins us to tells us everything we need to know about the contraceptive device.
The coil is one of the most effective types of contraception around. Also known as the IUD (intrauterine device) or IUS (intrauterine system), coils provide women across the globe with safe, reliable family planning. Some of the intrauterine systems also offer relief from heavy periods and can even be used to help with managing conditions such as endometriosis or polycystic ovarian syndrome (PCOS).
Typically, fewer than 1 in 100 women will get pregnant in one year when using a coil as their method of contraception. They can be fitted in women who have or have not had children.
Coil fitting has been featured in the press recently after BBC journalist Naga Munchetty and author Caitlin Moran came forward to describe their traumatic experiences with the coil. During a BBC Radio 5 show in June 2021, Naga recalled the event as “the most physically traumatic” thing that she has been through, reporting that she fainted twice during the procedure.
So, do the contraceptive benefits of the coil outweigh the potential discomfort of having one fitted?
There are two different types of coil. Both are flexible devices, often shaped like a capital ‘T’. The copper coil (often called the IUD) is made from a mixture of plastic and copper and contains no hormones. It lasts for up to 10 years.
The hormonal coil (known as the IUS) is also made from plastic but contains a core that releases a small amount of the hormone progesterone directly to the lining of the uterus. The IUS lasts from 3 to 5 years depending on the device.
IUDs and IUSs work in similar ways. Through the release of either copper ions or progesterone the cervical mucus is altered making it harder for sperm to reach the egg to achieve fertilisation. The presence of the device sitting in the uterus also makes implantation of a fertilised egg more difficult. In some women with the IUS ovulation might stop altogether, but this is not necessary to get the contraceptive benefits.
Both the IUD and the IUS provide an alternative to contraceptives such as the pill or patches. Neither interrupt sex and if the coil threads (thin, flexible threads attached to the base of the device to allow removal) can be felt, they can be trimmed to stop this from happening.
Interestingly, the copper IUD and hormonal IUS have opposite effects on periods; the IUD can make periods heavier and more painful, so is not a good choice for women who already have a heavier flow. On the other hand, the IUS can help periods become lighter and shorter, with some women experiencing no periods at all.
Coils can be fitted at any point during the menstrual cycle. Your coil fitter (who might be a nurse, GP or a gynaecologist) will discuss with you whether this is the right form of contraception for you, and if there are any additional checks that are needed, such as a pregnancy test or sexual health screening.
The vagina is held open with a device called a speculum, which is the same piece of equipment used for taking smear tests. Once the cervix has been seen the coil, packaged in an inserter that looks a little like a drinking straw, is inserted through the cervix and released into place.
As a gynaecologist I feel that it is very important not to tell women that the procedure will be pain-free. Most women will feel a cramping discomfort during the procedure and possibly be aware of a period pain type sensation for a few days afterwards, which can be quite intense.
Naga’s experience of fainting is something that most coil fitters will have come across; it is possible for any procedure that stimulates the cervix to cause what is known as a vasovagal response, which women experience as a feeling of nausea, sweating or even fainting. Fortunately, most women who feel a little dizzy or unwell during insertion will feel much better quite quickly.
My advice for making your coil fitting procedure as straightforward as possible are as follows:
Most women who have a straightforward coil insertion can return to normal activities right away. Sometimes women are advised to check that they can feel the coil threads in their vagina 3-6 weeks after fitting as reassurance that the coil is still in place, as there is a small chance of a newly inserted coil being expelled by the uterus.
In very rare situations a coil fitting can result in infection, so it is very important to seek medical help if after a coil fitting if you experience abnormal or smelly discharge, a high temperature or pain in the lower abdomen.
If a coil fails and a woman becomes pregnant there is an increased risk of ectopic pregnancy (a pregnancy that develops outside of the uterus) and so seeking medical attention as soon as pregnancy is suspected is very important. This is, of course, a very rare event, and most ectopic pregnancies are not associated with coil use.
Removing a coil is usually very simple and is generally much quicker than insertion. Using a speculum, the strings are identified and given a firm but gentle tug. You might be asked to cough at the same time. Fertility returns to normal right away, unlike some of the other hormonal methods of contraception.
I am hopeful that Naga’s bravery in speaking out will lead to gynaecologists working with women to make the insertion of these safe, effective and long lasting devices as comfortable as possible.
Article by Dr Rebecca Gibbs, Consultant Gynaecologist, at The Portland Hospital (part of HCA Healthcare UK).