Hormonal IUD (hormonal coil)

What is a hormonal IUD (hormonal coil)?

• IUD stands for intrauterine device, more commonly known as a coil.
• A hormonal IUD is small, flexible piece of plastic shaped like a T.
• It’s sometimes called the IUS (intrauterine system) or the LNG-IUD.
• It's inserted into the womb to prevent pregnancy.
• It’s more than 99% effective at preventing pregnancy.
• It’s easily inserted by a trained healthcare professional.
• It’s a method of long-acting reversible contraception.
• It can be used as contraception for 3, 5 or 8 years, depending on the type you have.
• It releases a hormone called levonorgestrel.
• It usually makes periods lighter, shorter and less frequent.
• For some people, periods stop while they’re using the hormonal coil.

How does a hormonal coil work?

A hormonal coil releases a progestogen hormone called levonorgestrel into the womb.

This thickens the mucus at the entrance of the womb so it’s difficult for sperm to pass through. It also thins the womb lining, so it’s difficult for a fertilised egg to implant there.

In some people, the hormonal coil stops ovulation (an egg being released).

How effective is a hormonal coil?

All types of hormonal coil are over 99% effective at preventing pregnancy. Fewer than 1 in 100 hormonal coil users will get pregnant in a year.

How long does a hormonal coil last?

A hormonal coil can protect you from pregnancy for 3, 5 or 8 years, depending on the type you get.

• Benilexa, Levosert and Mirena are effective for 8 years.
• Kyleena is effective for 5 years.
• Jaydess is effective for 3 years.

You can have the hormonal coil taken out at any time if you want to stop using it or change to a different type of contraception.

A coil that lasts for a longer time will need replacing less often. This may lower the chance of complications, such as perforation, which may be more likely when the coil is replaced.

Getting a hormonal coil fitted

Some services may offer you a consultation appointment and then a separate fitting appointment. Other services will do both at the same appointment.

You may be advised to screen for sexually transmitted infections (STIs) before the fitting.

If you’re getting a coil fitted after giving birth or have young children, try to arrange childcare or take another adult with you to the fitting appointment. If you think you’ll need to take a baby or child with you, check with your service first.

• The coil fitting appointment usually lasts about 20 to 30 minutes.
• You’ll have an internal (in the vagina) examination to check the position of your womb before the coil is put in.
• Your healthcare professional will use a speculum (narrow tube) to open the vagina and see the cervix.
• It usually takes about 5 minutes to insert the coil through your vagina and cervix into your uterus.
• This can be uncomfortable or painful. You should always be offered pain relief choices, including a local anaesthetic. If not, you can ask for this.
• You can ask to pause or stop the procedure at any time.

After the coil is fitted, your healthcare professional will show you how to check it’s in place by checking your threads/strings.

You may have some pain and/or a little bleeding. This should settle within a few days. If it doesn’t, call your GP or sexual health clinic in case you have an infection.

Does a hormonal coil have any benefits?

• It’s one of the most effective methods of contraception.
• It only needs replacing every 3, 5 or 8 years.
• It’s great at improving heavy or painful periods and can also benefit women in perimenopause.
• Its effectiveness is not affected by any medicines you take.

Are there any possible side effects or risks from a hormonal coil?

• Your periods will probably change while using a hormonal coil. They may become much lighter, less frequent, irregular or stop.
• Occasionally, the hormonal coil can cause temporary side effects such as spotty skin (acne), breast tenderness and mood changes. These tend to stop within a few months.
• In about 1 in 20 people, the hormonal coil can become displaced and gets pushed out of your womb (expulsion). It’s a good idea to regularly check it’s in place. Your healthcare professional will tell you how to do this.
• There is around a 1 or 2 in 1,000 risk of the coil perforating (poking into or through) the womb lining. This may mean the coil does not effectively prevent pregnancy. The coil should be removed. The uterus will heal by itself and after that you can have a new coil inserted if you want to.
• If you have a coil inserted soon after giving birth, the risk of expulsion and perforation can be higher.
  There’s a small risk you could get an infection within the first 3 weeks of having the coil fitted. Getting tested for STIs before the coil is fitted can help reduce this.
• You're very unlikely to become pregnant when using a hormonal coil but if you do, there’s a higher than usual chance of having an ectopic pregnancy.
• Current or recent users of any hormonal contraception, including the hormonal coil, may have a small increase in their risk of developing breast cancer. The overall risk is still very small. Everyone is advised to check their breasts or chest regularly.

Other things to consider when getting a hormonal coil

• In the first 3 months you may get irregular bleeding and spotting, and bleeding may last longer. After this, bleeding usually becomes lighter and less frequent and may be irregular or stop. In some people, periods may also be less painful.
• Experiences of having a coil fitted can vary. It can be painful or uncomfortable. You should always be offered pain relief choices, including a local anaesthetic. If you’re not offered this, it’s always ok to ask for it.
• You’re in control. You can pause or stop your coil fitting at any time.
• The coil is inserted through your vagina using a speculum. Your healthcare professional will need to feel inside your vagina first to check the position of your womb.
• You may feel a little sore or tender or have light bleeding after it’s been put in. Painkillers can help with the soreness and these symptoms do settle.
• The coil doesn’t help prevent sexually transmitted infections so you may want to use condoms too.

Where to get a hormonal coil?

A hormonal coil needs to be fitted by a trained healthcare professional. It’s not available to order from SHL.

Londoners can get a hormonal coil (IUD) fitted for free at:

• London NHS sexual health clinics
• Some GP surgeries
• Some young people’s services
• Some Women’s Health Hubs

A hormonal coil can be fitted at any time during your menstrual cycle if there is no risk you could be pregnant.

Removing or replacing the hormonal coil

• The hormonal coil needs to be removed by a trained healthcare professional.
• You can make an appointment at a sexual health clinic or your GP surgery.
• Your fertility returns to what’s normal for you once the hormonal coil is removed.
• If you want to get a new hormonal coil at the same appointment, make sure you go to a service that also fits coils.

Is a hormonal coil right for me?

• A hormonal coil could suit you if you want effective long-lasting contraception that you don’t need to remember. An added benefit is that it can help make your periods lighter and shorter – this might also help to make them less painful. In some people, periods can stop while you’re using the hormonal coil – some people love this and some people are less keen. If you need STI protection, you’ll need to be happy using condoms too.
• It’s not as instant as some other types of contraception because you need to wait for an appointment to get it fitted. But you should be in and out of the fitting appointment in less than an hour. And then you don’t need to think about it again for at least 3 years and as long as 8 years, depending on which type you get. But if you don’t get on with the hormonal coil, want to try a different method, or try to get pregnant, you can get it taken out any time. It just needs a quick trip to your GP or sexual health clinic.
• People often worry about whether having a coil inserted will be painful. Most people experience mild pain; but some describe having severe pain. It’s usually somewhere between uncomfortable and quite painful. Coil fitters are trained to offer you pain relief to minimise any pain. If yours doesn’t offer, you can ask for it. The insertion itself usually takes less than 5 to 10 minutes. You can stop or pause at any time. Once the coil is in place you shouldn’t be able to feel it or have any lasting pain.
• Other types of long-acting reversible contraception you could consider are: the implant (lasts years) and the injection (lasts for 3 months). Periods often become lighter, shorter or less painful when using these methods. They can stop completely for some people – but bleeding patterns can be unpredictable.
• The copper coil is a very effective non-hormonal option that lasts for 5 or 10 years. This may not be suitable if you have heavy or painful periods as it can make periods longer, heavier or more painful for some people.
• If you’d prefer something a bit more flexible, so you can manage your bleeding pattern in a way that suits you, you could choose from the combined pill, the contraceptive patch or the vaginal ring (NuvaRing). All these and progestogen-only pills are available by post from SHL.
  

This Brook tool can help you consider the best contraception for you.

Helpful Links

• IUS (intrauterine system) or hormonal coil - NHS
• LNG-IUD (Hormonal coil) | Contraception Choices
• What is the Hormonal Coil - Brook

Sources / Credits

Intrauterine Contraception | CoSRH

UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) | CoSRH