Long Acting Reversible Contraception

Contraceptive Implant

Risks 
There is always a risk of bruising, bleeding, infection and scarring with any minor surgery. With implants there is a risk, albeit a very small (tiny) risk of damaging nerves and vessels in the arm. The implant has a failure rate of 1/1000 which means it is almost perfect but not quite.

Procedure
We give you a small injection of local anaesthetic which does sting. We then fit the implant under the skin.

FAQs
There are some medications which make the implant ineffective. These are generally rare things, but it is important that if you are buying anything over the counter at the chemist, other than straight forward paracetamol or ibuprofen, or are being prescribed anything, you should check with whoever is supplying this whether or not it will affect your implant before you start taking it. If it does affect the implant you will need to use condoms carefully alongside the implant for the duration of the medication and for 4 weeks afterwards.

It does not give you any protection against sexually transmitted infections so if you think you may be being put at risk of these you should use condoms and get yourself tested.

The implant lasts for 3 years, and it is your responsibility to book and attend an appointment for replacement of the device.

If you do not manage to get the device replaced within 3 years you will need to use condoms carefully after it runs out until you get it replaced.

Side Effects
The side effects of the implant are changes in hair, changes in skin, changes in mood, changes in weight and headaches.

If you have side effects that you feel are unacceptable, the implant can be removed and the hormones will be out of your system within 7 days.

The bleeding pattern with the implant will be anything between no bleeding at all and bleeding every day like a period.

Most women will have a bleeding pattern that they find acceptable, but we ask that you give it three months for the bleeding pattern to settle down.

If at this stage, you are still having problems seek medical advice. You will be supplied with a card with the dates of fitting and when it will need to be replaced.

This form of contraception has an exceptionally low dose of hormone of which there are two IUS options:
•    Mirena
•    Kyleena
 
The Mirena is going to stop your periods, whereas the Kyleena is less likely to do so, but the Mirena contains a higher dose of hormone.
Most women do find that having a coil inserted is a painful/unpleasant experience. We advised taking some analgesia (pain relief) about 30 mins before your appointment. We also recommend that you have something to eat and bring a sugary drink with you.

Ideally you should arrange for someone to drop you off at the clinic and then collect you again so that if you are feeling a little unwell you do not need to drive home alone.

Once it is in and settled it a is a particularly good form of contraception and you will be able to rely on it for contraception for the next 5 years.

The Mirena is also licensed as part of HRT (hormone replacement therapy), and as part of the management of heavy menstrual bleeding and some other gynaecological problems.

Procedure
The IUS is, using a small plastic introducer, placed into the uterine cavity via the cervix (neck of the womb). There is always a risk of damaging the cervix and perforation the womb, and no matter how careful or experienced a practitioner is, this risk cannot be removed entirely.

How IUS works
The mucus plug at the cervix (neck of the womb) becomes very thick which prevent sperm being able to enter the uterus.


The lining of the womb (uterus), over time, becomes very thin so that any embryo is unable to embed in it (pregnancy). It is this thinning of the lining of the womb that causes periods to become lighter, less painful, and often stop altogether. It can take some time, weeks even months, for this to reach its full effect and whilst the IUS is doing this you may get spotting/bleeding sometimes daily.

It creates an in-hospitable atmosphere within the uterus which means sperm/eggs/embryos are not happy there. It will stop some/all of your ovulations. Most of the hormone works to produce the above effects, but a small amount of hormone does get into the blood stream.


The effects of this hormone can include changes in hair, changes in skin, changes in weight and changes in mood. Because it is such a small dose of hormone most women will either have none of these side effect or will have mild hormonal side effects for a brief period.

The hormonal coils have a failure rate of 1:300 which means if three hundred women use one for a year one of them will get pregnant.
If you are this unfortunate one that gets pregnant with a coil in, there is an increased risk that this pregnancy will be ectopic (pregnancy in the fallopian tubes rather than in the uterus where it is supposed to be).

It is not that the coil has caused an ectopic pregnancy, but that it has failed to stop it. It is particularly good at stopping intrauterine pregnancies and not so good at stopping ectopic pregnancy, so from a statistical point of view if it is going to miss a pregnancy it is the ectopic one it is going to miss.

It is therefore especially important that if anything makes you thinks you may be pregnant, you need to do a pregnancy test.


If this pregnancy test is positive you need to seek reasonably urgent medical advice so that a scan can be arranged to see where the pregnancy is, and then you can be advised on your options regarding this unplanned pregnancy.

The coils do not give you any protection against sexually transmitted infections, so if you feel you are being put at risk it is important to use condoms for sex and to seek an STI check.

Infection following having the coil fitted

The vagina contains bugs/germs, and when we fit a coil, we can take some of these bugs into the uterus. Normally your immune system will deal with this, and you will be unaware of what has happened but, occasionally you can get an intrauterine infection after a coil fit.
If this is going to happen it will be with the first 3 weeks of a coil fit and can end up with some of the following symptoms:

•    Aches and pains.
•    Feeling hot and cold alternately.
•    Vaginal bleeding.
•    Vaginal discharge which may smell.
•    Pelvic/abdominal pain.
•    Period pains.

If you are getting some or all these symptoms, you need to seek urgent medical advice and make sure that whoever you talk to knows that you have had a coil fitted in the last 3 weeks so that they can advise you accordingly.
 
Feeling for the coil strings/threads
The threads of the coil hang out of the cervix (neck of womb) up at the top of the vagina. Most women, by putting a finger into the vagina as though putting a tampon in, can feel their cervix, which feels like a donut shaped lump. By moving finger to the dip of the donut at the centre you should be able to feel the threads. You do not have to do this, but we recommend it as a way of regularly checking that your coil is in place and doing its job. Sometimes, during sex your partner may be able to feel the strings. Tell him not to worry and that this can be normal and will not cause him any harm.

Expulsion of the coil
Sometimes the uterus decides it is not happy with the coil and tries to get rid of it. This is called expulsion and if it is going to happen it is more likely in the first few months. It can either be partial expulsion, in which case the threads will suddenly feel much longer, and you may even feel something hard and plastic coming through the cervix, or complete expulsion, and in this case, you will not be able to feel the threads at all. In either of these cases, you need to assume your coil is not doing its job. If you have had sex in the previous 5 days you need to seek advice regarding emergency contraception, you need to start using condoms, and contact your doctor to arrange coil check/ultrasound scan/x-ray to locate your coil, and then manage the situation for you.
 
This all sounds a bit scary, but for you to give informed consent for the procedure you need to know all of this. Most women, after the coil is fitted and everything settles down, have many years of trouble-free effective contraception.

Intrauterine
System (IUS)

Intrauterine
Device (IUD)

IUCD (intrauterine copper device/copper coil) is a hormone free form of contraception. Most women do find that having a coil inserted is a painful/unpleasant experience. We advised taking some analgesia (pain relief) about 30 mins before your appointment. We also recommend that you have something to eat and bring a sugary drink with you. Ideally you should arrange for someone to drop you off at the clinic and then collect you again so that if you are feeling a little unwell you do not need to drive home alone. Once it is in and settled it a is a particularly good form of contraception and you will be able to relay on it for contraception for the next 5 or 10 years depending on which copper coil we fit.

 

Procedure 
The copper coil is, using a small plastic introducer, placed into the uterine cavity via the cervix (neck of the womb).

There is always a risk of damaging the cervix and perforation the womb, and no matter how careful or experienced a practitioner is this risk cannot be removed entirely.

How IUCD works and definition of conception vs contraception
The copper coil work by causing an inflammatory reaction within the lining of the womb and the cavity of the womb that makes it a poisonous atmosphere from sperm, eggs and embryos , and prevents any embryo that might develop from being able to embed itself in the uterine wall (conception- prior to this stage the pregnancy is not viable and this does not count as a termination, is described as a failure to implant and  is just passed out through the cervix.

As the copper device has no hormones in it you will experience your normal hormonal cycle, but it is quite possible that your periods will become heavier, longer, and more painful. Often the first few periods are the worst, and this can settle down. If you already have very heavy, painful periods the copper coil may not be the best option for you, and you may benefit from using one of the hormonal coils (IUS- intrauterine system), which make periods lighter, less painful and can often stop altogether.

The copper coil has a failure rate of 1:200 which means if two hundred women use one for a year one of them will get pregnant.

If you are this unfortunate one that gets pregnant with a coil in, there is an increased risk that this pregnancy will be ectopic (pregnancy in the fallopian tubes rather than in the uterus where it is supposed to be).

It is not that the coil has caused an ectopic pregnancy, but that it has failed to stop it. It is particularly good at stopping intrauterine pregnancies and not so good at stopping ectopic pregnancy, so from a statistical point of view if it is going to miss a pregnancy it is the ectopic one it is going to miss.

It is therefore especially important that if anything makes you thinks you may be pregnant, you need to do a pregnancy test.


If this pregnancy test is positive you need to seek reasonably urgent medical advice so that a scan can be arranged to see where the pregnancy is, and then you can be advised on your options regarding this unplanned pregnancy.

The coils do not give you any protection against sexually transmitted infections, so if you feel you are being put at risk it is important to use condoms for sex and to seek an STI check. Click here where SH24 tests can be ordered for asymptomatic testing. If you have symptoms, you will need to contact the sexual health services for a consultation- For further information call 0300 124 0102 or your GP may also be able to arrange these tests for you.
 
Infection following having the coil fitted
The vagina contains bugs/germs, and when we fit a coil, we can take some of these bugs into the uterus. Normally your immune system will deal with this, and you will be unaware of what has happened but, occasionally you can get an intrauterine infection after a coil fit.
If this is going to happen it will be within the 3 weeks of a coil fit and can end up with some of the following symptoms:

•    Aches and pains.
•    Feeling hot and cold alternately.
•    Vaginal bleeding.
•    Vaginal discharge which may smell.
•    Pelvic/abdominal pain.
•    Period pains

If you are getting some or all these symptoms, you need to seek urgent medical advice and make sure that whoever you talk to knows that you have had a coil fitted in the last 3 weeks so that they can advise you accordingly.

Feeling for the coil strings/threads
The threads of the coil hang out of the cervix (neck of womb) up at the top of the vagina.


Most women, by putting a finger into the vagina as though putting a tampon in, can feel their cervix, which feels like a donut shaped lump. By moving finger to the dip of the donut at the centre you should be able to feel the threads. You do not have to do this, but we recommend it as a way of regularly checking that your coil is in place and doing its job. Sometimes, during sex your partner may be able to feel the strings. Tell him not to worry and that this can be normal and will not cause him any harm.
 
Expulsion of the coil
Sometimes the uterus decides it is not happy with the coil and tries to get rid of it. This is called expulsion and if it is going to happen it is more likely in the first few months.


It can either be partial expulsion, in which case the threads will suddenly feel much longer, and you may even feel something hard and plastic coming through the cervix, or complete expulsion, and in this case, you will not be able to feel the threads at all.


In either of these cases, you need to assume your coil is not doing its job. If you have had sex in the previous 5 days you need to seek advice regarding emergency contraception, you need to start using condoms, and contact your doctor to arrange coil check/ultrasound scan/x-ray to locate your coil, and then manage the situation for you.
 
This all sounds a bit scary, but for you to give informed consent for the procedure you need to know all of this. Most women, after the coil is fitted and everything settles down, have many years of trouble-free effective contraception.

The most effective from of emergency contraception is the copper coil which can then be retained and used for ongoing contraception.

The details of when the copper coil can be fitted for emergency contraception is a little complicated so the best thing is if you think you want this form of emergency contraception contact X to advise of suitability and then an appointment can be booked as appropriate. You can also speak to your GP regarding this or contact the LSH service.

Procedure

The copper coil works as emergency contraception by causing an inflammatory reaction within the lining of the womb which prevents any embryo ( the result of an egg coming into contact with a sperm) from embedding in (becoming a pregnancy) and it is just passed through the cervix ( neck of womb) and out of the body.

The effective ness of the copper coil as emergency contraception is 99% however if you do get pregnant with a coil in, there is an increased risk that this particular pregnancy will be ectopic (pregnancy in the fallopian tubes rather than in the uterus where it is supposed to be).

It is not that the coil has caused an ectopic pregnancy, but that it has failed to stop it. It is very good at stopping intrauterine pregnancies and not quite so good at stopping ectopic pregnancy , so from a statistical point of view if it is going to miss a pregnancy it is the ectopic one it is going to miss.

It is therefore very important that you do a pregnancy test 3 weeks after your coil fit, regardless of any vaginal bleeding you may have had , and if  this pregnancy test is positive you need to seek reasonably urgent medical advice so that a scan can be arranged to see where the pregnancy is , and then you can be advised on your options regarding this unplanned pregnancy.

 

Additional forms of Emergency Contraception

The other 2 forms of emergency are hormonal emergency contraceptive pills:

Levonelle can be taken up to 3 days after unprotected sex.

EllaOne can be taken up to 5 days after unprotected sex.

Both tablets are more effective the sooner after unprotected sex they are taken.

Intrauterine
Device (IUD)