COIL INSERTION: WHAT YOU SHOULD EXPECT

An Intrauterine Device (IUD) is a small-sized T-shaped device that is inserted deeply into the uterus. It releases a considerate amount of progestin levonorgestreland can be effective for a duration of 3 to 12 years depending on the type. The copper that coils around an IUD acts as a spermicide making it an effective family planning method.

Mirena, Kyleena, Liletta, Skyla and ParaGardare the available types of IUD in the UK. The Mirena&Kyleena are effective for 5 years while Liletta& Skyla are effective for 3 years. ParaGard, on the other hand, is the only non-medicated IUD in the UK and can be effective for as long as 12 years.

One of the major advantages of choosing the intrauterine device (IUD) is that the woman does not necessarily have to do anything after the insertion of the device. Personal hygiene is the key to prevent infection.

COMMON MYTHS ABOUT IUD

One of the challenges against the use of Intrauterine device is the false information that has been circulated among people. Some people believe that:

  • Only women who have given birth can use an IUD.
  • Teenagers are not eligible to use IUD
  • IUDs cause Pelvic Inflammatory Disease (PID) and infertility
  • IUDs are not safe to use

Against all the odds, this information is false; they are just myths about the device. You must dispel these myths to alleviate your worries about the use of IUD.

STEPS FOR THE IUD PLACEMENT

There are 10 steps involved in the placement of the intrauterine device. These steps must be judiciously followed to avoid mistakes or complications.

  1. PREPARING FOR THE INSERTION: Before the device insertion, some medical professionals advise that pain relief medications should be taken an hour before the insertion. Non Steroidal Anti Inflammatory Drugs (NSAIDs) such as Ibuprofen will do just fine. This is aimed at minimising the accompanying cramps and discomfort due to the insertion of the device. It is also necessary to come along with sanitary pads that you could use in case bleeding occurs.
  2. INSIDE THE EXAMINATION ROOM: Your healthcare provider will have prepared all the equipment needed for the insertion of the intrauterine device. Before the insertion, he/she will explain the procedure steps to you and also answer all your questions and alleviate your worries. This will make you more relaxed, making the device insertion less painful for you.

A pregnancy test will be carried out to rule out the presence of pregnancy if you are not within the first 7 days of your menstrual period. A bimanual examination will also be carried out on you. This requires your doctor to insert two fingers into your vagina and place the other hand on the abdomen to feel the inner pelvic organs. The bimanual examination allows the doctor to determine the accurate position, size, consistency and mobility of the womb. Tenderness can also be identified which would be indicating infection.

  1. STABILISING THE CERVIX: After the bimanual examination, your healthcare professional will insert a vagina speculum to open your vagina properly. The speculum which looks like the beak of a duck will be inserted into the vagina for the healthcare provider to view the vagina properly. To prevent infection, the cervix and the anterior & posterior recesses of the vagina will be cleansed with an antiseptic solution. To reduce discomfort and pain, a 5% lidocaine gel may be applied as a local anaesthetic agent into the cervical canal.

Atenaculum(a long-handled, slim instrument) will then be used by your doctor to stabilise the cervix and ensure it is kept steady throughout the procedure.

  1. TAKING MEASUREMENT OF THE UTERUS & CERVICAL CANAL: A uterine sound will now be inserted into your vagina to measure the length and the direction of the uterus and the cervical canal. The main reason why your doctor must measure your uterus is the prevention of uterus perforation by the IUD. If the uterus is not measured, the IUD might be deeply inserted, causing a puncture in the uterus.

While inserting the uterine sound, your doctor will ensure contact with the speculum or the vagina is avoided. The uterine sound also has a round blunt tip that cannot perforate the uterus.

Some doctors prefer to make use of an endometrial aspirator instead of the uterine sound. Your uterine length or depth should be between 6 and 9cm. This is because the IUD must not be inserted if the uterus is less than 6cm deep.

  1. INSERTION OF THE INTRAUTERINE DEVICE (IUD): After the uterus has been measured by the uterine sound, it is taken out of the vagina. Your doctor will then remove the IUD from its sterile pack. The arms of the device are bent backwards and a slider housing the IUD is inserted. It is position well to the depth measured by the uterine sound by a plunger. Once in place, the arms of the IUD form a “T” shape.

The insertion is not a complicated procedure. However, some discomfort or cramping or pinching sensations might be felt during and after the insertion. Some women might feel dizzy. Deep breaths during insertion will help greatly.

Many women who undergo this procedure often experience some discomfort while about 5% experience moderate to severe pain.

Women who have had few births or have never given birth might experience reactions like vomiting, perspiring and fainting after the procedure. These reactions are rare.

  1. COMPLETING THE IUD INSERTION PROCEDURE: Once the intrauterine device has placed in the right position, the tube, plunger, tenaculum and the vaginal speculum will be removed by the doctor. The IUD comes with strings that have been attached to it. These strings will hang down into the vagina through the cervix.

The ends of this string will be cut by the doctor, although 1 to 2 inches will be left which will help check if the IUD is still intact.

You will be taught by your doctor on how to feel for the IUD strings. You will also be informed on the type of IUD that you have in you and date of replacement. It could be Mirena, Kyleena, ParaGard, Skyla or Liletta. Most oft, a small card which has all the information about the inserted IUD will be given to you. The information on the card will help healthcare professionals identify the type of IUD you have and the due date for removal.

  1. POST INSERTION ACTIONS: Slight discomfort can be felt during and after the procedure. Most women can comfortably drive home after the procedure and continue with the activities of the day. Since you can’t ascertain the way you will react to the IUD insertion, you should come along with someone who will drive you home. Rest and pain relief medications will help deal with the pain experienced due to the insertion.
  2. AT HOME: You may notice some spotting or experience bleeding during the first few days following the insertion. This is a normal experience; however, if the bleeding becomes heavy for the long term, call your healthcare provider to rule out infection.

You should expect your next period after the IUD insertion to be heavier than usual; and of course, it will come earlier than expected.

You should schedule an appointment with your doctor after your first menstrual period for follow-up and to ensure the device is still intact.

  1. PREGNANCY PREVENTION & SAFE TIME FOR SEX: You can have sex once you feel comfortable after the IUD insertion. You need to know that the prevention of pregnancy is dependent on the type of IUD inserted. That is:
  • ParaGard prevents pregnancy immediately after its insertion.
  • Skyla, Kyleena, Mirena and Liletta IUDs are able to prevent pregnancy immediately after insertion provided it was inserted within the five days after the onset of your menstrual period.
  • You need to use a different birth control method such as condom or spermicide during the first week of Mirena IUD insertion provided it was inserted at any other time during your period.
  • You can use a condom as backup protection in the first month after insertion solely to avoid infection.
  1. MAINTENANCE OF THE IUD: For the first few weeks after insertion, you need to regularly feel for the dangling strings to ensure the device is still in the proper place. You should also schedule an appointment with your healthcare provider after your first menstrual period post-insertion.
    Some women do ask their doctors to cut the strings to a shorter length (during this checkup) especially if felt by the woman’s sexual partner. Most often, the strings are eventually cut too short that the woman cannot be able to feel for the strings anymore.

WHERE TO SEEK FOR SUPPORT AND ADVICE

Women’s Health Care provides professional support services and reliable information on IUD insertion, as well as other birth control methods.  You can look through our official website for more information www.womenshealthcarepartners.org or walk into our office at Harley Street, London to speak with a Gynaecologist.