Could my body really expel the coil? 5 everyday misconceptions

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The copper coil, or intrauterine device (IUD), is an efficient method of contraception for those women seeking a hormone-free option.  Compared to other non-hormonal methods, such as condoms or the diaphragm, it’s much longer lasting, giving you an average of 5 to 10 years of use depending on which device is fitted. Many women find their risk of unwanted pregnancy being reliant on remembering to take a pill every day quite stressful, making the IUD a good choice.

However, despite its selling points, most women tend to approach the IUD with much trepidation, and a great deal of this is unfounded. Here, some of the common misconceptions associated with the IUD are dispelled.

Can I really expel the IUD?

The majority of women who have an IUD fitted will not encounter problems with the coil spontaneously removing itself.  The actual risk of expelling the IUD is 1 in 20. This risk is highest in the first three months after it has been fitted and the chance of expulsion may be higher in women who have previously expelled a coil.1  You may not even notice that you have expelled the coil.  This is the reason that women are advised to periodically check that they can feel the threads of their coil at the top of their vagina by self-examining.

Some women may experience symptoms if their coil is in the wrong position or expelling itself. These symptoms are normally in the form of discomfort or pain around the cervix, pelvis, or even the legs. If this occurs use additional contraception until you are able to get assessed by a medical professional. In this case, if your doctor or nurse sees the coil low down in your cervix they will most likely remove it as it will no longer be effective as a form of contraception.

Can the threads of my IUD disappear?

If you can’t feel your threads, don’t panic, but do use condoms until you are seen by a medical professional. They may be able to locate them by passing a speculum (the same device used when taking a smear or swab) into the vagina and seeing the threads, or they may organise a scan of your uterus to visualise the IUD.

From my own experience of seeing patients who have complained of not being able to feel their threads, I am often able to locate them when I do an internal exam.  Very occasionally, not being able to feel your threads, particularly if this is combined with abdominal discomfort and abnormal bleeding, could indicate a perforation, which is discussed in more detail below.

I am often asked if your partner can feel the threads during intercourse. The short answer to this is “no”.  The threads are cut at such a length that you can still examine yourself and feel them, but so that they don’t interfere during sex.  If your partner complains of being able to feel them, see the professional who fitted your IUD so they can assess with you whether the threads need to be trimmed shorter.

Will the IUD increase my risk of infections?

This is a common fear amongst women considering the IUD. Pelvic inflammatory disease is caused by infections in your genital tract ascending upwards, such as the sexually transmitted infections (STIs) chlamydia and gonorrhea.2  So, if you have an untreated infection like chlamydia in your genital tract and then get an IUD fitted this may increase your risk of it evolving into a pelvic infection.3

Therefore, an assessment of sexually transmitted infection risk should be undertaken before any IUD is fitted.  Women wanting an IUD who have no symptoms of an STI and either would like routine screening or have been recommended for screening by a health professional do not necessarily have to wait for the results before going ahead with the fit, however.4

If you have symptoms of an infection, awaiting the outcome of any swab tests and being treated for a positive result will likely minimise your risks.5 If the IUD is an emergency fit there can be ways around this such as taking swabs and taking antibiotics at the time of the insertion to minimise your risk.

Non-sexually related thrush and bacterial vaginosis (BV) infections can be linked with having the IUD, with the evidence for the latter being more convincing.6 If you develop troublesome and recurrent thrush and BV infections you may want to discuss changing over to a different form of contraception with your doctor or nurse. As with any cases of infection in the pelvis, see a medical professional as soon as possible for treatment if you develop symptoms. 

Can the IUD perforate my womb?

This is the risk that makes many people thinking about an IUD wince, but the chances are small, at about 1 in 1000.7  Symptoms of perforation are not normally severe, with some abdominal pain and bleeding, and about 30% of women do not experience any symptoms.8  If you do have symptoms, and particularly if these are combined with not being able to locate the threads in your vagina, then go and see your doctor.  Many perforations are self-healing, requiring no surgical repair. If it appears an IUD has perforated the uterus and is sitting somewhere in the abdomen that can’t be removed via the vagina then it will likely need surgical removal.9

Will my periods definitely get worse?

You are not automatically committed to horrendous bleeding once you have an IUD fitted.  Some women will experience more painful and prolonged periods.  In those who do, this is often the most common reason for early removal of an IUD.10  Always discuss with your doctor the symptoms of bleeding and pain in case it is something that requires further investigation.  Bear in mind that there are medicine options to assist with bleeding and pain so it may not mean you definitely have to have the IUD removed if your symptoms can be adequately controlled.

However, my advice to patients is that if you already have a baseline of heavy and painful periods then it is perhaps worth considering an alternative contraceptive.

References

  1. Faculty of Sexual and Reproductive Healthcare (FSRH), Intrauterine Contraception, 2nd edn., Faculty of Sexual and Reproductive Healthcare, 2015, pp. v, 9, 19.
  2. L. Newson, ‘Pelvic Inflammatory Disease’, 2014, [website], http://patient.info/doctor/pelvic-inflammatory-disease-pro, (accessed 1st March 2017).
  3. J. Guillebaud, Contraception Today, 7th edn., London, Informa Healthcare, 2012, pp. 123-127.
  4. FSRH, Intrauterine Contraception, pp v, 9, 19.
  5. J. Guillebaud, Contraception Today, pp. 123-127
  6. FSRH, Intrauterine Contraception, pp. v, 9, 19.
  7. M, Lowth, ‘Intrauterine Contraceptive Device’, 2014, [website], http://patient.info/doctor/intrauterine-contraceptive-device-pro, (accessed 1st March 2017).
  8. J. Kaislasou et al., ‘Uterine perforation caused by intrauterine devices: clinical course and treatment’, Human Reproduction, vol. 28, no. 6, 2013, pp. 1546-51.
  9. J. Guillebaud, Contraception Today, pp. 123-127.
  10. M. Lowth, ‘Intrauterine Contraceptive Device’.

Dr. Nupur Yogarajah BSc Hons MBBS DRCOG PgCert Clin Ed MRCGP

Nupur, a GP, graduated from the Royal Free & University College Medical School in 2006 and after rotating through various specialities she gravitated towards General Practice as it offered continuity with her patients and diversity in her caseload. She has particular interests in women’s, children’s, and sexual health, as well as medical education. Managing a variety of female patients over the years has given her experience of the common queries and misconceptions regarding women’s health. She is passionate about delivering health information in a digestible and accessible way, making The Femedic an ideal opportunity for her writing.

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