By Imogen Robinson
It is highly likely that if you are a sexually active woman of reproductive age you will have considered the coil as a form of contraception. Indeed, many women, after starting off on the pill in their teens, will then progress to the coil in their twenties, in a sort of contraceptive rite of passage as they decide they want something longer acting. The benefits, of both the copper coil (or IUD) and the hormonal coil (Mirena coil, or IUS), do indeed look brilliant on paper. The IUS is said to reduce, or eliminate, periods entirely, and puts a small dose of progesterone directly into the womb, limiting possible side effects like headaches and mood swings which are common with the pill. The copper coil, while actually causing your periods to remain the same or even get longer or heavier, skips entirely any potential hormonal side effects, so is said to be great for those that find they really don’t get on well with hormonal contraception. Of course, some women will be ineligible for one or both types of coil due to preexisting medical conditions, so make sure to thoroughly discuss your options with a doctor before you decide.
Making the leap to a form of long-acting reversible contraception (LARC) can be quite daunting. For one, you will literally have a foreign body inserted into your uterus. Secondly, you have no idea how it will affect you, and while you can get it taken out if it causes discomfort, you can’t do it yourself (or rather, you definitely shouldn’t do it yourself). Horror stories abound, of course, although it is perhaps better to avoid these, principally because those who have had a good experience with the coil aren’t going to write home about it, so you’ll only ever hear the bad stuff. One of the most pressing questions women will have before they decide to go for it is ‘will it be painful to insert?’, and understandably so.
You will be talked through the process prior to insertion by your doctor or nurse, who should prepare you for what you can expect. However, literature on pamphlets about each type of coil seems, invariably, to make a lot of use of the word ‘discomfort’ and little else. This is of no use to someone who would use the word ‘discomfort’ to describe having to stand for an hour on the tube at rush hour, or falling asleep wearing a bra, for example. So what actually does it feel like to get a coil inserted or removed. And is ‘discomfort’ just a by-word for pain, or is it really just a mildly uncomfortable experience?
The reality is, it does depend on a whole host of factors, including your pain threshold in general. 26-year-old Amy, head of PR at an agency in London, said the entire process for her wasn’t too bad, although she did have cramping afterwards. She had the Mirena coil inserted at her local GP practice after a two month waiting period to get it done. Her surgery, she adds, has a health practitioner there who does all the coil insertions, and every woman has a half hour slot.
Amy describes the actual insertion process as “uncomfortable”. “I took two Panadol an hour beforehand, which I was instructed to do,” she says. “It does just depend on your pain threshold though. It feels a bit like a pap smear, and it is sort of uncomfortable because it takes a while.” For her, in fact, the bit where they measured her (using the same tool they use in pregnancy to see how far you are dilated) was more uncomfortable than the insertion itself. “When they actually inserted it,” she says, “I barely felt it.”
The day after insertion, however, Amy had cramps that came in waves, and lasted for around 24 hours. “That was painful,” she says. “They were like period pain cramps. You feel like someone has kicked you in the uterus, it was painful to the point that I was doubled over in pain a couple of times. But after 24 hours they subsided and after two days I felt nothing.” Since, Amy says she has been entirely happy with the Mirena coil, with no negative side effects, and the added benefit of no longer really having periods.
Like Amy, 21-year-old Clara, who also works in PR, is happy with her coil so far, and, while painful, the insertion process was fairly unremarkable for her too. She had the copper coil, after not getting on well with the mini pill, and being unable to take the combined pill due to her increased risk of blood clots from a genetic condition. She went to the sexual health clinic near where she lives in London to get it done, after booking an appointment online.
“It was a set up a bit like a gynaecological exam,” she says. “They put in a speculum, a bit like a pap smear, and did a quick swab to check for chlamydia and gonorrhoea. They then explained the insertion process to me. Basically, the coil goes in a straw, which they put through the speculum. They measure the size of you to see which size coil you will need.” Clara was told there would be three painful points to the insertion process: the speculum, when they put the straw up, and when the coil gets released.
For Clara, she felt no pain on the insertion of the speculum, but when they started putting the straw up, she said there was two minutes of quite intense pain, although she adds that she forgot to take the recommended two painkillers prior to insertion, so she thinks she may not have helped herself. “It was like a really long, intense period cramp,” she says. “There are two minutes when you just have to breathe really deeply. I have a high pain tolerance, but it was painful, although it didn’t help I was nervous, and because it was a trainee doing it I think that added to my nerves. I just tried to focus on my breathing and after that it was fine.”
After the coil was inserted, the speculum was removed and although Clara did experience some bleeding she was told it should go within an hour, which it did. “I went out that same night,” says Clara, “so it was fine”. The doctor also told her how to check the strings to make sure it was still in place, and she was advised to go back and see them straight away if the bleeding continued for more than an hour or two. They also told her the pain might take a few weeks to settle down. “It bled a bit for the next 24 hours, and then it stopped except for some light spotting. However, I did get cramps a lot, weirdly that was actually mostly the next day. They got slightly better with painkillers, but it was very draining, like period cramps can be.”
Like Amy, 39-year-old Andrea had a Mirena coil fitted, and had a fairly pain-free and simple experience with regards to the insertion itself. “I had it done three years ago,” says Andrea. The whole thing took about 10 minutes, she says, but she also had a smear test just prior to the insertion. “The insertion was painful, like a snake bite,” she adds. “But the pain lessened quickly, and then turned to a cramping sort of pain that lasted for several hours. I felt faint for about 30 minutes after, so I would advise people to have someone drive you to the clinic just in case.”
The day after the insertion, Andrea likened the discomfort to “a heavy period that leaves a slight raw feeling” but adds that this may have been due to the fact that she had six weeks of bleeding previously, which is what led her to have the Mirena inserted in the first place. Unfortunately she now wishes to have the Mirena removed, although she says this is not because of the Mirena directly. However, she is slightly concerned going to get it removed as it was “so unpleasant” getting it inserted.
However, Jenny*, who is 25 and currently on her second Mirena coil (she had her first when she was 19) says the pain at removal is nothing like the pain at insertion and subsides very quickly. That being said, she does find insertion painful, perhaps more painful than Amy did. “I got it inserted at an evening clinic in a rural hospital in Dorset, and I had to book an appointment to coincide with my period,” she says. “It was a doctor and a nurse in the room, and the whole thing probably took 20 minutes including having it all explained to me.” According to Jenny, the measuring of the cervix prior to insertion was painful.
She got her second coil when she was 24, and had an appointment at a sexual health clinic in London, and booked the appointment on the same day as she got it inserted. Again, the insertion process took roughly 20 minutes – but for her they were a painful 20 minutes. “It’s a pain like nothing I’ve felt before, I imagine it feels a bit like birth? It starts as an intense cramp but then gets so much worse,” she says. “However, it is over within a minute. I’d recommend taking a painkiller before.” It does hurt a bit after too, she adds, and in fact she nearly fainted the second time she had it done “but it stops being so bad after a few hours”.
Once the coil is in, Jenny says she had no problems at all, although she did panic after her first one was inserted that it was in the wrong place. However, she went to another clinic to get it checked out, but it was absolutely fine. In terms of side effects, Jenny doesn’t really have any and the added benefit is that her periods are barely noticeable and she doesn’t even bleed enough to need to use a tampon. “The best part is it lasts five years, and you don’t have to remember to do anything,” she adds.
Unfortunately, not all insertions go smoothly, and there is a very small risk that the insertion could perforate the wall of the uterus or cervix, which is what happen to 41-year-old Nicki, who works in PR. She had the copper coil inserted, but can’t comment on the procedure itself as she was under general anaesthetic as she had it done at the same time as another procedure. She knew something was wrong after the insertion as she was in pain constantly for five months. “It was like having a knife continually digging into me,” she says. “I went to see my GP who referred me for a scan, and when I went for the scan I was horrified to find out that it had been inserted wrong, and was actually embedded in the wall of my cervix.” She had the coil removed there and then, which she describes as “agonising”, and she was sore and uncomfortable for a few days afterwards.
However, this experience didn’t put Nicki off getting another copper coil fitted a year later, and this time she had it done at the gynaecological department in a local hospital. Again, she was under anaesthetic as she had the insertion done at the same time she was having a polyp removed. “Obviously I did not feel it being fitted, and in any case I felt more assured now that the same thing would not happen to me again,” she says. She has now had the copper coil for five years and is very happy with it. “I don’t even know it’s there,” she says. “I have it checked regularly and although it did play on my mind that it slipped out of place, my doctor sent me for a scan and it was all okay.”
In short, all women will clearly have different experiences of coil insertion and removal. For the most part it seems that while the actual insertion itself is very painful for a short time, the pain subsides fairly quickly and after a few days you become unaware that the coil is even inside you. Of course, very occasionally things do go wrong, but, as in Nicki’s case, these can be quickly rectified. It is important to weigh up the risks with the benefits and realise, for the majority of women, the insertion process is fairly uneventful. Your doctor, or the health professionals at your sexual health clinic will be able to answer all your questions and put your mind at rest should you decide you want to get a coil inserted.
*Name has been changed