Fitting the coil
“I was asked to remove my trousers and underwear and lie on the bed with some paper towel over me - a bit like going for a bikini wax but without the mellow music and anticipation of searing pain.”
With more and more people opting for longer-lasting contraception methods, we explore the options available on the NHS and answer the question: what’s it like to get a coil fitted? SH:24’s Laura reveals all…
A few months ago, I went for my first Mirena coil (or IUS - intrauterine system) fitting at my local GP. I’ve had three children, and, while I’ve previously used the progestogen-only pill, and the natural cycles method, I decided that I’d give the coil a go now that we’ve decided we’re definitely not planning any more kids.
So, what happens when you get a coil fitted?
First of all, I called my GP practice to ask for a fitting appointment. I live in a rural area, so there are not many sexual health clinics nearby, and I have a great local practice. The receptionist told me that the doctor would want to speak to me before I came in, and I was called back the same day by my GP. She asked me why I wanted to use the coil, and talked me through how the coil works, the pros and cons, side effects, and any questions I had. She asked about my recent birth experience, whether I was breastfeeding, and how I’d got on with previous contraception.
She then explained how the fitting would work, and that I’d need to pick up the prescription myself, as they didn’t hold them in the practice. She also warned me that it comes in a very big box, but that the coil itself is only 1.26 inches long.
She told me that she’d book a double appointment as the fitting can take about 20 minutes - the procedure itself is only a few minutes but the discussion before and afterwards takes a bit of time, and the doctor and nurse need to work together to check each step as they go.
Finally, she asked if I was due a smear test (I was - the letter had arrived that morning). She told me she could do the smear at the same, to save me two experiences with the speculum.
I picked up my prescription note from the GP, and took it to a local pharmacy. Being in a rural area, I had to wait a couple of days for it to be ordered in, but the GP had accounted for that when she booked in the fitting appointment.
So I went back a couple of days later, and was very glad I’d had the warning about the size of the box (my kids were determined to open it as they were sure it must hold something exciting - I then got into a rather complicated explanation of what was actually in the box, by which time they got bored and lost interest).
Having secured the services of Grandma to look after the kids (I’d decided that taking three kids to see a doctor, who also happens to be one of the mums from nursery, stick various things into my vagina while I have my legs in the air, might end up being a playground story that I’d rather avoid), I arrived to see the doctor and the nurse in the treatment room. Unfortunately, as I’d just stopped breastfeeding, my period had started that day.
The GP reassured me that this wouldn’t matter, but that she would also stop if she felt that she wasn’t able to get the IUS into the right place, to avoid the very low but serious risk of perforation of the womb. She told me how many coils she’d fitted (I can’t remember, but it was a lot) which reassured me.
She then spent a few minutes going over the risks and potential side effects again, giving me another opportunity to ask questions, and drew some pictures to show where the coil sits within the cervix - it’s hard to draw a cervix, but you can always ask them to pull up an image online if you can’t visualise it. As she’d done on the phone, she explained that it was likely to feel a bit uncomfortable, and that some women experience painful cramps for a short period during and after the insertion.
I was asked to remove my trousers and underwear and lie on the bed with some paper towel over me - a bit like going for a bikini wax but without the mellow music and anticipation of searing pain. She then inserted a plastic speculum - just like having a smear test - and, with the nurse at hand, checked the position of my cervix.
She inserted the device, which took seconds, and then felt to see where the strings were.
I didn’t have a local anaesthetic but you can ask for this if you’d prefer it - it’s worth asking in your initial appointment or telephone consultation to make sure they can offer it. Having had three vaginal births and a very messy and traumatic miscarriage, I’m used to clinicians poking around down there and am totally uninhibited about it., but that’s just me. Some people may find it much more uncomfortable, both physically and mentally, than others do, and some may find the whole idea of two people staring into your vagina very disconcerting. That’s fine. Tell them if you’re feeling uncomfortable or if it is too painful for you.
My own experience was slightly uncomfortable but not painful. I had a few cramps, like light period pains, and I can’t say I like having a speculum cranked up inside me, but other than that it was pretty straightforward.
She decided not to do my smear test as there was a bit too much blood from my period to get a clear scrape (lovely), and very apologetically asked me to rebook this for 12 weeks time.
After I got dressed, she advised me about pain relief, and that I may get heavy bleeding for a few weeks, and possibly irregular periods for a month or so, but they should settle down to having no bleeding at all.
She booked me in for a 6 week check up, and gave me a little card to remind me that my coil would stop working in 2020 (hopefully Google will remind me as I suspect I’ll lose the card).
While cervical screening is not an STI test and not a service that we offer at SH:24, it is usually recommended that you arrange for your cervical smear test to be done in the middle of your cycle, which is approximately a week after your period has ended. Check with your GP or clinic when you book your cervical smear test.
The following weeks
I didn’t have any pain after the fitting, but I did have quite heavy bleeding for several weeks, so much so that I felt light headed at times. I’m not sure whether this was entirely to do with the coil, or whether it was as a result of stopping breastfeeding, as that has caused extended bleeding in the past.
It was manageable, though, and I knew I could call my GP if I was worried. I decided to wait until my six week check, by which time the bleeding had almost stopped.
At the six week check, the GP used the speculum to put her fingers into my vagina and check the placement of the IUS. This took less than a minute, and was only slightly uncomfortable. I asked her about the bleeding - she reassured me that this was normal and not to worry unless it carried on - and she asked if I had any other concerns. The whole appointment wasn’t much more than five minutes.
First few months with the Mirena coil
Since the fitting, I’ve had two periods, one light for a few days, the next only spotting, so I assume that I won’t get any more bleeding after this.
I haven’t noticed any changes in my mood or had any other physical pains, and have finally got the baby to sleep through the night so my partner and I might be able to make use of the contraceptive properties of the coil when I’m not completely exhausted, at last.
In fact, I’ve completely forgotten it’s there - I had been worried I’d be a bit squeamish about having something ‘inside’, but it seems that it’s easy not to think about.
So that’s it - step by step guide to coil fitting!
We’re all different
I must point out that this was my experience - there are many women who find that the coil fitting is painful or unpleasant, or who find the coil just doesn’t work for their bodies. If you think it’s not working for you, ask your clinician to take it out. It’s OK to try different contraception methods until you find the right one.
If you need to get some advice or reassurance, try the SH:24 forum, The Pill or What?, where you can talk to other people about their experiences, or ask questions of the SH:24 clinicians. It’s your body, your experience, and your choice.