Contraceptive coils (IUDs)

• they prevent your partner's sperms from getting through your womb and into your tubes
• they alter the secretions (mucus) in your cervix, so creating a further barrier for sperms
• they affect your womb lining – making it less likely to 'accept' an egg.

Do a lot of women use them?
Yes. In the UK in 2005, about 5 per cent of all sexually-active women are using IUDs.

But, in some other countries they're much more popular: in Scandinavia, around one in five of all women of reproductive age have IUDs.

However, it's unlikely that IUDs will ever be as popular as the Pill or the condom.

How well do they protect you against pregnancy?
Today's IUDs are almost 98 per cent effective, which makes them not far off being as good as the Pill (and about as good as the mini-Pill).

What this means is that if 100 women use IUDs for a year, then only about two of them would become pregnant. (This isn't very much when you consider that if they used nothing, then up to 20 of them would get pregnant.)

Are there any side-effects?
Very definitely – and you must be aware of these before you decide to have an IUD.

These devices generally:

• make your periods heavier
• make them longer
• may make them more painful.

So the IUD is not usually the best choice of contraception for a woman who already has heavy or prolonged periods. She might well do better with another method, such as the Pill or the IUS.

We'll discuss some other potential problems with the IUD in a moment.

Can anybody use an IUD?
No. Most women can use them, but not all. You shouldn't have an IUD if:

• you have some structural abnormality of the womb or cervix.
• you have a pelvic infection, for instance a sexually transmitted disease (STD).
• you have unexplained vaginal bleeding.
• you have heart valve problems (unless a heart specialist thinks you should go ahead).
• you have an allergy to copper (which is rare).
• you've previously had an ectopic pregnancy.
• you think you might already be pregnant.

Also, IUDs are really best for women who have already had a pregnancy – partly because the cervix is wider open, making the insertion of the device easier and less painful. But in practice, quite a lot of young women who have never had babies do opt for the IUD as their method of choice.

However, it's a fact that younger single women are more likely than average to catch STDs – especially if they have more than one sex partner.

In particular, the sexual infection called 'chlamydia' is now very common in Britain. In early 2005, it was recommended that anyone having an IUD insertion should have a test for chlamydia first.

How do I get myself an IUD?
Start by going to a family planning clinic, or to one of the minority of GPs who have experience of fitting IUDs. Also, a few women have their devices fitted by gynaecologists – either under the NHS, or privately.

Please make sure that whoever puts it in is properly trained! In the recent past, a few doctors who had little or no experience of IUDs 'tried their hands' at inserting them – often with poor results for the unfortunate patient.

In 2005, regulations are being brought in which should stop eventually that sort of thing from happening; doctors who insert IUDs will have to be properly qualified to do so.

What happens when you have an IUD insertion?
Once you're fully informed about having a 'coil' (and happy with the idea), you'll be asked to come to the clinic/surgery on a specific date. This is often at the end of your period (when the flow should be light) or just after it. You must make sure you haven't run any risk of pregnancy.

You'll be asked to take off your pants and tights, and to lie on the examination couch. The doctor will insert the little device called a 'speculum' which lets her see your cervix.

She'll then check the length of your womb with an instrument called a 'sound'. This might hurt very slightly.

After that, she will slip the slim instrument which is shaped like a drinking straw (see above) through the small opening in your cervix, and into your womb. Finally, she'll push the IUD out – so that it is released into your womb – and take away the 'straw'.

This whole process usually takes about 10 minutes. Is it painful? Yes it is – a bit. Of course, it's easy for me – as a man – to say that it's only 'a bit' painful. But in practice, most women say that it's much less unpleasant than a visit to the dentist. Others exclaim in a surprised way: 'Is that it ? I thought it would be much worse than that.'

But, a small proportion of women do find it very painful. The amount of pain which you feel depends on various factors, like:

• how relaxed you are.
• how skilled the doctor is.
• the size and shape of your womb
• whether you've ever been pregnant – insertions in women who've had babies are usually not very uncomfortable at all.

What happens after the insertion?
After the device has been put in, you should rest in the clinic or surgery for a good half-hour.

You may well need to take aspirin or paracetamol during the next few hours, because you'll probably experience some crampy pain.

Have some pads available, because you will very likely lose just a little blood that night and over the next few days. . (Personally, I advise against using tampons until you have your next period.)

What about love-making? I have known one or two highly-sexed women who went out and had intercourse immediately after an IUD insertion, but I feel that commonsense suggests that you should give the device 24 hours to settle down before having sex.

Are there any other drawbacks with the IUD?
Yes, a few.

Expulsion Surprisingly few people realise that IUDs are often 'expelled' - that is, they can come out! (In a few clinics, the expulsion rate is as high as 10per cent.)

This is why it's a good idea to check your vagina regularly with your fingertips, to make sure that your IUD is not 'coming down'. All you should be able to feel are the threads – not the device itself.

Perforation
Rarely, the device goes through ('perforates') the wall of the womb. Usually, it's at insertion that this happens. Perforation is an emergency, so if you ever get a great deal of pain in the lower part of your tummy, contact a doctor at once.

Infection
Infections are a little more common in IUD users, and are most likely to occur in the three weeks following insertion. Should you ever get a smelly discharge and a fever, consult a doctor.

Ectopic pregnancy
The IUD is very good at preventing normally located pregnancies – ie in the womb. So if a pregnancy does occur, there's an above-average chance that it might be ectopic (that is, outside the womb).

Symptoms are lower abdominal pain and bleeding; contact a doctor urgently if these occur.

Fertility problems
These are unlikely to occur unless you are unlucky enough to catch an infection.

How often should I have check-ups?
In the UK, it's common to have a check-up by a doctor or nurse at about six weeks after insertion. Thereafter, a yearly check is sufficient.

But don't hesitate to go back to the clinic earlier if you're having problems – for instance, if your periods are driving you crazy!

How long will the IUD last me?
Some of the original coils and loops were designed to last 'forever', and a few women are still using these devices. But all of today's British IUDs have a lifetime of between five and eight years, because they gradually 'wear out'.

At the end of that time, you need to have the IUD changed - or if you prefer, you can switch to another method.

The actual 'lives' of each brand are shown in the next section.

What types of IUD are available – and how can I choose?
To be honest, it's very rare for a woman to pick her own IUD, unless she's a nurse or doctor and knows a lot about these devices. But the following list of 'coils' may well be of help to you in discussing the choice with the clinic staff.

Most important: make sure you know what brand you've been fitted with, so that in years to come you will be able to tell any doctor or nurse you consult.

In 2005, there are seven types of IUD available in Britain. They are:

• The Flexi-T 300. T-shaped. Lasts five years.
• The Gynefix. Different from the rest, because it isn't T-shaped, and just consists of six copper tubes on a polypropylene thread. Lasts five years.
• The Multi-Safe 375. Lasts five years.
• The Multi-Load Cu 375. Lasts five years.
• The Neo-Safe T380. T-shaped. Lasts eight years.
• The Nova T 380. Copper and silver. Lasts five years.
• The T-Safe 380A. Yet another T-shape. Manufacturers say it lasts 'five to eight years'.

. Note: some women are still 'wearing' brands that are not on the above list, because they're no longer manufactured. To find out when yours needs to be changed, check with the clinic that fitted it.

Emergency post-coital contraception with an IUD
The morning-after pill (which should really be called 'the post-coital pill') can be used up to three days after sex.

The IUD can also be used post-coitally. A 'coil' can be inserted as emergency contraception, up to five days after unprotected sex. It works well, but isn't 100 per cent effective.

Unfortunately, it's a lot more difficult to obtain than the morning-after pill. If you're in difficulties, try calling a family planning clinic.

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