What is a copper coil?
A copper coil is a small device made from plastic and copper which sits inside the womb (uterus). Two threads are attached to the coil and pass out through the neck of the womb (cervix) to lie in the vagina. These allow the IUCD to be removed easily. Most devices are T-shaped (the two arms of the T fold flat for insertion) and are about as long as a matchstick. The inside of the womb itself is only a little longer than a matchstick, so the device sits neatly inside.
How does the copper coil work?
The copper in the device works mainly by making it difficult for sperm to fertilise an egg, by preventing the sperm getting in through the cervix, and from travelling through the womb. It also makes your womb lining much less likely to accept an egg. It works immediately after it has been fitted and you no longer need to use other contraception. The IUCD does not cause an abortion (which occurs when a pregnancy is ended after the fertilised egg as planted in the wall of the womb).
It can be fitted at any time during the menstrual cycle as long as there is no possibility for pregnancy, as well as immediately following a miscarriage or abortion under 24 weeks of pregnancy and during breastfeeding. If you wish to have a copper coil fitted following childbirth, then this can happen 4 weeks postpartum.
There are many different types of IUCD. Most copper IUCDs work well for at least five years, and many types now work for ten years. If you were over 40 years old when the device was fitted it can be assumed to last until your menopause.
How effective is the copper coil?
Modern IUCDs are very effective. Only 1-2 of every 100 women using the IUCD as contraception will become pregnant over five years of use. By comparison to this, more than 80 of every 100 sexually active women who do not use contraception become pregnant within one year.
Risks of Insertion and immediately following
Although the majority of women with an IUCD have no problems, the following may occasionally occur as side-effects or consequences.
- Bleeding: some bleeding is common after the Copper coil is inserted.
- Infection: If you suffer with an offensive discharge after insertion, please make an appointment to see your gynaecologist
- Heavy, painful periods: Some women find that their periods become heavier, longer or more painful with an IUCD, in the first few months after insertion and then often settles. This means that the IUCD may not be suitable if you already have heavy or painful periods. If you have painful, heavy periods with an IUCD in place this can still be treated in the same way as in women who do not have an IUCD.
- Perforation: The fitting of an IUCD can, very rarely, make a small hole in the womb – this is called perforation. It protrudes through the wall of the womb and can escape into the pelvis. This happens in fewer than 2 women per 1,000, usually at the time of fitting. It can cause pain but this is not usually severe and often there is no pain. The main symptom is not being able to feel the threads.
- Ectopic pregnancy: The chance of becoming pregnant is very small if you use an IUCD. However, if you do become pregnant, your gynaecologist will need to check this is not an ectopic pregnancy (a pregnancy in the Fallopian tube and not in the womb. However, the risk of ectopic pregnancy is not increased by IUCD compared to no contraception – it is in fact decreased by it.
- Expulsion: Rarely, the IUCD may come out without you noticing. This may happen during a period, most commonly in the first three months after fitting. It is slightly more likely to happen if you have not had children or if the fitting was particularly uncomfortable.
- Lost threads: When the IUCD is inserted the threads dangle out of the neck of the womb (cervix). Occasionally, however, the threads are lost. This can either mean that:
-The threads have come off the device, and the device is still in place.
-The device is in the right place but the threads have got tucked up behind it.
-The device has moved further into the womb so that the threads can no longer be felt.
-The device has come out.
What happens when you go to your appointment?
The copper coil be inserted by your gynaecologist. This will involve using the same instrument used when having a smear. It is likely that you will experience some cramps like discomfort during the insertion, however this usually settles after the procedure. These can be eased by painkillers such as paracetamol or ibuprofen, and it can be sensible to take these an hour before your fitting. Light vaginal bleeding may also occur for a short while. Very occasionally some local anaesthetic can be used if insertion turns out to be difficult. The position of the coil may then be checked with an internal scan to confirm correct placement.
How do I know it has not fallen out?
You can check your coil yourself by feeling for the threads with your finger through the vagina. It is advised that you check on a monthly basis, this is particularly important after any heavy bleeding. You will be advised to see your gynaecologist about six weeks after insertion, alternatively you may be asked to attend for a scan to check the coil is still correctly positioned.
What do you do if you want to try to get pregnant?
If you feel you would like to try for a baby, you will need to have the IUCD removed. Your fertility will return immediately and if your periods have been heavier than before they will usually return to normal after a couple of cycles. It is possible to get pregnant before you have your first period. This is because you produce an egg two weeks before a period occurs.
Key points:
- There is no medical reason to avoid exercise after copper coil insertion.
- You can use sanitary towels or tampons with an IUCD in place.
- A cervical smear can also be taken with an IUCD in place.
Dr Efterpi Tingi
Consultant Obstetrician and Gynaecologist
