Getting started with the hormonal coil
You’ll need to have the hormonal coil inserted by a doctor or a nurse practitioner with specialist training. Some people find it painful, others don’t. Preparing for your appointment and resting afterwards can help.
The Faculty of Sexual and Reproductive Healthcare (FSRH) issue a qualification to show that your doctor or nurse has had special training and has been assessed to safely fit coils.
To get the coil fitted, you can:
make an appointment with your doctor - find a local GP in the UK
or make an appointment at your local sexual health clinic
To be sure it’s right for you, you’ll be asked about:
previous pregnancies
how regular your periods are
if you bleed between periods
previous STIs (sexually transmitted infections)
serious illnesses or operations
any medications you’re taking
Your practitioner will also explain the process and risks, and give you a chance to ask questions.
When to avoid having a coil fitted
The hormonal coil can be fitted at any time but there are some exceptions:
you won’t be able to have the coil fitted if you’re pregnant, so if you’ve had a pregnancy risk, do a test 3 weeks later to check before the coil is fitted
if you’ve taken emergency contraception, you’ll also need to do a pregnancy test 3 weeks later to make sure you’re not pregnant before the coil is fitted
if you’ve had a baby, the hormonal coil can be fitted within the first 48 hours after giving birth. If you don’t have it fitted immediately after the delivery, you’ll need to wait at least 4 weeks
if you’ve had an abortion, you don’t have to wait to have the coil fitted
You can’t use the hormonal coil for emergency contraception.
What happens at the coil fitting appointment
What to do before you go
Make sure to eat a light meal or snack an hour before so your blood sugar isn’t low. Then you’ll be less likely to feel faint. At the same, time take a painkiller, such as paracetamol or ibuprofen, as this will help with any pain.
It’s a good idea to take someone with you, too. They’ll make sure you get home safely afterwards. It may also be a good idea to get a taxi or a lift from a friend if you can, rather than take public transport.
Will it be painful?
It can be painful but the pain shouldn’t last long. This pain is from stretching the entrance to the womb.
Some people also feel a little faint or sick for a short while afterwards. This is because stretching the cervix in some people causes fainting.
Getting the coil fitted at the end of your period means your uterus will be at its most open, and this will make the fitting easier. But you can have a coil fitted at any time as long as you’ve not had a risk of pregnancy since your last period.
It may be less painful if you’ve given birth vaginally as your cervix will have previously been stretched.
How is the coil fitted?
The procedure itself takes about 10 minutes, but you’ll need to prepare for your appointment and may want to take the rest of the day to recover afterwards.
Before the fitting process, the clinician will do an internal examination to assess the size and shape of your uterus. This involves putting 2 fingers inside the vagina to hold the neck of the womb steady and one hand on the lower part of your abdomen. Between the two hands, the clinician will be able to feel the size of the womb (uterus).
While you lie down, with your knees bent, a speculum will be used to hold your vagina open. The same instrument is used when having a smear test done. Local anaesthetic gel is applied to the cervix, which will feel cold.
The clinician will use forceps to hold the cervix steady. Then they’ll measure the length of your uterus using a sterile probe.
The coil comes with its arms folded down, packed inside a narrow tube. The clinician will put the tube into the vagina, through the cervix and into your womb.
Next they'll pull the plastic tube out, leaving the coil in place and letting the arms fold open.
Then they'll position the coil correctly at the top of the womb.
Before the speculum is taken away, the strings of the coil are cut. This leaves 1 to 2cm hanging down at the top of your vagina so you can feel them and make sure it’s still there.
What happens afterwards?
You may want to lie down after the fitting for a while and take it easy for the rest of the day.
Paracetamol, hot water bottles and warm baths can all help with period-type pain after a coil is fitted. It usually goes away in a few hours, but it can last a couple of days.
Real contraception experiences
The insertion process was unpleasant, but not terrible. I was surprised by the pain. It was fine at first, but when the coil went into my womb it was suddenly painful – not agonising but like very bad period pain. It took me about 10 mins to recover afterwards and I went home on the bus, but I wish I hadn’t as I had a lot of cramps.
Once I was home, I lay down with a hot water bottle and things started to get much better. By later that evening I was fine and back at work the next morning.
Check for coil threads after your period
1 in 20 hormonal coils falls out, most often in the first 3 months after it’s been put in. Check the threads after every period so you know it’s still there.
Feel for your cervix with your fingers – it feels like a smooth lump at the top of the vagina. This is different from the rough walls of the vagina. As you try to run your fingers over the cervix you’ll feel the threads. They’re thicker than cotton but thinner than normal household string.
They’re often tucked up to the side of the cervix.
What do you do if you can’t feel your hormonal coil threads?
If you can’t feel your hormonal coil threads, see your healthcare professional. Start using other contraception (such as condoms) until you know for sure that the hormonal coil is in the right place.
The threads may just be tucked up inside the neck of the uterus. But it may also be a sign that your coil has fallen out. Your healthcare professional will check if they can see the threads. If not, they’ll use an ultrasound scan to see whether it’s still there.
How do you get the coil removed?
The hormone coil can be removed by a clinician without specialist training. This is a very simple procedure that lasts just a couple of minutes.
They’ll insert a speculum so that they can see the entrance to the womb and the hormone coil threads. Then they’ll use forceps to grasp the threads and gently pull the hormonal coil out of the womb and down through the vagina.
Use another contraceptive 7 days beforehand
There's a risk of pregnancy around the time you have a coil removed, so use another method of contraception or avoid sex in the 7 days before the removal.
This is because if there’s a fertilised egg already moving down the fallopian tube, which can take a few days, the coil won’t be there to prevent it from implanting.
Rare but important risks of having the coil fitted
Infection
Fitting the hormonal coil does not cause infection. If you already have an infection (like chlamydia or gonorrhoea) sitting at the entrance of the womb, the process of fitting a hormonal coil can move it to the womb.
You will be asked about your risk of infection when the coil is fitted and when you were last tested for STIs.
If you haven’t been tested recently, and have been at risk of infection, then you’ll usually be offered an STI test at the time of fitting.
If you get any of these within a few weeks of having the hormonal coil fitted, you should see your GP:
a high temperature
pain in your lower abdomen
a smelly discharge
Perforation
There is a very small chance – 1 in 500 people – that the hormonal coil goes through the wall of your womb and out the other side. It then sits in the abdomen outside the womb.
It usually happens only when it’s fitted and may not be noticed at the time. If this has happened, you will not be able to feel the coil’s threads. If you can feel the threads, that usually means everything’s fine.
Risk of it falling out
The hormonal coil may fall out without you noticing, particularly during a heavy period. This happens with 1 in 20 hormonal coils. It’s important to check your coil threads after each period.
If the coil is partly out then the threads might feel longer than usual, or you may feel the lower tip of the coil in the vagina. If you notice this, use an extra type of contraception, like condoms, until you can get to your clinic or GP.
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