The coil

People have used all manner of methods to prevent pregnancy and one of the most successful ones has been devices inserted into the uterus, the modern day Intra Uterine Contraceptive Device (IUCD) or the Coil, writes DR MARGA BOYANIThe coil is the world’s most widely used and inexpensive long-term reversible method of contraception for women. The varieties available in Kenya include the Copper T, the Nova T and Mirena. Mirena is a hormone-releasing coil whereas the Copper T and Nova T are both hormone-free and made up of a soft piece of T-shaped white plastic with vertical and horizontal arms that have copper metal coiled around them. This copper is slowly released into the uterine cavity enhancing the contraceptive effect. Both coils have a ‘string’ attached made of a single strand of strong, smooth plastic that cannot absorb or ‘wick’ fluid or bacteria from the vagina into the uterine cavity. The string allows for easy removal and it also allows a woman or her doctor to know if the coil is still in the correct position. If the string shortens or lengthens, the coil may have moved out of place or if it can’t be located, the coil may have been expelled or translocated to another part of the uterus or pelvis. The Copper T prevents pregnancy for over ten years and the Nova T for five years. Both are inserted into the uterus in a procedure that takes only minutes and it stays in the uterus until a doctor takes it out. Once inserted, the coil is immediately effective and when removed, its contraceptive effect is immediately reversed. A coil can be inserted at any time during the menstrual cycle but many doctors prefer inserting it during one’s period when the woman’s cervix is open and she is least likely to be pregnant. The menstrual fluid also provides lubrication during the insertion. Another good time to have a coil inserted is mid-cycle, during ovulation. How it works:It is thought to slow down or stop the sperm’s movement through the reproductive tract as well as make the ovulated egg travel down the fallopian tube faster. This keeps the egg and sperm from meeting so that the egg is not fertilised. The coil also interferes with implantation of a fertilised egg in the lining of the uterus by making this lining hostile to implantation. The copper adds to the effectiveness of the coil by increasing prostaglandin secretion in the lining of the uterus preventing implantation of a fertilised egg. Its advantages:• It’s the most effective reversible long-term method of birth control.• It’s cost-effective because it gives long term contraception.• It’s convenient because there isn’t much to do like remembering to swallow a pill daily.• It is safe and private.• It can be used by women who cannot use oestrogen-containing birth control pills. • It can be used by breastfeeding women.• It can be inserted immediately following delivery, an abortion or after removal of another coil. • If a woman has a coil or is fitted one past the age of 40, it can be left in until one year after menopause, which is the last period a woman will ever have in her lifetime. Its disadvantages:• It does not protect against sexually transmitted infections.• One’s periods may become heavier and longer, causing anaemia.• Period pains may become worse. • One may have an allergic reaction to copper.• The coil may be expelled by the uterus and if the woman does not notice it, she can easily become pregnant.• In some rare cases, the coil may attach to or become deeply embedded in the uterine wall or may work its way through the uterus into the pelvis or abdomen and then has to be taken out through surgery. • There is a slightly higher risk of pelvic inflammatory disease and tubal (ectopic) pregnancy. • If a pregnancy occurs when a woman is using a coil, there is a 50 to 60 per cent chance of miscarriage if the coil is not removed.After insertionHave a checkup after your first period and not longer than three months after insertion to make sure your coil is still in place. Then have check-ups at least once a year to make sure everything is all right. Check your pads or tampons whenever you change them during your period to see if the coil has fallen out

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