What Happens at Your Appointment?
We usually start by talking about your concerns and symptoms and getting some details around your general health. It can be useful to have a list of any medications you are on. If required, an examination may be carried out which may include an internal examination and a transvaginal scan. You may need a biopsy or a blood test and this will be discussed with you prior to anything being done.
You will get a copy of your notes and a digital copy of any scan images from the appointment. You may also get a letter to hand in to your GP, as well as information leaflets that will help with your understanding of your condition as well as treatment options. I aim to have these e-mailed to you within 7 working days.
Results of blood tests and biopsies can take anywhere from 2 days to 3 weeks depending on the test being done. You will be e-mailed a copy of the results once they are available.
Please bring a friend or your partner with you for support if you want but it does help to not have more than 1 other person in the consultation with you. You may feel faint after some procedures so is it advisable to either not drive yourself or allow enough time to recover before driving. There are some refreshments provided in the waiting area while you wait.
There is some information in the health advice section that you may find useful to look at prior to your appointment if you are having a procedure carried out.
A follow up appointment is sometimes needed to assess progress with treatment, discuss possible side effects and look at alternatives if required or a repeat ultrasound scan. There may also need to be a planned annual review for some patients on HRT where a blood test may be recommended to check hormone levels.

Information About The Coil
IUCD – Copper Coil
This is non-hormonal T shaped plastic and copper structure that sits within the uterus. The copper makes it difficult for the sperm to fertilise the egg, stops the sperm from getting through the cervical mucus and makes the womb lining less likely to allow the egg to implant.
The contraceptive effect is immediate and it is very effective- only 1-2 women out of every 100 using the IUD over 5 years will become pregnant. It can be used as emergency contraception up to 5 days after you have had unprotected sex.
The 5 year coil has a smaller frame and less copper than the 10 year coil so it will have less of an effect on the heaviness of your periods and is more suitable for some women with a smaller uterus. If your coil is inserted over the age of 40, you can keep using it until you are 55.
IUS – The Mirena or Kyleena
This is the hormonal coil, which slowly releases Levonorgestrel, a progestogen. It works by thinning the lining of the womb and thickening the cervical mucous to prevent sperm form entering the womb. If it is inserted on D 1-7 of your cycle (day 1 is the first day of your period), then it is effective immediately, at any other time, it takes 7 days to be effective so use alternative methods ( ie condoms) or continue with your current method of contraception for 7 days.
The Mirena IUS – (52 mg LNG) Can be used for 8 years for contraception, and 5 years for treatment of heavy menstrual bleeding or for endometrial protection. If you are 45 or over at the time of insertion of a Mirena IUS, you can continue to use it for contraception until the age of 55. If your Mirena is being used for endometrial protection / HRT it should be replaced after 5 years.
The Kyleena IUS – (19.5 mg LNG) Much lower dose of hormone and smaller frame compared to the Mirena. Can be used for 5 years for contraception. This is useful for women who want an IUD for contraception but have slightly heavier periods that could get heavier with a copper coil.
You can take paracetamol or ibuprofen 1 hour prior to your appointment to help with pain relief. It is best to be hydrated and have a light meal prior to your appointment.
You are welcome to bring a friend or partner for support. Some women use distractions such as listening to music or breathing exercises to help remain calm and re- lax the muscles during the procedure.
Coil Insertion
Prior to inserting a coil, you will have a consultation to determine if it is suitable for you. The device can be fitted during the same appointment if suitable.
A coil cannot be inserted if there is a risk you might be pregnant at the time. A pregnancy test may be carried out prior to your coil insertion if required.
Make sure you have no risk of pregnancy:
1.If you already have an IUD in place, use additional contraception or avoid sex in the week before your appointment.
2.If you have recently been pregnant, use effective contraception even if your periods have not started again or are not regular.
3.If you are not using reliable contraception, do not to have unprotected sex between your last period and your appointment at the clinic
4.If you are not having regular periods, use contraception or avoid sex for 3 weeks prior to your appointment. A pregnancy test can be done prior to the Coil insertion.
You will have a pelvic examination prior to insertion of the coil. Local anaesthetic is used- there are different types available at the clinic a gel, a spray and an injection.
The coil threads are trimmed to about 2-3 cm so you will be able to self check the threads.
You may experience some cramp and bleeding for a few days after insertion.
It is advisable to self check the threads within 4-6 weeks of your coil insertion then at regular intervals, after your period.
If you are unable to feel your coil threads, use additional contraceptive methods until you can be seen as it may be a sign of expulsion or perforation. You may need to consider emergency contraception if there is uncertainty about where the col is.
Coils do not protect against sexually transmitted infections.
Coil Removal or Replacement
There is a pregnancy risk if there has been unprotected sex in the 7 days prior to a coil removal or replacement, so it is advisable to use additional contraception (ie condoms ) or avoid sex in the 7 days before your appointment. Most coil removals are fairly quick with minimal discomfort.
Removal of a coil can be more difficult if the threads of the coil are not visible. You may require an ultrasound to see where the coil is located. You may also require local anaesthetic during the removal. Rarely, it may not be possible to remove the coil and you may need to be referred for a hospital procedure.
You may experience some spotting or bleeding after the coil removal.
Side Effects – During insertion or removal, you may feel pain, dizziness or experience bleeding.
Sometimes a coil insertion/ removal may take longer if the threads are not visible or there are other issues such as cervical spasm. Please ask for additional local anaesthetic if you feel you need it. Very rarely, the coil cannot be inserted/ removed.
IUCD – During the first few months after an IUCD insertion, three may be some bleeding or spotting between periods as well as some cramp- this usually settles within 3-6 months. Your period may be heavier and longer.
IUS – The common side effects seen with the IUS are acne, breast tenderness, headache and irregular bleeding. The side effects tend to settle with time.Most women find that after a few months, bleeding becomes lighter and after 1 year most women have infrequent or no bleeding.
Women who experience recurrent thrush or bacterial vaginosis may want to consider alternative methods of contraception.
Risks of Using a Coil
- Infection – ( <1%) The highest risk is in the first 3 weeks after insertion. It may be associated with a sexually transmitted infection. If you think you may be at risk of having a sexually transmitted infection, you could consider having tests done prior to having a coil inserted. Pelvic inflammatory disease after a coil insertion affects 1.6 in 1000 women.
- Expulsion – about 1 in 20, highest in the first 3 months and in the first year after insertion. This is more common you have fibroids or very heavy bleeding.
- Perforation of the uterus or cervix- about 2 per 1000. The risk is around 6 times higher if you are breastfeeding or have recently given birth- you should wait at least 4 weeks after delivery before having a coil inserted.
- Ovarian cysts may occur in some women using the IUS, most cysts are asymptomatic and resolve by themselves.
- Pregnancy – very low risk. The failure rate after 1 year is 0.8% with a copper coil and 0.2 % with a hormonal coil ( compared to 9% for women on the combined contraceptive pill)
- If a pregnancy does occur with an IUD in place, there is a 6% chance that it is an ectopic pregnancy.
- Cervical shock- bradycardia (low heart rate) 1.8 %, hypotension (low blood pressure) 2.1%
Seek medical assistance if there is concern of pelvic infection, pelvic pain, abnormal bleeding, a missed period and a positive pregnancy test, and if you can’t feel the threads, the threads feel longer than usual or if you can feel the stem of the coil.
Benefits of Using a Coil
- Long lasting contraception
- Very effective at preventing pregnancy.
- The IUS (hormonal coil) can make your periods lighter and decrease painful periods, and pain associated with endometriosis and adenomyosis. It can reduced the risk of endometrial cancer
- The IUCD may reduce the risk of cervical and endometrial cancer.
Do Not Use a Coil
- If you are pregnant or may be pregnant.
- If you are within 4 weeks of having a baby.
- If there is an infection in the womb or pelvis
- If you have any undiagnosed abnormal bleeding
- If you have an untreated gynaecological cancer.
- If you have Wilsons disease (copper coil)
- If you are allergic to any of the component of the IUCD/ IUS
- If you have certain cardiac conditions, or are on long term steroids, it is recommended that you have your coil inserted in a hospital setting not in an outpatient setting such as this clinic.
More information on IUCD and IUS can be found on
Sexual Health Scotland – sexualhealthscotland.co.uk
NHS Inform – nhsinform.scot
www.nhs.uk
Information About The Contraceptive Implant
The contraceptive implant Nexplanon is a long acting hormonal contraceptive which is inserted under the skin of your arm. It contains Etonogestrel, a progestogen. The implant lasts for 3 years and is 99% effective at preventing pregnancy.
It works by preventing the release of an egg from the ovaries ,thickening the cervical mucus to make it difficult for sperm to enter the womb and thins the lining of the womb.
Implant Insertion
Prior to the implant insertion, you will have a short consultation to determine if it’s suitable for you. Some people have a pregnancy test carried out prior to the insertion if there is a risk they might be pregnant on the day of the appointment.
The implant is inserted just under the skin of your arm using local anaesthetic. Paper stitches are applied which are removed after 4-5 days, and a pressure bandage to reduce swelling and bruising is used for 24 hours.
You should be be able to feel the implant after insertion. You will be given some information on wound care after your appointment.
If the implant is inserted on day 1-5 of your cycle (day 1 is the first day of your period) then it is effective immediately. If it is inserted at any other time of your cycle, you need to use back up contraception ( condoms) or continue with your current method of contraception for 7 days until your implant is effective. The implant is effective for 3 years. The risk of getting pregnant in the 4th year is very low, but you may wish to get it replaced after 3 years or use additional methods of contraception.
Implant Removal
For implant removals in this clinic, the implant needs to be easily felt under the skin. If you are unable to feel your implant it may have been inserted too deep and you will be referred to a deep implant removal service to be seen by a specialist who is trained in complex implant removals after a scan.
Implants are removed under local anaesthetic through a small incision made in the skin. Paper stitches are applied and can be removed after 4-5 days, and a pressure bandage to reduce swelling and bruising is used for 24 hours.
A new implant can be inserted immediately after the old implant is removed using the same incision as long as it is in the correct location.
Once an implant has been removed, the hormone level drops in 7 days and pregnancies have been reported within 14 days of an implant removal. If you need alternative contraception, this can be discussed at your appointment.
You will be given some information on wound care after your appointment.
Risks and Complications
After an insertion or removal, some bruising, pain, swelling and itching may occur. There will be a small scar. Expulsion or migration of the implant after insertion is possible. There is a risk of infection at the wound site- if you experience redness, swelling or discharge from the site, please see your GP as you may have an infection and may need antibiotics.
Advantages of Using The Implant
- Very reliable – 99% effective at preventing pregnancy.
- It can help improve painful periods.
- It can help with endometriosis pain
- Some women experience lighter periods
- No long term effects on fertility
Possible Side Effects of The Implant
Common- ( may affect more than 1 in 10 people)- acne , headache, nausea, breast tenderness, irregular bleeding. 1 in 5 women had no bleeding, 1 in 5 had frequent and/or prolonged bleeding. The bleeding pattern can be unpredictable and change at any time. If you have troublesome bleeding after the implant insertion, around 50% of women find that it improves with time.
Some women have reported mood changes and weight gain with the implant but there is no evidence that these are caused by the implant. There are other side effects that are listed in your implant information sheet which are not as common.
Do Not Use Nexplanon
- If you are allergic to Etonogestrel
- If you have a thrombosis ( blood clot)
- If you have jaundice or severe liver disease.
- If you are pregnant or suspect you may be pregnant.
- If you have breast cancer
- If you have had a stroke or heart disease.
- If you have any unexplained bleeding
More information on the implant can be found on
NHS Inform – nhsinform.scot
Sexual Health Scotland – sexualhealthscotland.co.uk
www.nhs.uk
Contraceptive Implant Wound Care Instructions
If you have had the contraceptive implant inserted, be sure to check you can feel it after insertion.
After insertions or removals, paper sutures and an adhesive dressing will be put over the wound, as well as an outer compression bandage.
Keep the compression bandage on for 24 hours- this will help to reduce swelling and bruising.
Once the pressure bandage is removed, keep the wound dressing and paper sutures clean and dry for another 3 -5 days to allow the wound to heal. When showering or bathing, you can cover the bandage with cling film to protect it and keep it dry.
When removing the paper sutures, gently lift both ends towards the centre of the wound before removing them. They can be soaked with warm water to aid removal.
You may experience pain, swelling , itching, bruising and discolouration around the wound site that can last for up to 2 weeks. You can take simple painkillers such as paracetamol or ibuprofen if required.
A small number of women develop an infection at the wound site. Contact your doctor if you have redness, warmth or draining from the site, fever or chills. You may need a course of antibiotics.
In some cases, if there is persistent infection despite antibiotic treatment, the implant will have to be removed.