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11/13/24, 8\:16 PM Guide | Copper coil counselling

Copper coil counselling

Table of contents

Introduction

Contraceptive counselling often features in OSCEs, and it’s important to be familiar with the various methods of
contraception available.
This article focuses on counselling patients about the copper intrauterine device (commonly referred to as the copper coil or
Cu-IUD), including the common questions patients ask, the information you’ll be expected to give and how best to structure the
consultation.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain the reason for the consultation\:
c o n t r a c e p t i o n . I s t h a t c o r r e c t ?”
.
“ I u n d e r s t a n d y o u a r e i n t e r e s t e d i n u s i n g t h e c o p p e r i n t r a u t e r i n e d e v i c e / c o p p e r c o i l f o r
It is important to establish a good rapport and an open line of communication with the patient early in the consultation\:
h a v e a n y q u e s t i o n s a t a n y p o i n t , o r i f s o m e t h i n g i s n o t c l e a r , p l e a s e f e e l f r e e t o i n t e r r u p t a n d a s k m e .
”
“ I f y o u
Make sure to check the patient’s understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as ‘chunking and checking’).

Ideas, concerns and expectations

A key component of contraceptive counselling involves exploring a patient’s ideas, concerns and expectations (often referred
to as ICE).
In a contraceptive consultation, it is important to explore ICE, as many patients will have researched or have prior experience
with contraceptive methods. This will help you tailor the consultation and the advice you give regarding speci
important to identify any patient concerns and expectations early in the consultation, as this may a
method and subsequent contraceptive e
It can sometimes be challenging to use the ICE structure in a way that sounds natural in your contraceptive consultation, but
we have provided some examples for each of the three areas below.

Ideas

Explore what the patient currently understands about the copper intrauterine device\:
“ H a v e y o u h e a r d o f t h e c o p p e r i n t r a u t e r i n e d e v i c e / c o p p e r c o i l ?”
“ W h a t d o y o u a l r e a d y k n o w a b o u t t h e c o p p e r i n t r a u t e r i n e d e v i c e / c o p p e r c o i l ?”

Concerns

Ask if the patient has any concerns about the copper intrauterine device\:
“ I s t h e r e a n y t h i n g t h a t w o r r i e s y o u a b o u t t h e c o p p e r i n t r a u t e r i n e d e v i c e / c o p p e r c o i l ?”
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Expectations

Explore the patient’s expectations of the copper intrauterine device\:
“ W h a t f a c t o r s h a v e m a d e y o u c o n s i d e r u s i n g t h e c o p p e r i n t r a u t e r i n e d e v i c e / c o p p e r c o i l ?”
“ W h y d o y o u t h i n k t h e c o p p e r c o i l i s t h e b e s t c h o i c e f o r y o u ?”

Eligibility

Before starting any method of contraception, it is vital to check the patient's eligibility and for any contraindications.
The Faculty of Sexual and Reproductive Health (FSRH) produce the UK Medical Eligibility Criteria for Contraceptive Use
(UKMEC) which guides clinicians on the safety of di
characteristics and medical co-morbidities\:
UKMEC 1\: no restriction
UKMEC 2\: bene
UKMEC 3\: theoretical or proven risk generally outweighs the bene
UKMEC 4\: contra-indicated

UKMEC 4 criteria

UKMEC 4 criteria for the copper coil include\:
Postpartum or post-abortion sepsis
Active pelvic in
Symptomatic chlamydial infection
Current gonorrhoea infection
Unexplained vaginal bleeding (suspicious for a serious cause, before assessment has occurred)
Gestational trophoblastic disease with persistently elevated hCG levels or malignant disease
Cervical cancer (awaiting treatment)
Endometrial cancer
Pelvic tuberculosis

UKMEC 3 criteria

UKMEC 3 criteria for the copper coil include\:
48 hours to \<4 weeks postpartum
Complicated organ transplant (rejection, failure)
Long QT syndrome
Previous radical trachelectomy
Uterine
HIV infection (\<CD4 \<200)

What is the copper coil?

Using patient-friendly language, explain that the copper intrauterine device is a form of long-acting reversible contraception
(commonly referred to as LARC methods or ‘
The coil is a small plastic and copper device inserted into the uterus during a procedure in clinic. Its insertion is via an insertion
tube, which passes through the cervix.
Depending on the amount of copper on the device, they can provide contraception for 5 - 10 years.
Example
https\://app.geekymedics.com/osce-guides/counselling/copper-coil-counselling/ 2/611/13/24, 8\:16 PM Guide | Copper coil counselling
“ T h e c o p p e r c o i l i s a s m a l l p l a s t i c a n d c o p p e r T -s h a p e d d e v i c e t h a t w i l l s i t i n s i d e y o u r w o m b a n d a c t t o p r e v e n t
p r e g n a n c y . I t i s h i g h l y e
d e p e n d i n g o n t h e t y p e o f d e v i c e t h a t i s
a n d r e m o v e i t .
”

How e

When counselling patients regarding contraception, it is very important to explain how e
any factors which may impact e
Explain to the patient that the copper coil is over 99% e
immediately for contraception once emergency contraception.
Example
“ L e s s t h a n 1 c o p p e r c o i l u s e r i n 1 0 0 w i l l ge t p r e g n a n t i n o n e y e a r .
”
“ I f 1 0 0 s e x u a l l y a c t i v e w o m e n d o n’ t u s e a n y c o n t r a c e p t i o n , 8 0–9 0 w i l l ge t p r e gn a n t i n a y e a r .
”

How does the copper coil work?

Explain to the patient that the copper within the intrauterine device is spermicidal. The concentration of copper in the cervical
mucus inhibits the motility of sperm into the womb, and the copper causes changes to the endometrium that can prevent
implantation.
Example
“ T h e c o p p e r c o i l w o r k s b y p r e v e n t i n g a n y s p e r m f r o m s u r v i v i n g o r r e a c h i n g a n e gg. E v e n i f a s p e r m w e r e t o r e a c h a n e gg,
t h e c o p p e r a l s o c a u s e s c h a n g e d t o t h e w o m b l i n i n g t h a t w o u l d m a k e i t m o r e d i
t h e r e .
”

Advantages and disadvantages of the copper coil

When discussing contraceptive options, it is important to give the patient enough information to make an informed
decision and direct them to reputable sources of further information.
When explaining potential advantages and disadvantages, you should consider the patient’s ideas, concerns and
expectations (identi
Signposting is important to help you structure the consultation\:
h a v i n g t h e c o p p e r c o i l a n d s o m e o f t h e p o t e n t i a l d i s a d v a n t a g e s . “ N e x t , I’ d l i k e t o t a l k a b o u t s o m e o f t h e a d d i t i o n a l b e n e
I s t h a t o k ? .
”

Advantages of the copper intrauterine device

Advantages of the copper intrauterine device include\:
Highly e
Immediately e
Long lasting (up to 10 years, depending on the type of device
‘Fit and forget’
– no requirement to take a daily pill or attend regular appointments.
Easily reversible (once removed, fertility returns instantly)
Does not contain hormones (may be an important factor for some users)
https\://app.geekymedics.com/osce-guides/counselling/copper-coil-counselling/ 3/611/13/24, 8\:16 PM Guide | Copper coil counselling
No medication interactions
Safe in breastfeeding
Example
“ T h e c o p p e r c o i l b e g i n s w o r k i n g s t r a i gh t a w a y a s c o n t r a c e p t i o n , c a n l a s t u p t o 1 0 y e a r s , a n d i s 9 9 % e
r e a s o n s w h y i t i s s o e
r e a s o n d o e s n o t i n t e r a c t w i t h o t h e r m e d i c a t i o n s y o u m i g h t n e e d . A s s o o n a s t h e c o p p e r c o i l i s r e m o v e d , f e r t i l i t y r e s u m e s
a s n o r m a l .
”

Disadvantages of the copper intrauterine device

Potential disadvantages of the copper intrauterine device include\:
Heavier and more painful periods
Does not protect against sexually transmitted infections
Requires a procedure to
1/20 risk of expulsion of the device (highest in
Does not prevent ovulation (therefore, it would not help with premenstrual syndrome symptoms)
Ectopic pregnancy\: whilst the chance of pregnancy is extremely low, if users were to become pregnant with the device in
situ, there is an increased risk of ectopic pregnancy
Example
“ Y o u r p e r i o d s m a y b e h e a v i e r , l o n g e r a n d m o r e p a i n f u l t h a n t h e y w e r e p r e v i o u s l y d u e t o t h e e
t h e d e v i c e . U n f o r t u n a t e l y , t h e c o i l d o e s n o t p r o t e c t y o u f r o m s e x u a l l y t r a n s m i t t e d i n f e c t i o n s ( S T I s ) . B a r r i e r c o n t r a c e p t i o n
( e .g . c o n d o m s ) a r e t h e o n l y m e t h o d o f c o n t r a c e p t i o n t o a l s o p r o v i d e p r o t e c t i o n f r o m i n f e c t i o n s .
”
“ T h e c o p p e r i n t r a u t e r i n e d e v i c e r e q u i r e s a s h o r t p r o c e d u r e t o
”
a s t h e r e a r e a
“ A f t e r
k n o w n a s e x p u l s i o n , a n d t h e r i s k i s h i g h e s t i n t h e

t h a t t h e d e v i c e i s s t i l l p r e s e n t . I f y o u h a d a n y c o n c e r n s t h a t t h e c o i l m i g h t h a v e b e e n e x p e l l e d , y o u s h o u l d n o t r e l y o n i t f o r
c o n t r a c e p t i o n a n d s e e k a r e v i e w f r o m y o u r l o c a l G P o r s e x u a l h e a l t h s e r v i c e f o r o n go i n g s u p p o r t .
”
“ Y o u w i l l c o n t i n u e t o p r o d u c e a n e g g e a c h m o n t h a s n o r m a l w i t h t h i s m e t h o d , t h e r e f o r e , i f y o u n o r m a l l y e x p e r i e n c e
p r e m e n s t r u a l s y m p t o m s ( P M S ) , t h e s e w i l l l i k e l y c o n t i n u e . A l t h o u gh t h e c h a n c e s o f ge t t i n g p r e g n a n t w i t h t h e c o p p e r
i n t r a u t e r i n e d e v i c e i n s i t u a r e v e r y s m a l l , i f y o u w e r e t o b e c o m e p r e gn a n t , y o u r c h a n c e o f h a v i n g a p r e g n a n c y d e v e l o p i n g
o u t s i d e t h e w o m b ( a n e c t o p i c p r e g n a n c y ) w o u l d b e h i g h e r . T h e r e f o r e , i f y o u b e c o m e p r e gn a n t , i t i s i m p o r t a n t t o s e e k
m e d i c a l a d v i c e . Y o u r o v e r a l l c h a n c e o f h a v i n g a n e c t o p i c p r e g n a n c y i s s t i l l l e s s t h a n s o m e o n e n o t u s i n g a n y
c o n t r a c e p t i o n .
”

How is the copper coil

Insertion of a copper intrauterine device

A copper intrauterine device can be inserted anytime during the menstrual cycle. Inserting a copper intrauterine device
requires a trained
through the cervical canal. Patients may have anxieties about having a coil
ideas and concerns regarding the procedure.
Risks of insertion include\:
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Pain
Bleeding
Infection
Perforation of the uterus
In nearly all cases, an intrauterine device can be
advised to take some simple analgesia shortly before the procedure to help with their comfort. Before the device can be
inserted, you must ensure there is no risk of pregnancy. A routine pregnancy test may be indicated.
Once
Using patient-friendly language, explain the procedure for
Example
“ A s w e’ v e d i s c u s s e d , i n s e r t i n g a c o p p e r c o i l i n t o t h e w o m b r e q u i r e s a s h o r t p r o c e d u r e . I t i s a go o d i d e a o n t h e d a y t o t a k e
s o m e p a r a c e t a m o l a n d i b u p r o f e n a r o u n d 1 h o u r b e f o r e y o u r a p p o i n t m e n t t o h e l p m a k e t h i n g s m o r e c o m f o r t a b l e d u r i n g
t h e p r o c e d u r e .
”
“ T h e p r o c e d u r e i n v o l v e s a n i n i t i a l i n t e r n a l e x a m i n a t i o n ( u s i n g 2
p o s i t i o n o f t h e w o m b . F o l l o w i n g t h i s , t h e c l i n i c i a n w i l l i n s e r t a s p e c u l u m t o v i s u a l i s e t h e c e r v i x ( t h e e n t r a n c e t o y o u r
w o m b ) . A t t h i s p o i n t , p a i n r e l i e f ( l o c a l a n a e s t h e t i c ) c a n b e a p p l i e d t o t h e c e r v i x o r i n s e r t e d i n t o t h e w o m b . A d e v i c e i s
p l a c e d o n y o u r c e r v i x t o k e e p i t s t i l l f o r t h e n e x t p a r t o f t h e p r o c e d u r e . A s m a l l m e a s u r i n g i n s t r u m e n t i s i n s e r t e d t o
m e a s u r e t h e l e n g t h o f t h e w o m b . T h e c o p p e r c o i l i s t h e n i n s e r t e d , t h e t h r e a d s a r e t r i m m e d , a n d t h e s p e c u l u m i s
r e m o v e d .
”
“ A n u n c o m p l i c a t e d i n s e r t i o n n o r m a l l y t a k e s a r o u n d 1 0 m i n u t e s . T h e c o p p e r i n t r a u t e r i n e d e v i c e i s t h e n i m m e d i a t e l y
e
”

Analgesia

All patients should be oIUS) is inserted. Options for
analgesia include\:
An intracervical block (using local anaesthetic)
Local anaesthetic spray to the cervix
Insertion of anaesthetic gel into the uterus
Simple analgesia (paracetamol/ibuprofen)\: patients are advised to take simple analgesia before and after the procedure.
It is important the user feels in control during the

Removal of a copper intrauterine device

An intrauterine device is removed during a short procedure, which is less invasive than an insertion. A speculum is used to
visualise the cervix and threads. The threads can be pulled to remove the device from the uterus.

Aftercare

Checking the threads

Explain to the patient they will need to check the threads of the IUD around 4-6 weeks after it has been
may feel uncomfortable with self-examination and checking threads. It may be appropriate to arrange a follow-up speculum
examination after

Safety netting

Patients should be informed to seek medical advice if\:
They are unable to feel their threads on examination
They experience ongoing pain after the
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They experience an unexpected/ unwanted change in their bleeding pattern
They experience unusual vaginal discharge or fever, which could indicate infection relating to the device
There is a change to their medical history
Example
“ T o c h e c k t h e t h r e a d s a n d t h a t y o u r c o p p e r c o i l i s p r e s e n t , i n s e r t a
s o m e t h i n g
t o g e t h e r ) a r o u n d y o u r c e r v i x . D o n o t p u l l t h e m , a s l o n g a s t h e y’ r e t h e r e , y o u k n o w t h e i n t r a u t e r i n e d e v i c e i s i n p l a c e .
”
“ I f y o u c a n n o t f e e l t h e t h r e a d s , d o n o t r e l y o n t h e d e v i c e f o r c o n t r a c e p t i o n , a n d b o o k a n a p p o i n t m e n t f o r a c l i n i c i a n t o
p e r f o r m a s p e c u l u m e x a m i n a t i o n t o c h e c k a n d u s e a n a l t e r n a t i v e m e t h o d o f c o n t r a c e p t i o n w h i l s t w a i t i n g f o r t h i s .
A d d i t i o n a l l y , i f y o u e x p e r i e n c e o n g o i n g p a i n a f t e r
u n u s u a l v a g i n a l d i s c h a r g e , f e v e r o r a c h a n g e i n y o u r m e d i c a l h i s t o r y , t h e n p l e a s e s e e k m e d i c a l a d v i c e .
”

Closing the consultation

Close the consultation by summarising what you have discussed. This allows you to emphasise the key points of the
consultation to ensure patient understanding.
Ask the patient if they have any further questions or concerns that haven’t been addressed.
If the patient is not currently using contraception, o
insertion of the copper intrauterine device.
Finally, thank the patient for their time and o
intrauterine device (e.g. Sexwise IUD lea).
Dispose of PPE appropriately and wash your hands.

Reviewer

Reviewer

Dr Ashley Je

References

FSRH. Intrauterine Contraception. 2019. Available from\: [LINK]
Source\: geekymedics.com
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