IUD & coils

The coil is the only reversible method of contraception that is as reliable in everyday life as it is on paper. It is also the one most women are most wary of – because of the fitting. Both belong in the same conversation, and both are covered here.

What a coil is

A coil – technically an intrauterine device, IUD – is a small, usually T-shaped device placed inside the uterus. It is about three centimetres long, weighs almost nothing and stays in place for three to eight years depending on the model. Two fine threads run from its lower end through the cervix into the vagina; they allow you to check its position and make removal straightforward.

There are two families, and they work in fundamentally different ways:

• Hormonal coils release the progestogen levonorgestrel in very small amounts directly into the uterus. The practice fits Jaydess, Kyleena and Mirena.
• Hormone-free coils work through copper ions. These are the classic copper coil and the gold coil, whose gold core is intended to slow the corrosion of the copper.

The practical difference lies less in reliability – both are highly reliable – than in what happens to your bleeding. For most women, that is what decides the choice.

How a hormonal coil works

It releases a steady, very small dose of levonorgestrel: about 14 micrograms a day initially for Jaydess, 17.5 for Kyleena, 20 for Mirena. A progestogen tablet delivers a multiple of that, and into the whole body. The coil acts overwhelmingly where it sits.

Three effects work together:

1. The cervical mucus thickens and becomes virtually impassable for sperm. This is the main mechanism.
2. Sperm that do get through lose motility.
3. The lining of the uterus barely builds up, which is why bleeding becomes lighter – and why it stops altogether in some women.

With the smaller hormonal coils, ovulation usually continues. For many women that matters: the natural cycle carries on, only the bleeding is lighter.

How a copper coil works

Copper ions impair the motility and survival of sperm and alter the lining of the uterus so that a fertilised egg cannot implant. No hormones are involved; the cycle continues unchanged, ovulation happens, and bleeding comes as before – usually heavier.

For women who do not want hormones or cannot tolerate them, this is the method of choice. For women who already bleed heavily, it is usually the wrong one.

How reliable coils really are

The Pearl index states how many out of 100 women become pregnant within a year. It exists in two versions: perfect use and typical use. For the pill these differ by more than a factor of twenty – 0.3 against 7. Not because the pill is poor, but because people forget it.

That is precisely where the coil’s strength lies: once fitted, there is nothing left to do wrong, and the two figures converge.

Note the third row: the hormonal coil is statistically more reliable than sterilisation – and, unlike it, reversible. All methods side by side are in the contraception comparison.

The individual devices

Jaydess

The smallest hormonal coil: 28 × 30 mm, with an inserter 3.8 mm across. It contains 13.5 mg of levonorgestrel and stays in for three years. Bleeding becomes lighter and shorter; in about twelve out of a hundred women it stops altogether after a year. Its small size makes it a common first choice for young women and for women who have not given birth.

Kyleena

Same dimensions and inserter as Jaydess, but 19.5 mg of levonorgestrel and five years’ duration. Bleeding becomes markedly lighter; it stops in roughly 23 out of a hundred women after a year. For many this is the sensible compromise: small device, long duration.

Mirena

The larger hormonal coil: 32 × 32 mm, inserter 4.4 mm, 52 mg of levonorgestrel, licensed for up to eight years of contraception. It reduces bleeding the most.

Mirena is the only coil also licensed as a treatment – for heavy menstrual bleeding. If you are coming because of heavy periods and want contraception anyway, one procedure answers both questions. It also serves as the progestogen component of hormone replacement therapy in the menopause.

Copper coil

Hormone-free, five years, available in several sizes. The cycle stays unchanged. Bleeding becomes heavier, longer and often more painful, especially in the first months. As emergency contraception up to five days after intercourse it is by far the most effective option available – and it simply keeps working afterwards.

Gold coil

Built like the copper coil, with a gold core intended to slow corrosion. No proven advantage in effectiveness or tolerability over the plain copper coil follows from that – but for women concerned about copper allergy it is often the better option.

All five side by side, with prices and cost per year, are in the IUD comparison.

The procedure: two appointments, not one

Fitting a coil here involves two appointments. That is not a detour – it is the reason the second one is short and bearable.

First: the consultation

A conversation about your history, bleeding pattern, plans for children and how you tolerate hormones. Then the examination: ultrasound to assess the size and position of the uterus, a wet mount, and vaginal cultures. At the end you know which device is suitable – and that there is no infection that could be carried upwards during the fitting.

Second: the fitting

The procedure itself takes a few minutes. The cervix is prepared; the device is passed through the cervical canal in its inserter and released. The threads are trimmed to length. An ultrasound check at the end confirms the position.

The package price covers the check-up, ultrasound, pregnancy test, wet mount, medical preparation, the fitting and the device itself. Amounts are on the fees page.

Does it hurt?

Yes, the fitting is uncomfortable – claiming otherwise helps nobody. But the honest answer continues: how uncomfortable depends considerably on how it is done. Four things make the difference: preparing the cervix, the timing within the cycle, the diameter of the inserter (3.8 against 4.4 mm sounds like little and is not), and taking the time.

What to expect: a brief, strong cramping pain as the inserter passes the cervix, then a dragging ache like severe period pain that fades over a few hours. Some women take the rest of the day off; many go back to work. A painkiller an hour beforehand makes sense and will be discussed with you.

A brief drop in blood pressure with dizziness or nausea can happen during the procedure. It is harmless and passes within minutes, and you may stay lying down for as long as you need afterwards. Bring someone with you if you would rather not travel home alone – it is a common request and never an inconvenience.

The first months, and the checks after

With a hormonal coil, irregular spotting in the first three to six months is the rule rather than the exception – and the most common reason coils are removed early. It is worth knowing in advance: after that period, bleeding usually becomes markedly lighter, shorter and less painful.

With a copper or gold coil it is the other way round: heavier, longer and often more painful periods, again most pronounced early on.

One check four to six weeks after fitting, then annually. Ultrasound shows whether the device is still correctly placed – it can shift, most often in the first months and most often during a period. You can also feel for the threads yourself.

Risks worth knowing about

• Perforation of the uterine wall during fitting: rare, in the order of one in a thousand, and usually without consequence when recognised. More common shortly after childbirth and while breastfeeding, which is why twelve weeks are usually allowed to pass first.
• Ascending infection: slightly more likely in the first three weeks after fitting, not afterwards. The cause is not the device but the possibility of carrying an existing infection upwards – which is exactly what the consultation appointment with swabs is there to prevent. Fever, increasing lower abdominal pain or foul-smelling discharge in the weeks after fitting should be assessed the same day.
• Ectopic pregnancy: if pregnancy occurs despite a coil, it lies outside the uterus more often than usual – not because the coil causes this, but because it prevents implantation in the uterus particularly well. In absolute terms the risk is lower with a coil than with no contraception at all.

Coming off the pill: what changes

The commonest switch in this practice is from the combined pill to a hormonal coil. What changes is worth naming in advance.

What falls away: thinking about it every day; the uncertainty after vomiting, diarrhoea or a missed tablet; the thrombosis risk that comes with oestrogen; the recurring prescription. If you have migraine with aura, have had a thrombosis, or smoke and are over 35, the combined pill is not an option at all – a hormonal coil is, because it contains no oestrogen.

What comes back: your own cycle. On the combined pill there is no real ovulation and no real period, only a withdrawal bleed in the break. With the smaller coils ovulation resumes, and with it the hormonal ups and downs of a natural cycle. Some women experience that as a relief; others notice premenstrual symptoms that had been suppressed for years. Both happen, and both are better heard beforehand than discovered afterwards.

What stays: side effects the pill was solving do not necessarily disappear. Acne that improved on an anti-androgenic pill can return – levonorgestrel has no anti-androgenic effect. It is one of the few points on which the pill beats the coil.

If you have recently moved to Austria

Two things differ from many other countries and are worth knowing before your first appointment.

Contraception is not covered by public health insurance in Austria. Neither the pill nor a coil is reimbursed; you pay for the device and the procedure yourself. This practice is a Wahlarztordination – a private practice without a health-fund contract – so you pay the fee and submit the invoice to your fund, which refunds 80 per cent of the corresponding contracted tariff for the medical service. That is 80 per cent of what the same service would have cost with a contracted doctor, not 80 per cent of the fee you paid, and the device itself stays with you either way. All amounts are on the fees page.

Screening intervals are different too. An annual gynaecological check-up is covered by the e-card, with a cervical smear yearly up to 29 and HPV testing from 30 at intervals of at least three years. Having a coil changes none of this: contraception and cancer screening run independently of one another. The screening planner shows what applies at your age.

Consultations can be held entirely in English. If you would like that, say so when you arrange the appointment – see practical information for how.

Checking the threads yourself

Once the first check has confirmed the position, you can feel for the threads yourself if you wish: squatting or with one foot raised, two fingers into the vagina until you reach the cervix – firm, smooth, roughly the shape of a nose tip. The threads sit in its centre and feel like two short pieces of fishing line. Do not pull on them.

This is optional, not homework. It is worth doing after an unusually heavy or painful period, which is when a coil is most likely to shift. What matters is what changes: threads that suddenly feel much longer, that cannot be found at all, or a hard tip of plastic at the cervix are all reasons to book an appointment rather than to worry. Until it has been checked with ultrasound, use condoms as well.

When a coil is not suitable

• during pregnancy
• with an acute genital infection – treat first, then fit
• with unexplained bleeding – investigate first
• with malformations or large fibroids distorting the uterine cavity
• hormonal coils: with a history of breast cancer (the copper coil remains possible)
• copper coils: with Wilson’s disease or copper allergy

Next step

If you are considering a coil, the next step is the consultation appointment, where the choice of device and the timing of the fitting are decided. See practical information for how to arrange it, or compare the options first in the IUD comparison.