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Contraceptive counselling often features in OSCEs and therefore it’s important to be familiar with the various types of contraception available. This article focuses on counselling patients regarding the Copper coil (also referred to as the Copper Intrauterine Device) including the common questions patients ask, the answers you’ll be expected to articulate and how best to structure the consultation overall.

Check out the Copper coil counselling mark scheme here


Opening the consultation

  • Introduce yourself
  • Check the patient’s details (name/date of birth)
  • Check the patient’s understanding of the types of contraception available
  • Explore the reasons why the patient wants the Copper coil

 


Patient’s ideas, concerns and expectations

It is important to explore the patient’s ideasconcerns and expectations early in the consultation, as you may need to correct any misconceptions about the Copper coil and address any of the patient’s concerns.

When exploring concerns, it is important to do so in a sensitive and honest manner.

It’s also important to clarify the patient’s expectations of the Copper coil, because if these are unrealistic, other forms of contraception may be better able to meet their needs.

 


What is the Copper Coil?

Ensuring to use patient-friendly language, explain that the Copper coil is a small plastic and Copper device that sits inside the uterus. ¹ There are two (or sometimes one) thread(s) which pass through the cervix and lie in the vagina.

“The Copper coil is a small plastic and Copper T-shaped device that will sit inside your womb. There are normally two threads attached to the device which pass through the neck of the womb, these are important in allowing you to check that the coil is still in place.”

 


How does the Copper Coil work?

Explain to the patient that the Copper coil is spermicidal and the concentration of Copper in the mucus inhibits the motility of sperm. The Copper coil can also be used as emergency contraception. ²

“The Copper coil works by preventing any sperm from surviving. The Copper can change the cervical mucus slightly, which stops sperm from reaching an egg.”

 


How effective is the Copper Coil?

Often patients want to know how effective contraception is, as this can help guide their decision on what contraception to choose. As a result, it’s useful to know some basic statistics on efficacy. However, if you’re unsure, signpost the patient to a reliable source and don’t guess!

  • “The Copper coil is over 99% effective”
  • “Less than 1 Copper coil user in 100 will get pregnant in one year”
  • “If 100 sexually active women don’t use any contraception, 80–90 will get pregnant in a year.”

 


Pros and Cons of the Copper Coil

Always give patients as much information as possible so that they can make an informed decision. It is useful to do this by discussing the pros and cons of choosing the Copper coil.

“If it is okay with you, I’d like to tell you about the benefits and disadvantages of the Copper coil, then hopefully you will have enough information to make a decision.”

 

Advantages of the Copper Coil

Effective contraception

  • “The Copper coil is 99% effective and will last for up to 10 years. One of the reasons why it is so effective is that you do not need to remember to use it.”

 

Immediate contraception

  • “The Copper coil works as soon as it is put in, this is why sometimes it can also be used as emergency contraception.”

 

Easily reversed

  • “As soon as the Copper coil is removed, fertility resumes as normal.”

 

No effect on other medication

  • “The Copper coil will not have any effect on your other medications, this makes it a good option if you are taking certain medications such as antiepileptic drugs.”

 

Breastfeeding

  • “The Copper coil is safe to use if choose to breastfeed your baby.”

 

No hormonal content

  • “Unlike some other forms of contraception, there are no hormones in the copper coil.”

 

Disadvantages of the Copper Coil

Heavier bleeding

  • “Your periods may be heavier, longer and more painful, especially in the first few months.”

 

Protection from STIs

  • “Unfortunately, the coil does not protect you from sexually transmitted infections (STIs). Barrier contraception (e.g. condoms) is the only form of contraception to provide protection from STIs.”

 

Some risks of the Copper Coil

Expulsion of the Coil

  • “Sometimes the coil can come out without you realising. If this does happen, we can give you advice on what to do next, and we will teach you how to check that the coil is still in place.”
  • The most likely time for this to happen is soon after insertion and/or during a period, so we typically advise to check your coil is in place after each period, once a month.”
  • “If you were concerned the coil might be been expelled, you would need to use an alternative method of contraception and seek review from your local GP or sexual health service.”

 

Damage to the womb

  • “When you get the coil fitted there is a very small risk that the device might perforate your uterus or cervix.”
  • “This is rare, occurring in around 2 in a 1000 Copper coil insertions.”
  • “If this was to happen, you may have to undergo surgery to remove the device and repair the perforation.”

 

Infection

  • “There’s a small chance of you getting an infection during the first few weeks after an IUD is put in. You may be advised to have a check for sexually transmitted infections before a coil is fitted or at the time it’s fitted.”
  • “If you were to develop an infection, you would likely notice some abdominal pain, vaginal bleeding, fever and abnormal discharge. This can often be treated with a course of antibiotics, however, in some cases, the coil may need to be removed.”

 

Ectopic pregnancy

  • “The copper coil is a highly effective contraceptive method, however if you do fall pregnant whilst using the copper coil, there is a high risk that the pregnancy may have implanted outside of the womb, in the fallopian tubes, which is known as an ectopic pregnancy.”
  • “Ectopic pregnancy is potentially life-threatening and therefore if you have a positive pregnancy test whilst using the copper coil you need to see a doctor urgently, who will assess you and arrange a scan to check the location of the pregnancy.”
  • “Your overall chance of having an ectopic pregnancy is still less than someone not using contraception.”

 


How is the Copper Coil fitted?

It is useful to explain the process in a beforeduring and after structure. This will also help you remember the key points for each step.

Before

  • “Before the copper coil is fitted, we need to be confident you are not pregnant and therefore we would advise avoiding any unprotected sexual intercourse in the 2 weeks prior to insertion. A urine pregnancy test may be performed, to check you are not pregnant.”
  • “The coil can be fitted at any time in your menstrual cycle.”
  • “Ideally, you should take some paracetamol and ibuprofen around 1 hour before the procedure, as this will help make things more comfortable.”
  • “A doctor or nurse will perform a bimanual vaginal examination, which involves placing two fingers into your vagina and one hand on your tummy to assess the position of the womb, which is important to know before inserting the device.”

 

During

  • “The nurse or doctor will insert a speculum into the vagina, to allow the neck of the womb to be visualised.”
  • “You may then choose to have some local anaesthetic injected into the neck of the womb, which can make the insertion process less uncomfortable.”
  • “A surgical instrument is then attached to control the position of the neck of the womb. There can sometimes be some discomfort when this is attached.”
  • “A small plastic tube is then passed through the neck of the womb, to check the size of the womb cavity, before being removed.”
  • “The Copper coil is then inserted using another thin plastic tube. Once the coil is inside of the womb, the T-shaped arms open out to secure the device. As the Copper coil device is inserted through the neck of the womb, you may experience period-like cramping.”
  • “The insertion device is then removed.”
  • “Finally, the two threads of the coil will be trimmed, so that they sit high up in the vagina.”
  • “Overall the procedure should take around 5 minutes in total.”

 

After

  • “After the procedure, you may have painful cramps and light vaginal bleeding for the next few hours, so we advise resting and using painkillers as needed.”

 

Follow up

  • “As long as you are able to feel the threads yourself in a months time, you do not need to come back for a review. If however, you are unable to feel them, you will need to book an appointment.”
  • “The coil lasts for 10 years when used for contraception, so you would need to have the device replaced or use an alternative method of contraception once the expiry date is reached.”

 


Removing the device

  • “The copper coil can be removed at any time via a simple procedure. Should you want to have the device removed, you need to make an appointment with your GP or local sexual health clinic.”
  • “It is important to know that if you are planning to have the copper coil removed, you will need to abstain from sex or use an alternative method of contraception for the week prior to removal. This is because sperm can survive for several days in the vagina and womb and therefore there is a theoretical risk of pregnancy after removal of the device.”

 


How do I check the threads?

“A Copper coil has one or two threads attached to the end that hang a little way down from your womb into the top of your vagina. The nurse or doctor will tell you how many threads there should be.”

The patient should be shown how to check the Copper IUD threads using a test device, to allow them to get an idea what the threads should feel like.

“We would advise checking you can feel your threads a few times in the first month and that at regular intervals each month (e.g. after your period). If you were concerned the coil might be been expelled (e.g. you can’t feel the threads), you would need to use an alternative method of contraception and seek review from your local GP or sexual health service.”

 


Closing the Consultation

  • Ask the patient if they have any further questions or concerns that haven’t been addressed.
  • Throughout the consultation you should check the patient’s understanding at regular intervals, using phrases such as “Can you just repeat back to me what we’ve just discussed regarding…”.
  • It may also be useful to quickly summarise what you have spoken about and direct the patient to any websites or leaflets with further information.
  • Make it clear that it is entirely the patient’s choice on what contraception she would like, and offer her time to think about her decision.
  • Encourage the patient to use condoms if is she is currently not using any contraception and is sexually active.
  • Thank the patient for her time.

 


References

1. Fpa.org.uk. (2018). The Intrauterine Device- Your Guide. [online] Available at: https://www.fpa.org.uk/sites/default/files/intrauterine-device-iud-your-guide.pdf [Accessed 31 Oct. 2018].

2. Loweth, M. (2014). Intrauterine Contraceptive Device (IUCD) Information Page. [online] Patient.info. Available at: https://patient.info/doctor/intrauterine-contraceptive-device-pro#nav-9 [Accessed 31 Oct. 2018].

 


 

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