Choosing a coil pathway: copper, hormonal, removal or replacement

You have usually arrived here because you want a coil fitted, taken out, or swapped, and the screen then offers copper, hormonal, removal, replacement, an arm implant and a gynaecology slot all at once. Those are not interchangeable, and picking the wrong diary is how people sit in a planned fitting with pelvic pain that needed assessment, book an implant when they wanted a coil, or wait for a hormonal device when the job was emergency contraception.

Choosing a coil pathway at Medical Express Clinic is about which of the four coil bookings is yours, and when the visit should be something else. The four are copper fitting, hormonal fitting, removal, and combined removal with a new device on the same day.

Is a copper coil different from a hormonal coil?

The copper coil, the IUD, contains no hormones. Copper ions make it harder for sperm to reach an egg. The hormonal coil, the IUS, releases progestogen locally in the uterus, which thins the lining and thickens cervical mucus. That local action is why the hormonal device is a period conversation as well as a contraception conversation.

A coil is a small T-shaped device placed in the uterus.

If you want to avoid hormones and your periods are manageable, copper is the usual choice. It may make periods heavier, especially in the first few cycles. If heavy or painful periods are part of the reason you are here, Dr Naoum can discuss whether a hormonal coil would suit you. Hormonal coils usually make periods lighter. Mirena may stop periods. Kyleena uses a lower local hormone dose and is slightly smaller than Mirena, which some people who have not had children find more comfortable. Neither is better for everyone.

The copper coil can be used as emergency contraception within the CoSRH window. Hormonal coils are not recommended as emergency contraception in UK guidance. College of Sexual and Reproductive Healthcare (CoSRH, formerly FSRH) guidance is that a copper IUD can be inserted within five days after the first unprotected sexual intercourse in a cycle, or within five days of the earliest estimated date of ovulation, whichever is later.

Dr Naoum recommends a device from your history, your periods and what you want the coil to do. He explains how long the suitable device is licensed to remain. If you are considering perimenopause care, ask whether a hormonal coil could sit alongside oestrogen as part of HRT. T-Safe and T-Safe Mini are the copper devices kept in stock. Mirena and Kyleena are the hormonal devices kept in stock.

Are fitting, removal and replacement different bookings?

Whether you want a coil fitted for the first time, need the current device removed, or are due a replacement, you can do that here without a referral.

Consultation and the procedure happen in one visit of about 20 to 30 minutes, because devices are kept in stock.

Copper fitting is T-Safe or T-Safe Mini, with the sister clinic's coil fitting as a separate diary. Hormonal fitting is Mirena or Kyleena. Removal is the visit when the coil comes out and nothing is put back, while combined replacement takes the old device out and fits a new one on the same day. If you still want a coil, book combined replacement rather than removal. If you only want it out, say so when you book. If you do not want to become pregnant, avoid sex or use condoms for 7 days before a removal, because sperm already present can cause a pregnancy after the coil is out.

Removal is often under a minute once the threads are accessible. Fitting takes the longer share of the visit because it includes the consultation. An optional six-week check can be arranged after fitting, including ultrasound if needed. It is neither one of the four coil bookings nor automatic, so if you want it, say so after the procedure.

Nexplanon is a small flexible rod placed under the skin of the upper arm. It is a consultation-led service, not one of the four coil appointments.

Who does the procedure, and what happens on the day?

Every IUD and IUS fitting and removal at Medical Express Clinic is done by Dr Hikmat Naoum, Consultant Gynaecologist, GMC 3047637, personally, with a nursing chaperone throughout. Coil clinics run on Thursdays and Fridays by appointment at 117a Harley Street, London W1G 6AT. The clinic is CQC-registered and has practised in that building since 1984. Instillagel, a lidocaine gel, is applied to the cervix as standard. Ultrasound is used during the procedure when position or a difficult removal requires it.

No special preparation is required, and the visit does not have to fall during a period. Ibuprofen or paracetamol an hour before can help if cramping is a concern. Bring a note of current medicines, the date of your last period if you know it, and any paperwork about a coil you already have. Dr Naoum will explain any contraception precautions that apply.

After a short consultation there is a speculum examination and the fitting or removal. He explains each part of the procedure, and you may ask him to pause. Most people describe a strong period cramp lasting a short time during insertion. You can return to usual activity the same day. Mild cramping or light spotting for a day or two is common. After-care instructions are given before you leave.

Copper and hormonal coils can be used while breastfeeding. Dr Naoum fits coils regardless of whether you have had children.

When is a coil booking the wrong visit?

Pelvic pain, abnormal bleeding, fertility questions or an early-pregnancy concern need consultant gynaecology before anyone should be fitting a coil. A coil is contraception or, for copper, emergency contraception. It is not a way of investigating pain, a heavy bleed you have not had assessed, or a pregnancy worry.

A difficult removal, or a visit that belongs with the sister clinic, sits with the Gynae Clinic coil service for coil removal rather than this Medical Express Clinic diary. New, severe or rapidly worsening symptoms belong in same-day GP or emergency care.

When is copper emergency contraception time-sensitive?

The copper coil is the most effective method of emergency contraception in CoSRH guidance, and it remains effective after ovulation provided it is inserted well before the earliest likely date of implantation. It also provides immediately effective ongoing contraception. Hormonal coils are not recommended as emergency contraception in UK guidance.

If that is why you are here, call the clinic promptly. Coil clinics are Thursday and Friday only. Do not wait for a quieter week if you are still inside the CoSRH window. The clinic can talk through whether you are still inside it. Oral emergency contraception is a different route, usually through pharmacy or a GP, and it is not this appointment. If you cannot be fitted today, get oral emergency contraception from a pharmacy now as well. Levonorgestrel does not stop a copper coil being fitted later.

How does private fitting differ from the NHS?

The device itself is the same. The difference is who fits it, whether consultation and fitting happen together, and how you book. On the NHS the wait varies, and the person who fits the coil may be a GP, a nurse or a doctor with coil training. Primary care often splits the conversation and the procedure across two visits, and you may be asked to bring a device if the surgery does not stock it.

At Medical Express Clinic every coil is fitted and removed by a consultant gynaecologist, Dr Naoum, with a nursing chaperone, in one visit, with devices in stock. The NHS remains a reasonable option if you can get a timely appointment through your GP or a sexual health clinic.

What helps beforehand?

Decide which of the four coil bookings you need before you pick a slot.

• If emergency contraception is the job, say that when you call, because copper is the device that can do it and the CoSRH window does not wait.
• If pelvic pain, abnormal bleeding, fertility or early pregnancy is the real problem, book consultant gynaecology rather than a fitting.
• Ibuprofen or paracetamol an hour before can take the edge off cramping.
• You do not need to time the visit to a period, and you do not need a referral letter.
• Bring the name of any coil you already have, a medicine list, and the date of your last period if you know it.
• If you have never been pregnant, say so, because that can change which hormonal device is discussed.
• If you are breastfeeding, or already on oestrogen as part of HRT, bring that into the consultation.
• If you want the optional six-week check, ask after fitting.
• If the method you want is an arm implant, ask about Nexplanon as a separate service.

What should you avoid?

Do not treat copper and hormonal coils as interchangeable.

• Copper has no hormones and may make periods heavier.
• Hormonal coils use local progestogen, usually lighten bleeding, and are not recommended as emergency contraception in UK guidance.
• Do not invent how many years a device can stay in from a forum.
• Dr Naoum explains how long the suitable device is licensed to remain.
• Do not book a planned fitting for pelvic pain, abnormal bleeding, a fertility question or a possible pregnancy.
• Do not use a coil slot for Nexplanon.
• Do not assume a difficult removal will simply convert into this diary.
• Do not delay copper emergency contraception until a later week if you are still inside the CoSRH window, because this clinic is Thursday and Friday only.
• Do not skip a simple pain-relief tablet if cramping worries you.
• Severe pain, heavy bleeding or a fever after the procedure is a reason to call the clinic.
• If you do want consultant-led coil fitting or removal at Medical Express Clinic, the details sit on the contraceptive services page, or you can call 020 7499 1991.

Related guides: whether to see a GP or a gynaecologist first.