Indication and contraindication
The spiral is particularly suitable for women who have already given birth to a child but whose family planning is not yet complete. Women who do not want to or should not take oral contraceptives because they are unreliable when taking the pill also benefit from the method of the coil. Finally, the use of the IUD is also useful for women over 40 years of age when the “pill risk” increases, for example in connection with blood clots (thrombosis).
The IUD should not be used in cases of genital infections, unclear bleeding abnormalities, uterine abnormalities, genital tumor and pregnancy. Special advice is required, for example, for frequently changing sexual partners, age under 25, bleeding disorders, anemia, diabetes mellitus and heart disease. Also with first-birthing women (nulliparous), special care must be taken when using the coil, as there is an increased tendency to inflammation by ascending germs (ascending infection).
The IUD must be selected in shape and size according to the uterus.For this purpose, the uterus is measured using ultrasound and, if necessary, examined with a rod or tube-shaped instrument (probe) that is inserted into the uterus. The insertion is performed under sterile conditions during menstruation, as the cervix is then easily accessible. Exceptions are the application directly after sexual intercourse as “spiral after” and the insertion approx.
6 weeks after birth (postpartum insertion). After the insertion, the thin thread is shortened to 2 to 3 cm and the position of the coil is determined by means of ultrasound (sonographic). Afterwards the fit must be checked regularly – the first time after the next menstruation, then every six months.
The control can be done by the length of the thread and by ultrasound. Depending on the manufacturer’s instructions, the coil can remain in the uterus for 3 to 5 years. Although the Pearl index is between 0.9 and 3 for the copper coil and 0.16 for the gestagen-containing coil, pregnancies can still occur.
50-60% of the pregnancies that occur with the coil in place end in miscarriage (abortion), so they are always considered high-risk pregnancies. The coil should be removed when the thread is visible because of the increased risk of infection. The coil, whether with or without hormones, must be inserted through the vagina into the uterus.
Since the cervix is softer and more permeable during menstruation, the insertion of the IUD is usually placed on the second or third day of bleeding. A few hours before insertion, a medication can be taken, which makes the cervix even softer and thus makes insertion less painful. For the insertion itself, the gynecologist first uses metal spatulas to get a good view of the cervix.
Then the cervix can be opened slightly and the position of the uterus can be changed so that the guide rod with the coil can be pushed straight into the uterus. Since the movement of the uterus is a stimulus for the peritoneum, some women experience circulation problems when using the coil and should therefore not stand up directly. The insertion itself only takes a few minutes.
Before and after the insertion ultrasound examinations are performed. Before that to determine the size and position of the uterus and afterwards to check the position of the coil. Tampons should not be used immediately after insertion.
However, this is possible again after one week. The Mirena is a hormone coil. This coil permanently releases the hormone levonorgestrel to the uterus, thus combining the effects of a hormone-free coil and the pill.
The mirena can remain in the uterus for up to five years, after which a seamless transition to the next mirena is possible. Other coils with a similar effect are the Jaydess and the Kyleena. The Jaydess is slightly smaller compared to the Mirena and can therefore also be used in younger girls with a small uterus.
