Why are GPs so keen to push the coil that can ruin women’s lives?
Yes, it’s the perfect contraceptive for many. But with some others suffering terrible side-effects ...
DANIELLE GRAY broke down sobbing in her GP’s surgery, pleading with him not to send her away again, as he’d done twice before during the previous six months.
The mother-of-two insisted she wouldn’t leave until he’d removed her Mirena coil, a contraceptive device he had fitted seven months previously. It had, says Danielle, made her life a ‘living hell’.
The 29-year-old medical secretary from Northumberland had been bleeding constantly since having the coil fitted in January 2011, some nights so profusely that she had to sleep in the bath.
She felt so lethargic, owing to the amount of blood she was losing, and so depressed, that she could barely eat. She was constantly irritable with her children and husband, Nicholas, a medical photographer, putting their relationship under huge strain.
‘Those seven months I had the Mirena coil were the worst of my life,’ says Danielle, shuddering at the memory. ‘I had no idea what I was letting myself in for when my GP suggested it, and I agreed because I was struggling to remember to take my contraceptive pill every day.
‘But the whole experience was such a nightmare that after a month, and then again after four months, I pleaded with my GP to remove it, but he assured me my symptoms would soon settle down.
‘By the time I went back to see him after seven months I was in such a state, terrified to take my two children to school because of the bleeding and worried sick about the effect my mood was having on Nicholas and my little ones, who were then just five and three, that wild horses wouldn’t have dragged me from his surgery until he’d taken out that coil.’
The number of women for whom coils are the contraceptive of choice has jumped from less than a fifth to almost a third over the past ten years. Doctors and family planning clinics, it seems, are pushing them onto women with increasing zeal.
The reason — according to coil enthusiasts — is that they provide foolproof, cheap contraception, guaranteed for up to five years, resulting in fewer visits to overstretched GP surgeries.
Some 41,540 women had a coil inserted at a family planning clinic last year and, as many more of these procedures are performed in GP practices, the total number could be double that.
There are two types of coil, the Mirena, known as an Intrauterine System (IUS), and the copper coil, referred to as an Intrauterine Device (IUD), both of which are T-shaped and inserted into the womb. Both are 99 per cent effective.
The Mirena works by releasing progestogen (an artificial form of progesterone), which thins the lining of the uterus to prevent a fertilised egg implanting, thickens cervical mucus to stop sperm meeting an egg and, in some women, inhibits ovulation altogether.
ANIUD is a small plastic and copper device, the copper in which creates a hostile environment for sperm and egg to meet and, if any slip through the net, prevents an embryo implanting in the womb.
For some women, insertion is so painful they need a local anaesthetic. But, once in, the Mirena — by far the most commonly prescribed coil — is effective for five years.
Patients should always be warned that there will be a settling-in period as their bodies get used to the surge in the hormone progesterone.
And it can’t be stressed strongly enough that the vast majority of women report no problems with the devices.
However, between five and ten per cent of the women who now have coils fitted annually have an extreme and intolerable reaction to them.
In fact, some women have such terrible experiences that, between 2002 and 2011, 98 lawsuits involving coils were brought against GPs. Of these, 39 involved perforation of the uterus during insertion.
Other reasons included doctors not removing an old IUS before fitting a new one, women becoming pregnant following an alleged error, and GPs failing to detect that the woman was already expecting a baby before inserting a coil, which raises the risk of miscarriage.
According to the Medical Defence Union, which represents doctors accused of malpractice, this has led to compensation payouts of up to £100,000.
Danielle, like many women, says she felt ‘pushed’ into agreeing to a coil by her GP
with whom she had made an appointment to discuss something unrelated. She had been taking the Pill since her daughter, Violet, now seven, was born and had never considered a coil. However, by the end of her appointment, Danielle had been fitted with a Mirena.
‘ He told me that my heavy bleeding and period pains would stop and that, in fact, I might experience no bleeding at all,’ recalls Danielle. ‘I think most women would like the sound of that.
‘The heavy bleeding and severe cramping, like labour pains, started almost immediately and the bleeding carried on for seven months. I would never have believed it possible that a person could lose so much blood and still be alive.
‘Thankfully, I was a full-time mum at that point, so didn’t need to worry about going to work, because some days I couldn’t leave the house. I’d have to ask friends to take my children to school.
‘The last thing I felt like doing was making love, so it was also pretty pointless as a contraceptive.’
Four weeks after having the coil inserted, Danielle went back to her GP and asked him to remove it.
She was persuaded to persevere as he claimed the benefits in the long-term, with reduced bleeding and stomach cramps, were worth waiting for.
When she was still having major problems three months later, Danielle again went back to the surgery and asked for the Mirena to be removed. Once again, she was talked out of it. Finally, when she returned seven months after having the coil fitted, Danielle refused to take no for an answer.
‘I was in floods of tears and begged the doctor to remove it,’ recalls Danielle. ‘I screamed: “Take it out now!” Although he didn’t seem happy about it, he called in a nurse to assist and removed it.’
Within weeks Danielle felt back to her old self. She is now taking the Pill again but says that, whenever she visits a different GP, she is asked if she would like to swap to a Mirena coil instead.
Dr Helen Stokes-Lampard, a GP who practises in Lichfield, Staffordshire, and is treasurer of the Royal College Of GPs, says one reason for the Mirena’s popularity with doctors is that, aside from sterilisation, with an effectiveness rate of over 99 per cent, it is the most foolproof contraception available.
THEMirena is also prescribed as a way to reduce heavy periods in some women, especially those in their 40s approaching the menopause, because the progesterone makes the lining of the womb thinner.
Although doctors receive a payment of around £70 for each coil they fit, Dr Stokes-Lampard says this is not the reason so many recommend them to their patients.
‘ Many GPs offer the service because we believe it is of great benefit to our patients,’ she says. ‘It’s not a money-making activity, if anything our practices lose money fitting coils because you need to counsel a patient beforehand, then both a doctor and a nurse, or a healthcare assistant, need to be present when it’s fitted. We take swabs to check for infection before fitting, then there’s a follow-up six weeks later to see how it’s working.
‘That’s compared with the ten minutes it takes to prescribe a packet of pills or administer a contraceptive injection.’
However, if all goes well with the coil, GPs ultimately save themselves time as they need to see women only every five years, when they’re due for removal or replacement, compared to annually for women who are on the Pill and must have their blood pressure monitored.
Also, each coil costs the NHS £88, which, according to Dr StokesLampard, ‘is considerably cheaper’ than five years’ worth of Pills.
While it is mostly prescribed to mothers, as fitting is easier and less painful for women whose cervixes have dilated to give birth, GPs also recommend the coil for younger women with heavy periods.
‘I fully accept it’s not for everybody,’ says Dr Stokes-Lampard. ‘There are five to ten per cent of women who it just does not suit.
‘Some see no reduction in their bleeding while others suffer sideeffects from progesterone, such as increased bleeding and weight gain.’
Jessica Lane, 37, suffered all of these symptoms and more for a year, before finally having her coil removed four weeks ago.
The youngest of her three children, Verity, was just eight months old when she complained to her GP about heavy periods and was advised to have a Mirena fitted.
Their family complete, Jessica’s partner, Raymond, 29, a joiner, had undergone a vasectomy, so she did not need a contraceptive.
However, Jessica, a receptionist, was persuaded to have a coil fitted in February last year after being told by a doctor at the family planning clinic, to which her GP referred her: ‘There’s a good chance your periods will stop altogether.’
In fact, Jessica bled heavily for 28 days out of every 31 for the next 12 months. Not surprisingly, she lost her libido and, on the rare occasions she and Raymond were intimate, she found sex painful.
Not yet having shed her baby weight, Jessica also gained an additional stone-and-a-half, which made her feel unattractive and even less interested in sex.
SHEsays: ‘I got so down I went to the doctors and came very close to asking for antidepressants. I’m a positive, upbeat person, but the hormone in the coil had a terrible impact on my body and mind.
‘It was a horrendous year and what frustrates me is that I could have avoided it if the doctors had warned me how badly some women react. I’d never have taken the risk.
‘I was a nightmare to live with, and the effect it had on my sex drive would have driven a lesser man away.’
However, last month, Jessica’s Mirena coil spontaneously expelled itself from her womb. ‘I honestly believe that my body, knowing what effect it was having on me, just got rid of this foreign thing, and I’m so grateful it did,’ she says.
Four weeks down the line, Jessica feels almost back to normal. The bleeding has eased, her mood has improved and she is rediscovering her sex drive.
‘Ever since having mine fitted, when friends and colleagues are contemplating a Mirena coil I tell them, “Don’t do it!” ’ says Jessica. ‘It’s not the miracle contraceptive we women are led to believe.’
Dr Martin Scurr, a GP who writes a weekly column in the Daily Mail’s Good Health section, says that for doctors to be accredited to insert Mirena coils, guidelines from the National Institute for Health and Care Excellence (NICE) state that GPs must first receive training in inserting coils and then maintain their skills by fitting at least one device a month to stay accredited to provide this service.
This quota may, of course, explain why some women feel a degree of pressure to get an IUD.
‘Before the Mirena, a lot of middleaged women would end up having surgery, due to excessive bleeding, which can now very often be
controlled by the coil,’ says Dr Scurr. ‘But, of course, there are exceptions, women who just cannot tolerate it.’
This seemed to be the case for Harriet Robson, 30, who runs an events company in Newark, Notts, who blacked out while having her coil inserted five years ago.
‘The pain was so intense I lost consciousness for a minute,’ recalls Harriet. ‘I was too woozy to go home alone so the surgery had to call my partner, Tom.’ For the next three years Harriet says she felt permanently pre-menstrual — irritable, angry and emotional. ‘I would take my bad moods out on Tom,’ says Harriet. ‘And my libido was so low I was never in the mood for sex.’
Eventually, after three years, she had her coil removed. Her moods have now stabilised and her sex drive has been reignited.
And hotel duty manager Dawn Young, 31, also blames the coil she had fitted last Christmas for creating such problems with her boyfriend, Steve, that, within weeks of hav- ing it fitted, they broke up. ‘The coil turned me into a horrible person, someone I didn’t recognise,’ says Dawn, from Glasgow.
‘One minute I felt angry and aggressive, the next desperately tearful and down. Things got so bad I thought I’d fallen out of love with Steve. Everything about him, right down to the way he breathed, annoyed me and I ended our relationship.’
But in late February, just two months after her coil had been fitted, she demanded it be removed. Within days her mood had lifted and her feelings for Steve returned and they have since got back together.’
Again, we must remember many thousands of women use these devices with no ill effects — and that all forms of contraception have advantages and disadvantages, and work better for some than others.
But judging by the numbers who take to internet forums to bemoan their experience, isn’t it time doctors gave women the full picture before prescribing the coil that, for some, brings serious problems?