Copper/Hormonal Coil

Essential Information About Coil Appointment

If this is a new coil or your coil/contraceptive method has expired, you must use adequate contraception for 21 days (3 weeks) prior to the appointment. You will be asked to confirm this on the day of your appointment and if you have had any unprotected sexual intercourse in the 3 weeks prior, then the coil cannot be inserted as we would be unable to rule out a potential early pregnancy.

Contraception can include barrier methods (e.g. condoms), contraceptive pills, a depot injection given less than 12 weeks ago, an implant that remains in date, or a coil that remains in date.

Please note: Hormonal coils such as Levosert and Mirena can now be used for 8 years for contraception. If they are used as part of Hormone Replacement Therapy (HRT), they must be changed at 5 years.

About the Copper IUD (Coil)

An IUD is a small, flexible plastic and copper device that’s put into your uterus (womb). It has one or two thin threads on the end that hang through your cervix (the entrance to the uterus) into the top of your vagina.

An IUD works for contraception for 5 or 10 years, depending on the type. If you are aged 40 or older when the IUD is fitted, it will work for contraception until after the menopause, when contraception is no longer needed.

An IUD is sometimes called a ‘coil’ or ‘copper coil’. There are different types and sizes available.

For more information, please visit the NHS website: Copper IUD (coil)

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I have read an fully understand the side effects, effectiveness and complications of the implant.

I am aware that I need to use adequate contraception until device fitted, If not inserted on day 1 to 5 of cycle (day 1 being 1st day period) I need to use barrier methods or abstain for 7 days.

The doctor has explained I am to have the Copper IUD fitted for the following reason The Copper IUD is a contraceptive device which will be inserted inside the uterus through the vagina and cervix.

The Copper IUD offers effective and long-term contraception for 5 years and can be used as emergency contraception for up to 5 days after unprotected sexual intercourse. There are benefits and risks with all procedures. In signing this document, I agree that I have been informed of both the benefits and the risks of using the Copper IUD.

I acknowledge that the doctor has explained the proposed procedure. I understand the risks of the procedure and the likely outcome. The doctor has explained other relevant contraceptive options and their associated risks. I was able to ask questions and raise concerns with the doctor, which have been discussed to my satisfaction.

I hereby request to have the procedure and authorise Dr and such assistants to perform the insertion of the Copper IUD.

I consent to the practice collecting and storing my data from this form.

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Copper Coil Request

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