Coil & Pessary Clinic

You have been offered an appointment at the Community Coil and Pessary Clinic (CCPC) for the fitting of a Mirena Coil as treatment for heavy menstrual bleeding. You will be seen by a clinician specially trained to assess and fit this. If you have a preference for a female clinician, please make sure we are aware of this when we book your appointment.

What is a Mirena Intrauterine System (Mirena IUS)?

It is a type of intra uterine device which is made of plastic and carries a hormone progesterone in it.  When placed inside the uterus it releases the hormone gradually into the womb to control the bleeding.  This is also a contraceptive method and is commonly referred to as a Coil.

What are the advantages of having a Mirena Coil?

• The coil is recommended as a treatment of choice for heavy menstrual bleeding as this eliminates the need for a surgical procedure or general anesthetic.
• It is also a recommended treatment of choice for endometriosis, fibroid uterus and polycystic ovaries.  The Coil can also be used as a part of HRT management.
• Once inserted, you can forget about it for 5 years.
• It does not interfere with the sexual intercourse.
• Periods get lighter, overall blood loss will be less and one third of women will stop having periods completely. This happens as the continuous release of hormone thins the lining of the womb.
• The majority of patients also have a reduction in pelvic pain. This treatment is a good alternative to hysterectomy.

Am I suitable for a Mirena IUS?

Before your GP referred you to the CCPC they will have already assessed you as a suitable candidate for a Mirena Coil insertion.  Clinicians at the CCPC will examine you at your appointment to ascertain your suitability before fitting the Coil.

What about side effects?

The most common side effect is an irregular menstrual cycle.  This may take up to 3 or 4 months to settle down.  Even during the first 3 months, it is usually spotting and a mild bleeding as opposed to heavy bleeding.

Hormonal side effects such as breast tenderness, headaches, acne spots, bloating and mood changes are common.  However, the amount of hormone released into the blood stream is small, these side effects are less common compared to oral hormones such as contraceptive pills. Studies have shown that there is no weight gain caused by the Coil.

What complications can happen?

• There is a small risk of perforation of the womb at the time of fitting, which is very rare.
• There is a chance of worsening any pre-existing pelvic infection such as undiagnosed chlamydial infection, hence the need to check for any asymptomatic infection before your clinic appointment.  Your GP can do this.
• There is a risk of ectopic pregnancy and unplanned pregnancy, which are both extremely rare.

When can I remove it?

Anytime, if you have unacceptable side effects even after 3 or 4 months, it can be removed.  If it is an acceptable treatment for you, you can replace it in 5 years.  This can be done by a suitably qualified clinician.

Can it get dislodged or fall out?

This can happen if you suffer from very heavy periods and can be passed in clots. It is not unusual for the patients not to notice this so if in doubt it is recommended to have a follow up with your own GP surgery to check if the threads are in place.  This can also be done by the nurses who normally do smear tests.

You can feel the threads yourself.  However, some patients may not feel these as they very fine. When the coil is dislodged, it may cause pain, your partner may feel it and you may feel the lower end of Coil.  If you are using it for contraception as well, there is a risk of pregnancy. You need to ensure you have adequate protection against pregnancy until you confirm the Coil is in place.  You may need an ultrasound to ascertain the position of the coil.  Contact your GP to arrange this.

Are there other treatments available?

There are other hormonal and non-hormonal methods for treating heavy bleeding. Visit the NHS website to learn more

Follow-ups, removal or renewal

The CCPC is a pilot service initially running from June to September 2021. If successful it may continue after this time.  Contact your GP if you have any concerns about your fitting or to make arrangements in 5 years to have it removed or replaced.

If you have any problems after having a coil fitted, please contact the CCPC Administrator by email or phone using the contact details above.  We will update your GP that you have had an appointment with our service once your appointment has been completed.

You have been offered an appointment at the Community Coil and Pessary Clinic (CCPC) for the fitting of a Ring Pessary and will be seen by a clinician specially trained to assess and fit pessaries. If you already have a pessary, it will be removed and replaced with a new one.

If you have preference for a female clinician, please make sure we are aware of this when we book your appointment.

A Ring Pessary is a latex-free, non-sterile, donut shaped device.  It comes in various sizes and this clinic uses a 12.5mm thick wall pessary as it is flexible.  There is another pessary which is thin walled – this type is not used in CCPC due to its rigidity.

The Ring Pessary is used to correct utero-vaginal prolapse which is causing discomfort to patients.

The Pessary can be fitted as a temporary measure while you are waiting for an operation.  However, many patients prefer it as a permanent method to control their prolapse.

Sizing and fitting the pessary is carried out by an appropriately qualified clinician.

Accurate measurement of the pessary size is not possible as it is a clinical judgement and it is a trial and error process.  You may feel uncomfortable during the removal and fitting of a Ring Pessary but once fitted correctly, you should not feel any discomfort and you should be able to pass urine and open your bowels without any problems.

Once the correct size of pessary is fitted, it is recommended to change the pessary every 4 to 6 months. When a pessary is removed, your vagina will be checked for any abnormalities.  If you develop symptoms such as pain, irritation, abnormal or smelly discharge, or bleeding, please contact your GP.

The CCPC is a pilot service initially running from June to September 2021. If successful it may continue after this time.  We will contact you in September to invite you back to the CCPC for your pessary review and replacement or to invite you to have your review with The Hillingdon Hospital Gynecology Service if the CCPC pilot ends.

If you have any problems after having a pessary fitting, please contact the CCPC Service Administrator by email or phone using the contact details above.  We will update your GP that you have had an appointment with our service once your appointment has been completed.