Family Planning UNMET NEED The Nurse Mildred Radio Talk Shows TOPIC 9: IUD/COIL Guests FP counsellor from MSU, RHU& UHMG Nurse Mildred Nurse Betty Objectives of the programme: To inform listeners about the coil/iud method of family planning. To correct misconceptions and rumors about the IUD/ coil. To convince listeners that IUD/coil is an effective and safe family planning method. To create a positive (and desired) image of people who use the coil/iud. To encourage listeners to seek more information about the coil/iud. uestions for the interviewer: 1. Nurse Mildred, I have heard about the coil as a modern family planning method? Can you tell us more about it and how it looks like? 2. Ok if the coil is what you say, how does it work when in the body? 3. Last time you talked about injectables, what is the difference between injectables and the coil? 4. So nurse is the coil given like other modern family planning methods and is it painful? How long does it take when inserting and can a woman engage in the normal day to day activities when the coil/iud has been inserted? 5. re there specific women who can use the coil/iud? 6. What about breastfeeding mothers? Is the coil/iud safe for them? 7. Nurse Mildred, after all the you have said about the coil, are there any side effects associated with its use? 8. What are the benefits of using the coil/iud? 9. Where can one get the coil/iud? 10. How can women and men ask about the coil to get more information? (What should they ask? To whom? Where? When? Why should they ask give reasons to motivate seeking more information) 11. People believe that the coil can move through the womb and pierce other organs. Is this true? Key Points the Coil: 1
The coil is small device which is inserted into a woman s womb, so it is called an IUD or Intra-Uterine Device. Coils are inserted after a physical examination by a trained health care provider. The provider first measures the length of the womb to ensure the device fits properly for each woman and then inserts the coil. The coil works by preventing men s sperm from reaching women s eggs. The coil changes the environment in the womb, making it hard for the sperm to move through the woman s reproductive tract. It does not kill the fertilized ovum. There are types of coils in Uganda: The coil is one of the safest and most highly effective family planning methods. The coil is more than 99% effective in preventing pregnancy. major benefit of the coil is that there are few side effects from using it. This is because there are no hormones on it. In the first few months, some women may experience longer and heavier menstrual periods, cramps or slight bleeding. If these symptoms do not go away, consult your health provider. fter the first few months, most women don t notice it anymore. When a woman wants to get pregnant, removal is easy and has no adverse effects. trained provider can remove the coil, at any time and for any reason. fter removal, a woman may get pregnant immediately. The coil is suitable for most women of child-bearing age, including women who have not yet had a child, and women who may be HIV-positive. The coil can remain for any length of time: 1 or 10 years lso suitable for breastfeeding mothers and those who cannot use hormonal methods. But, men cannot use the coil. If a woman is interested in using the coil, her husband can support her by discussing family planning options with her. He can also get involved by going to a provider for family planning counseling with his partner, so he can understand how the method works and how to support her. If a man is interested in using contraceptives himself, he should talk to his provider about available options such as a condom or vasectomy for him. Benefits of using the Coil are: few side effects, easily reversible, convenient - can be used up to 12 years without needing to return to the health center, comfortable and does not interfere with intercourse. 2
It is important to note that the coil does not protect against sexually transmitted infections including HIV/IDS. Women using the coil, who are at risk (i.e. not in a completely monogamous relationship with one person who has been tested for HIV), should use condoms as well. * These are questions related to the many prevalent myths. If you are asked one of these questions, you should make a clear concise response, and then if appropriate refer them to a medical provider. Frequently sked uestions about the Coil* What are the side effects of the Coil? There are few or no side effects from the Coil. This means that most women using the coil will not feel bad and will be perfectly healthy from using it. This is because there are no hormones on it. In the first few months, some women may experience longer and heavier menstrual periods, cramps or slight bleeding. But after the first few months, most women don t notice it anymore. nd it can be used for up to 12 years! Can the Coil delay conception after you have stopped? No. The woman can become pregnant immediately after the coil is removed. It is very important to remember that Coil does not protect against STIs. STIs are the leading cause of infertility in Uganda, which would cause someone to not get pregnant. What if I become pregnant while using the coil? Very few women become pregnant with the coil. If you suspect you are pregnant, you should visit your health care provider right away. If you are pregnant, you should have the coil removed. Can the coil fall out of my body? Not often. In rare cases, the coil can be pushed out of the womb and out of her body through the vagina. Check for strings each month (usually after the period), to ensure that the coil is in place. Can the strings of the coil be felt during intercourse? Normally, the strings of the coil should not be felt by the woman s partner. In these cases, the woman can return to the clinic to have the strings of the coil checked and trimmed if necessary. I heard that the coil can move inside a woman's body to her heart or her brain? No, this is not true. There is no passage from the uterus to the other organs of the body. The IUD is placed inside the uterus and unless it is accidentally expelled, stays there until it is removed by a trained health care provider. If the IUD is accidentally expelled, it comes out of the vagina. 3
I heard that a woman who has the Coil cannot do heavy work? No, this is not true. Using an IUD will not stop a woman from carrying out her regular activities in any way. There is no correlation between the performance of chores or tasks and the use of an IUD. I heard that a woman who was using the coil got pregnant and the baby was born with the coil embedded in his forehead? No, this is not true. The baby is very well-protected by the sac of fluid inside the mother's womb. If the IUD is left in place during a pregnancy, it is usually expelled with the placenta or with the baby at birth. However, if a woman gets pregnant with an IUD in place, the health provider should remove the IUD immediately due to the risk of infection. Is it true that the coil can rust and cause an infection in the womb? No, the coil will not rust. This element is rust-free and it has been found safe during tests. Why should I get more information about the Coil? Where can I get more information about the Coil? From a health facility with a yellow flower and the rainbow over it IUDs The information provided here is meant to give general information about IUDs and does not replace the need to talk to a health care provider if a couple would like to use IUDs for contraception. What is an IUD? n intrauterine Device (IUD) is a long-acting contraceptive method intended to be used for several months or years. It is a small device that is usually made of plastic or of plastic and copper. doctor or a trained health care worker places an IUD in the woman's uterus. The most commonly used IUD, the Copper T380-, can be left in place for 10 years. Mirena is a new intrauterine device (IUD) that gradually releases the progestin levonorgestrel, thereby delivering the hormone to the lining of the uterus. The direct effect of levonorgestrel on the lining of the uterus results in less bleeding than is experienced with other IUDs. 4
How does it work? n IUD prevents the man's sperm from meeting the woman's egg. The physical presence of the IUD in the uterus keeps the sperm from moving normally inside the uterus and fallopian tubes. The levonorgestrel in the Mirena IUD is released in the uterus and helps to prevent pregnancy by thickening the cervical mucus, making it difficult for sperm to enter the uterus to fertilize the egg. It also reduces the growth of the lining of the uterus. Is it effective? The IUD is very effective immediately after insertion. The Copper T380- is effective for 10 years. The Mirena IUD continues to be effective for up to five years. Fewer than one woman out of 100 will become pregnant while using an IUD for contraception. How do I use an IUD? s with any other method, talk to a health care provider or a family planning counselor at a local clinic or hospital before using an IUD as a contraceptive method. The following instructions are provided to help a couple decide whether an IUD may be right for them. When may an IUD be inserted? IUDs may be inserted at any time during the period, or at any time a woman and her health care provider believes that she is not pregnant. If she has just delivered a baby, she may have the IUD inserted within the first 48 hours while she is at the hospital following delivery, six weeks after delivery, or at any time a woman and her health care provider believe she is not pregnant. She may use the IUD whether or not she is breastfeeding. What happens during the procedure? The health care provider will perform a pelvic exam and then insert the IUD. The exam and procedure usually take less than half an hour. The woman may feel some cramping or pain during the insertion procedure. If she is having an IUD inserted postpartum, she may or may not have a pelvic exam before the procedure. When does the IUD take effect? The IUD is effective as soon as it is inserted. How to check the IUD strings: 5
It is important that the woman learns to check the IUD strings so that she can be sure the IUD is still in place. To check the strings: to follow: Wash hands with soap and water. Stand with one foot on the edge of a chair, bed, bathtub, toilet, or squat or lie on her back. Gently insert a finger into the vagina. Feel for the cervix. It feels firm, like the tip of a nose. Feel for the strings, but do not pull the strings. Pulling the strings might move the IUD or cause it to come out. How often to check the strings: fter the IUD has been in place for one month, check the strings after each menstrual period or whenever she has more than a normal level of cramping. Use another contraceptive method, such as condoms, and go to the health facility for a check-up if: She does not feel the strings. The strings feel longer than they used to be. She feels the hard part of the IUD in the vagina or at the cervix. Other instructions: fter the IUD has been inserted, she may have sexual intercourse as soon as it is comfortable for her. If she has no problems, return to the health facility for a check-up as suggested by the health care provider (usually in 3-6 weeks) when not menstruating. re there any side effects associated with IUDs? Expect to have some cramping within the first few days after insertion. During the first 3-6 months after insertion, there may be frequent spotting or light bleeding in addition to the monthly menstrual period. The monthly period may become irregular. Some women may have heavy or prolonged bleeding during this time. With the Copper T380-, she many have longer periods than before, and may have heavier bleeding during periods. With the Mirena IUD, she may experience a reduction in menstrual flow over time, because the levonorgestrel in Mirena works to reduce the growth of the uterine lining. With the Mirena IUD, other side effects include breast tenderness, nausea, headaches, and mood changes all of which generally disappear within four months of insertion. What are the characteristics of IUDs? 6
Characteristics refer to the range of experiences that an individual or couple may have with a contraceptive method. What may be considered an advantage to one person may be a disadvantage to another. Therefore, rather than identifying the advantages and disadvantages of IUDs, the "characteristics" of IUDs are used to present user experiences. The IUD (Copper T380- and Mirena): Does not require daily attention Is easy to use Is not linked with sexual intercourse Must be inserted and removed by a trained health care provider Provides long-acting contraception Can be inserted immediately following an uncomplicated abortion in an uninfected uterus llows for rapid return to fertility Does not provide protection against HIV infection and other STIs. side from abstinence, male and female condoms offer the best protection against these infections. The Copper T380- IUD: May cause heavier bleeding and longer periods than before 7