Intrauterine contraceptive devices (IUDs)

IUDs are suitable for use in all women, including nulliparae

The most effective IUDs contain at least 380mm² of copper and have banded copper on the arms e.g. T-Safe 380A QL are thought to be more efficacious. Alternatives are Nova-T 380 and Mini TT380 Slimline for women whose uterine cavity is of an insufficient size for the T-Safe 380A QL

All IUDs should only be fitted by those who have been appropriately trained.

MHRA Drug Safety Alert (June 2015): Before inserting an intrauterine system (IUS) or intrauterine device (IUD), inform women that perforation occurs in less than 1 in 1,000 women and that the symptoms include:

• severe pelvic pain after insertion (worse than period cramps)
• pain or heavy bleeding after insertion which continues for more than a few weeks
• sudden changes in periods
• pain during sex
• not being able to feel the threads

Explain to women how to check their threads and tell them to return for a check-up if they cannot feel them (especially if they also have significant pain). Partial perforation may have occurred even if the threads can still be seen; consider this if there is severe pain following insertion.

An IUD fitted or re-fitted after a woman's 40th birthday, does not need to be changed. It can be removed one year after the last period

If a surgery is unable to provide an IUD insertion, patients can arrange a fitting by contacting:

• Devon Sexual Health (Barnstaple, Exeter, and Torbay) (electronic referral system available)
  • A patient can self-refer by phoning 0300 303 3989 for a consultation within 24 hours. Please give relevant treatment information to the patient to bring to clinics, i.e. results of previous cultures and any treatments.
• SHiP (Sexual Health in Plymouth)

Patient or GP must mention the appointment is for an emergency fitting.

T-Safe 380A QL

• Intrauterine contraceptive device (£10.55 each)

Notes

1. 10-year life and more effective than other copper IUDs

Nova-T 380

• Intrauterine contraceptive device (£15.20 each)

Notes

1. A slimmer device but 5 year life

Mini TT380 Slimline

• Intrauterine contraceptive device (£12.46 each)

Notes

1. Requires minimum uterine length 5cm. Replace every 5 years

Vaginal contraceptive caps and diaphragms

Caps and diaphragms are the least effective form of contraception. These methods are used infrequently and patients are best referred to the Contraception Service (01392 284982 or 284931 for appointments) for advice on choice, prescription and fitting of caps and diaphragms. For this reason these products are 'second line'.

Diaphragms are usually used. They are normally replaced approximately annually, have expiry dates and are used with spermicides.

Type B Coil spring diaphragm

• Silicone sizes 60-100mm (rising in 5mm)

Type C Arcing spring diaphragm

• Silicone sizes 60-95mm (rising in 5mm)

Caps are used less often, e.g. prolapse, poor muscle tone, urinary symptoms. They last longer than diaphragms, have expiry dates and are used with spermicides.

Vaginal contraceptive cap silicone

• Size 22mm, 26mm, 30mm (£15.29 each)