In conjunction with the various contraception modalities being discussed this month, I am puzzled as to why Dr G has not mentioned one of the more common family planning methods.

My wife and I are both in our late twenties and have been married for one year. Although we are eager to have children, we are currently prioritising our careers and time together without children.

Since getting married, I have used barrier methods as contraception, but we both find condoms cumbersome and unnatural for intimacy.

My wife then opted for oral contraceptive pills. However, despite trying different types, the side effects were unbearable.

Determined to find a solution, we consulted general practitioners for more options. I was surprised to learn about the Intrauterine Contraceptive Device (IUCD).

From what I understood, metals are inserted into the womb to prevent an embryo from attaching to the uterine wall, thus preventing pregnancy.

I found the idea somewhat harsh, but my wife seems keen. As I am still unsure how the IUCD works, I want to understand it before my wife undergoes such a procedure.

What exactly is an IUCD, and how long has this form of contraception been around? How did the concept of inserting coils into the womb originate, and how does it work?

How common is the IUCD, and how many couples use it as contraception? What are these coils made of, and do they cause harm?

Lastly, will my wife face difficulties getting pregnant once we decide to remove the coil?

My mind is spinning with confusion over the idea of the coil. Please help.

Coiling Carl

Intrauterine contraceptive devices (IUCDs), also known as coils or intrauterine devices (IUDs), are among the most effective long-acting reversible contraceptive methods globally. The concept of intrauterine contraception dates back thousands of years.

Historical accounts suggest that Arab traders inserted stones into camel uteruses to prevent pregnancy during long journeys, a rudimentary example of intrauterine interference. In the early 20th century, the first recorded human use of intrauterine devices occurred in Germany. German physician Ernst Grafenberg introduced a ring-shaped silver IUCD in the 1920s, laying the foundation for modern IUD development.

The global usage of IUCDs varies widely based on geography, culture, and access to healthcare. According to recent WHO estimates, about 14% of women using contraception worldwide use IUCDs.

They are especially popular in countries like China, Vietnam, Egypt, and parts of Central Asia. Use in developed countries, such as the US and UK, is rising due to greater awareness and updated clinical guidelines. In developing nations, uptake is variable, influenced by healthcare access, provider training, and social acceptance. IUCDs are approved for use for 3–10 years depending on the type and are endorsed by the WHO and various national health agencies.

Barriers to IUDs include cultural and religious factors, myths and misconceptions, and limited resources and access to trained providers.

During the sexual revolution of the 1960s, plastic devices like the Lippes Loop (a flexible polyethylene device) were developed, marking a shift from metal-based to plastic IUCDs for safety and comfort.

The introduction of copper-bearing IUDs (e.g., Copper T380A) significantly improved efficacy in the 1970s and 1980s. Around the same time, the first hormonal IUDs (e.g., those releasing progestins like levonorgestrel) were developed. Modern IUCDs include copper IUDs and hormonal IUDs (such as Mirena, Kyleena, and Skyla).

Copper IUDs prevent fertilisation by creating a hostile environment for sperm. They are more than 99% effective and can last up to 10 years (e.g., Copper T380A). Hormonal IUDs release levonorgestrel, thickening cervical mucus and suppressing endometrial growth. Medicated IUDs are even more efficacious, typically lasting 3–8 years. The effectiveness of both devices is comparable to sterilisation, but IUCDs are reversible.

Though IUCDs are safe for most users, certain risks exist, particularly around the time of insertion. Cramps or pain during insertion are the most common side effects. Irregular bleeding, especially in the first 3–6 months, and heavier or prolonged periods with copper IUDs are also reported. Expulsion of IUCDs may occur, especially in younger women or postpartum insertions, with rates as high as 2% to 10%. Uterine perforation occurs in 1 in 1,000 insertions, which may require surgical intervention. Infection risk increases in the first 20 days post-insertion, especially in women with dormant sexually transmitted infections.

Long-term complications associated with IUCDs include ectopic pregnancy. Long-term copper IUD use may cause persistent heavy or painful periods in some women, despite device removal. Hormonal IUDs can also lead to amenorrhea or lighter periods over time.

Migration and embedment of IUCDs may cause fertility delay post-removal. There is no reported permanent effect on fertility, but a short delay in returning to normal cycles may occur in some users.

The IUCD represents a major advancement in reproductive healthcare, offering highly effective, long-lasting, and reversible contraception. While it carries some risks, particularly at insertion and in the early months, these are generally manageable with proper screening and follow-up care.

As awareness and accessibility improve, the IUCD continues to be a vital option for individuals seeking reliable contraception.

When couples are toying with the idea of coils as a form of contraception and seeking Dr G’s opinion, his view is: “As long as you are still toying with the idea of contraception, you are definitely going to make mistakes.”

On that note, stop toying and start coiling if the method suits!