Coil ‘more effective’ than morning after pill

2016-09-15

“Women should use the coil rather than the morning-after pill as emergency contraception, according to official new guidelines,” the Mail Online reports.

The guidelines, from the National Institute for Health and Care Excellence (NICE), cite previous research showing the coil has a lower failure rate than other forms ofemergency contraception.

The coil, also known as intrauterine device (IUD), is a small, T-shaped contraceptive device made from plastic and copper. It’s inserted into the uterus by a trained health professional. It may prevent an egg from implanting in your womb or being fertilised.

This isn’t “news” as such – it has long been known that the contraceptive coil is more effective and can prevent unwanted pregnancy up to five days after unprotected intercourse, compared to only a few days with the morning-after pill. It also has other advantages, including that it can be used as an ongoing method of contraception to prevent further need for emergency contraception or unwanted pregnancy.

Where did the guidance come from?

The National Institute for Health and Care Excellence (NICE), is the guideline body that provides national guidance on health and social care issues.

The current guideline on contraception is what is known as a Quality Standard. These documents set out the priority areas for improvements to the quality of care delivery across the country. They give a list of statements that will help improve and standardise care.

The contraception quality standard covers all methods of contraception, not just emergency, but does not cover related sexual health issues such as sexually transmitted infections. Quality Standards accompany other clinical guidelines that give recommendations on how conditions should be diagnosed and managed.

The information on coils, injections and implants has been drawn from NICE’s clinical guideline on long acting reversible contraception.

Information on other contraceptive methods, including pills and condoms, has been drawn from guidelines produced by the Faculty of Sexual and Reproductive Healthcare (FSRH).

Why was the guidance needed?

As NICE says, it is estimated that almost one in five pregnancies are unplanned, with younger people at greater risk. However, things are improving – since 1998 the under-18 conception rate is said to have halved.

Between 2013 and 2014 there was a 6.8% decrease in rates, giving a conception rate of about 23 per 1,000 15-17 year olds, which is the lowest it’s been since the end of the 1960s.

There remains room to improve though. In 2014 there were also 184,571 terminations or abortions, with the highest rate among young women in their early 20s at 28 per 1,000 pregnancies. For under-18s it was 11.1 per 1,000. More than a third of abortions are in women who’ve already had one or more previously.

In 2014/15, the vast majority of emergency contraception issued by sexual and reproductive health services was for the morning-after pill.

What does the guidance say about emergency contraception?

NICE’s second quality statement is that “Women asking for emergency contraception are told that an intrauterine device is more effective than an oral method”.

An intrauterine device (IUD) refers to the copper coil. It shouldn’t be confused with the hormone-releasing intrauterine system (IUS); another long-term method of contraception.

The IUD can be inserted up to five days after unprotected intercourse, and has a lower failure rate than the morning after pill.

Furthermore, it has the advantage that once it’s inserted it provides an ongoing method of contraception which will reduce the risk of further unplanned pregnancies or need for emergency contraception.

If a woman wishes to have an IUD fitted as a form of emergency contraception, but the healthcare practitioner is not able to fit it there and then, NICE advises that the woman is given the morning after pill in the interim, and then directed to a service that can fit the coil.

There are two morning after pills. The standard morning after pill (levonorgestrel, brand name Levonelle) can only be taken up to three days after unprotected sex. The newer pill (ulipristal acetate, brand name ellaOne) is a longer acting pill and is also effective up to five days after unprotected sex.

Conclusions

The quality standard emphasises best medical practice on this issue – women requesting emergency contraception should be advised on the benefits of the copper coil or IUD for several reasons. Namely, it being the method:

• with the lowest failure rate
• that can be used up to five days after sex
• that provides a long-acting ongoing method of contraception

Despite the IUD’s known effectiveness and benefits, in 2014/15, the vast majority of emergency contraception issued by sexual and reproductive health services was for the morning-after pill. It’s worth taking a moment to consider why this may be the case.

The morning after pill can be purchased over the counter at a pharmacy – the woman doesn’t need to see a doctor and they don’t have to have an examination to have a coil fitted, both of which some women could naturally feel embarrassed about or averse to. Also, some women may not like the idea of long-term coil left in place.

It should also be recognised that while IUDs are effective at preventing pregnancy, they do not protect against sexually transmitted infections (STIs) in the same way as barrier methods of contraception such ascondoms. And if you get an STI while you have an IUD, it could lead to a pelvic infection if not treated.

Nevertheless, in terms of effective emergency contraception, as Professor Gillian Leng, deputy chief executive of NICE says: “We want to empower women with the best information about all methods of contraception and their effectiveness so they can make an informed decision … We also want to ensure women are told the coil is more effective than the pill as emergency contraception.”

Dr Jan Wake, GP and member of the guideline development group said: “The advantage of the coil, on top of being more effective is that it can be retained and used as long term contraception, some can even be left in place for 10 years … Timing however is essential and women deciding on the coil should make contact with the clinic they have been advised to attend as soon as is possible.”

For more information on choices about contraception visit the NHS Choices Contraception Guide.