Coil Fitting Checklist and Consent

I have read through the leaflet on IUD/IUS

I understand that it is not safe to insert an IUD/IUS if I might be pregnant.

I am using an effective method of contraception and haven’t had any problems (eg. burst condom/missed pill)

I have not had unprotected sex or used the withdrawal method since my last period.

If attending for a first time coil fitting or a removal of coil and replacement I can confirm that I have abstained from sex for the last 7 days.

I understand the fitting clinician might conduct a pregnancy test on the day of my fitting.

I will make sure that I have eaten on the day of the appointment. You may also wish to take an over the counter painkiller 30 minutes before your appointment.

I understand that an IUD/IUS is more than 99 per cent effective (less than 1 in 100 chance of pregnancy)

I understand that the IUD/IUS will not protect against sexually transmitted infections, but using condoms does.

I understand that there is a small risk (1 in 1,000) that the IUD/IUS might go through (perforate) my womb or cervix when it is put in. If this does happen, the IUD/IUS may have to be removed surgically. This risk of perforation is higher while breastfeeding. Severe pelvic pain, pain during intercourse, heavy bleeding or pain lasting for more than a few weeks after insertion or not being able to feel the strings can be a sign of perforation and urgent medical advice should be sought.

I understand that occasionally due to stimulation of the nerves to the cervix during the procedure there can be a temporary episode of light headedness and rarely faintness (cervical shock) and that sometimes it is not possible to fit the coil despite trying.

I understand that there is a 1 in 20 chance of the device falling out. If I cannot feel the strings I should seek medical advice and not rely on the coil for contraception.

I understand that there is a small risk of infection (1 in 100) in the first 20 days following insertion of a device.

I know that a copper IUD will make my periods slightly heavier, longer and more painful.

I know that an IUS will make my periods much lighter but causes erratic bleeding and spotting in the first 6 months of use. For some people bleeding continues to be bothersome.

I know that the IUD is effective immediately.

The IUS (Mirena/Jaydess) takes 7 days to be effective from insertion unless inserted in the first 5 days of my cycle so I need to use alternative contraception during this time.

I consent to having a copper IUD coil or an IUS (Mirena/Jaydess) coil inserted.