Step 1 - Starting the conversation
To establish a woman’s contraceptive needs:
Form questions that match a woman’s goals and needs, for example:
Understand her experience of different methods:
‘What contraception do you use now (if any)? What have you used before (if any)?’
‘How happy are/were you with those methods? What did you like most about your previous/current method? What did you like least?’
Step 3 - Discussing the benefits of IUC
Discuss the key potential benefits of IUC with the woman:
Supporting information is provided for HCPs
This step includes discussion points for extra time
- NHS. Intrauterine system (IUS) - Your contraception guide [online]. Updated 22 February 2018. Available from: https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/ [Last accessed: November 2019].
- NICE clinical guideline [CG30]. Long-acting reversible contraception [online]. Updated July 2019. Available from: https://www.nice.org.uk/guidance/cg30 [Last accessed: September 2019].
- Brant AR. Curr Obstet Gynecol Rep (2017) 6:109–117
- Carr BR, et al. Return of fertility in nulliparous and parous women after levonorgestrel 52 mg intrauterine system discontinuation [ASRM abstract O-104]. Fertil Steril. 2018;110(45 suppl):e46.
Step 3 - Extra time?
In certain cases, you may find that you have a little more time available with your patient. If so, consider discussing:
The effectiveness of IUC compared to oral contraceptives and/or other methods
The effect of some IUC methods on menstrual blood loss in women experiencing heavy menstrual bleeding
Step 4 - Background reading - common barriers and myths
Many HCPs have misconceptions about IUC which results in them not proactively discussing or offering it as part of their contraceptive discussion1
To dispel many of the common barriers and myths, the Global INTRA Group have developed a review paper published in EJC
Further barriers to the use of IUC covered in this review paper include:
Health system barriers include
Lack of understanding of the value/cost effectiveness of IUCs
The number of trained providers
User barriers include:
Lack of awareness and
understanding of IUC
Fear of IUC, particularly pain on insertion
Cost of IUC
Step 4 - Addressing ‘user’ barriers
Women also have a number of misconceptions about IUC which may need to be addressed within a consultation:
Pain on insertion has been shown to be lower than often feared:
A study of 117 women found that 62% of women taking part felt no more than ‘period pain’ during insertion of IUC1
- Brockmeyer A, et al. Experience of IUD/IUS insertions and clinical performance in nulliparous women–a pilot study. Eur J Contracept Reprod Health Care. 2008 Sep;13(3):248-54. doi: 10.1080/02699200802253706.
Step 4 - Putting risks and side-effects into perspective
Any method of contraception has risks and side effects. Helping a woman make an informed choice about IUC involves an appropriate discussion of these, using your clinical knowledge and experience
Risk of ectopic pregnancy
Changes to her monthly bleeding pattern
‘The most common side effects can be headaches and abdominal pains but not all women experience these. Just be aware that having an IUC won’t protect you against STIs so as you would with the pill, you’ll need to use a condom if you think you might be at risk.’
Step 4 - Extra time?
If possible, this theme can be expanded upon by discussing the CHOICE study:
- Birgisson NE. J Womens Health (Larchmt). 2015 May 1; 24(5): 349–353.
- PCWHF. 10 Top Tips for Intrauterine Contraception (IUC) [online]. Updated November 2019. Available from: https://pcwhf.co.uk/wp-content/uploads/2019/01/PCWHF-10-Tips-IUC.pdf [Last accessed: November 2019].
- Peipert J, et al. Obstet Gynecol, 2011;117:1105–13.
Step 5 - Use clinical experience & be honest when addressing concerns
Share your knowledge and clinical experience to support her decision to use IUC
Bear in mind that IUC won’t be the right choice for every woman
‘Based on what you’ve told me these are the most effective options to suit your needs – which of these do you think would suit you best?’
Include risks and potential side effects into your counselling
‘For most women, placement can cause a little pain, a bit like period pain, which quickly passes.’
Step 5 - Offer personal experience
If pertinent, personal disclosure has been found to be useful at this time:
‘In our practice we have a large number of women using this method.’
‘Amongst the patients I see, there are many who opt for an IUC.’
‘Many of the women who work here use IUC.’ (If you and your colleagues are comfortable)
Step 6 - Ahead of insertion
Before proceeding with IUC insertion, ensure that:
You meet your local requirements for informed consent at the time when the woman returns for the device to be inserted. When gaining this consent, remind her of the potential risks and side effects1
If the woman does experience side effects she should contact her healthcare professional immediately including pain, fever, unusual discharge, or severe bleeding2
It is important to note that cervical screening is independent of IUC placement and not a prerequisite2
Effective IUC counselling – video demonstration
These videos demonstrate that it is possible to have a simple, short, & very effective counselling session about IUC in under 7 minutes.
Counselling on Long-Acting Reversible Contraception (LARC)
To support contraceptive counselling in the UK, the Bayer Women’s Health team have developed virtual reality technology to help deliver LARC counselling to patients. The LARC VR programme offers virtual reality and interactive content to help women understand the different options available when considering Long Acting Reversible Contraceptives.