Changes to guidelines for Mirena coils have caused confusion over reproductive healthcare. Once again, women are paying the price for poorly funded services, says Olivia Petter
THE FIRST TIME Sonia * , 29, tried to get her five-year-old intrauterine system (IUS) replaced, she was turned away. ‘The nurse told me Mirena coils could be kept in for up to six years and, although it hadn’t yet been licensed in the UK, the clinic had been given “special permission” to allow it,’ she recalls. ‘She explained that there was no sense putting me through a painful procedure if it didn’t need to be replaced.’ Like many women, Sonia had not had periods since using the Mirena – but a few months after being told that the device was good for another year, her periods returned, accompanied by terrible cramps. She went back to the clinic. ‘I was convinced my coil wasn’t working any more but the nurse told me I could now actually keep it for eight years. I didn’t trust that at all.’
Sonia is one of many women to have faced barriers when accessing reproductive healthcare due to a sudden – and surprisingly under-reported – change in guidelines. In January, the Medicines Health Regulatory Authority approved an extension to the Mirena coil’s licence from five years to eight for contraception. This was based on a review of all the available evidence and clinical studies, which found that it can be used until the end of the eighth year with low failure rates and no real change to patterns in bleeding. ‘It means women can have them changed less frequently, which is good when there is a lack of funding and training for coil fitters in the NHS,’ says Alice Pelton, founder and CEO at women’s health review platform The Lowdown.
This is a positive in theory, but in practice it has become another area in which some women aren’t being listened to or properly informed about their care. Milly * , 38, faced a similar struggle to replace her coil. ‘As my Mirena neared its expiry date, I started experiencing heavy periods as well as terrible mood swings,’ she says. For months, she waited for an appointment. ‘When I chased my clinic, they told me the guidelines had changed. Despite me telling them I felt something was wrong, they didn’t seem keen to help. They didn’t even allow me to explain what was going on; I felt like I didn’t have a choice over my body.’ It wasn’t until Milly visited a different clinic that she was able to get it changed.
‘Women should always be advised that they can have their coils removed on request before it expires,’ says Jill Zelin, consultant GU physician at Barts Health. ‘Many non-specialists are not up to date with the guidelines and, even if they are, the information may not be shared with the admin staff who are making appointments.’
In Sonia’s case, it emerged that the extension
