‘How long can you leave a coil in?’: What to do if lockdown has affected your access to contraception

The UK lockdown has made it difficult for people to access regular healthcare, including that which is provided at sexual health clinics.

A study ​carried out by the British Association for Sexual Health and HIV found that women are struggling to access their usual methods of contraception due to sexual health services being plunged into chaos in the wake of the coronavirus crisis.

Many clinics have been shut or are running a skeleton service, as staff have been deployed to other parts of hospitals to help with the coronavirus emergency while large numbers of GPs are off sick with coronavirus or self-isolating.

The study found 86 per cent of clinics could not offer the most effective long-acting contraceptive choices of a coil or an implant, and only two-thirds could still fit a coil for emergency contraception.

Although some services, like abortion, have been adjusted by the government to improve access via telemedicine, many are still struggling. Some women are turning to unregulated sources of contraception, such as buying pills on eBay or other sites, a move which has been described as “deeply worrying” by contraceptive experts.

As a result the Faculty of Sexual and Reproductive Healthcare (FSRH) of the Royal College of Obsestricians and Gynaecologists has published a comprehensive guide for women seeking contraception, abortion and other sexual and reproductive healthcare during the Covid-19 epidemic.

From how to top-up supplies of your regular pill to whether or not you can leave the coil in for longer than you’ve been told, here’s everything you need to know about accessing contraception in lockdown.

If this is your first time seeking contraception, head to the NHS website to familiarise yourself with the different methods.

Then, the FSRH suggests contacting your GP or normal health provider who will offer you a phone or video consultation.

Depending on the method you choose, you may be able to collect your medication from the clinic, or it might be necessary to book a face-to-face appointment.

All contraception is free on the NHS.

If you are on the progestogen-only pill (POP), it is possible to receive a top-up via a prescription that can be posted to you, or an electronic prescription that can be sent to the pharmacy of your choice for collection, says Dr Anne Lashford, vice president of the FSRH.

Alternatively, you may be advised to collect your medication from the clinic. The same applies to women using the combined pill or patches, if they have had their blood pressure measured in the last 12 months and weight is stable.

When it comes to the contraceptive injection, women should contact their GP or clinic, says Dr Lashford.

“If it is not possible to offer a face-to-face appointment, you may be offered the progestogen-only pill in the short term.”

For women already using the self-injectable injection (Sayana Press®), it should also be possible to issue a further supply that can be collected from the clinic or by using an electronic prescription to the pharmacy.

“Some GPs and clinics may be able to provide video consultations to show women how to start using the self-injectable injection safely and correctly,” Dr Lashford adds.

Your first port of call should be the place you usually access care for your sexual or reproductive health, says the FSRH. “If they are not able to help you, they should direct you to other services that can.”

Your service provider will then tell you how you can collect any necessary medication, or whether or not you need a face-to-face appointment.

Some lockdown requirements might have changed, but it’s still not clear whether women will be able to get appointments to have their long-acting reversible contraception such as IUDs, IUS (commonly referred to as “coils”) and implants, changed.

Due to the risk of Covid-19 infection to both patients and NHS staff, it might not be possible for doctors and nurses to fit or change an IUD or IUS given that it requires direct face-to-face contact.

“In this scenario, women will be offered temporary oral contraception, and arrangements will be made for the woman’s chosen method to be fitted when the situation allows,” says Dr Lashford.

“I advise women to discuss their options with their GP or another clinician, as some practices and clinics may be able to offer a fitting.”

This depends on the type of coil or implant you have, says Dr Lashford.

“Some methods of long-acting reversible contraception are effective for contraception for a year or longer than is usually recommended. They don’t cause health problems if used for longer, so women can postpone replacement for the time being,” she adds.

In the case of coils, it depends on which type women are using. Banded copper IUDs, such as T-Safe®, are licensed for 10 years but can be effective for contraception for up to 12 years.

Meanwhile, 52mg levonorgestrel intrauterine systems, such as Mirena® and Levosert®, which are licensed for five years, can be effective for six years. If fitted after the age of 45, these can be used safely for contraception until the age of 55.

There are exceptions, such as the copper IUDs that have a five-year license for use, and the low progestogen intrauterine systems Kyleena® and Jaydess®.

“If such methods require replacement, women should use an additional contraceptive method to prevent unplanned pregnancies such as the progestogen-only pill (POP), which a doctor can prescribe over the phone, or condoms,” says Dr Lashford.

Contraceptive implants, such as Nexplanon®, which are licenced for three years, can be effective for contraception for up to four years.