IUC should only be inserted by health care professionals who hold the FSRH Letter of Competence in Intrauterine Techniques (LoC IT), or have achieved equivalent recognised competencies, maintaining their skills as per FSRH guidelines.
A full medical history should be taken, and health professionals should check UKMEC to assess an individual woman’s eligibility, including being reasonably sure the woman is not pregnant (this may involve a pregnancy test if there is any doubt, and again 3 weeks after the last episode of unprotected sexual intercourse). The woman should be fully counselled about the procedure for insertion, including the possible adverse outcomes (failure of insertion, cervical pain, vasovagal symptoms, infection, perforation, expulsion) as well as expected side effects (in particular, unscheduled bleeding). Consent must be obtained, a bimanual examination is carried out and women at high risk of STI should be screened for chlamydia as a minimum (if known STI, IUD insertion should be delayed until it has been treated).
When inserting a coil, most clinicians will stabilise the cervix with forceps, sound the uterus with a probe and then guide the IUC device through the cervical os into the uterine cavity to release the coil. Occasionally, a local cervical anaesthetic block is given, especially if cervical dilatation is required. The rest of the device is then withdrawn, and the canal is checked before the strings are cut 2-3 cm below the external cervical os.
If LNG-IUS is inserted after Day 7 of the woman’s cycle, or she is switched from CHC during HFI or week 1/POP/Cu-IUD, she should be advised to use extra precautions for 7 days; the CU-IUD is effective straight away.
Before leaving, the woman should be given advice to monitor for postoperative complications and offered follow-up at 4-6 weeks to discuss any problems. The date for removal/replacement should be given to the woman.