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Coil crises, have you fallen through the gaps?

Like many other women I watched the latest Davina program on the pill revolution last night on channel 4. The Davina documentaries may not be for everyone but one thing they do well is to raise awareness and open up the conversation on women's health with many people.

It's great to be talking about the pill and all the contraception options we have available to us in the UK this is the only way to promote more research, change and for women to be heard. However are we all able to access the contraception we want or that is right for us at the right time? Many women talked on the documentary about not having all the information or time to make the right choice. Access to contraception at the right time was also mentioned.

If you are a patient access to contraception is not something that you routinely think about, as a patient you discuss with a health care professional the right contraceptive options for you and then receive a prescription or book an appointment for a relevant procedure. However if you are using a contraception for other reasons things may start to get a little more complicated.

We also use contraceptives for other reasons, for example the pill can be used for period problems or to help with acne. The mirena coil is also regularly used for period problems and as the progesterone part of HRT. This small coil is inserted into the uterus, it contains and releases the hormone progesterone which as a contraception thickens the mucous within the cervix preventing fertilization. It also keeps the endometrium (lining of the uterus) thin which often stops or makes periods irregular.

If you are using the mirena as a contraception this can usually be fitted in a local sexual health clinic, although there may be a waiting list this clinic is usually accessible and there is likely to be one in your local town where you can book an appointment. However if you are looking to have the mirena coil for other reasons such as for heavy periods or part of your HRT, this is when things are not so straight forward.

Sexual heath clinics only receive funding to fit the mirena coil if it is going to be used as a contraception, if you need it for other reasons this is not something they are usually able to offer. I know it sounds crazy thinking about money, after all contraception is free in the UK and this is the NHS, so why should it matter? However whilst there may not be a cost to the patient, like all large organisation each area or clinic in the NHS have their own policies, budgets and funding pots.

If you would like the mirena coil for non contraceptive reasons, it may not be as easy to access the right area of care to get this fitted. Not all GPs are able to offer coil fitting, this could be due to training for the right staff, capacity and funding. If this is service is not available in primary care via your GP then it is possible that you may need to be referred to gynaecology in secondary care or your local hospital.

Whilst this is not a difficult procedure for a gynaecologist, again this impacts on the capacity of clinics within secondary care and there may also be a significant waiting list. Due to Covid 19 and all the pressures our wonderful NHS is now under, this waiting list could be much longer in some areas of the country. Long waiting lists and complicated referrals also mean that patients are likely to fall through the gaps, or have to use other options or medication whilst they are waiting.

My question is why should women have to wait for possibly over a year to receive a mirena coil as part of their HRT or for period problems? With more women in work and education than ever before we have to ask what is the impact of this waiting time on women? If they are still suffering from problem periods or not able to optimize their HRT this is likely to have an impact on both their personal and working lives. It is a false economy to do nothing.

What we need are accessible women's health hubs where women don't need to attend a hospital to receive the basic care that has a big impact on their lives. Women don't want to take up appointment spaces in hospitals, having a coil fitted is something that for most women can be done in primary care, we just need the funding, training and the right staff to implement.

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