Holly Grigg-Spall, Author of 'Sweetening the Pill', 17 June 2015

IUS evangelism: The troubling truth behind the rise of the coil

Women and their doctors have been encouraged to think the IUS hormonal coil is the answer to womankind’s problem with the Pill. Author Holly Grigg-Spall sounds a note of caution

The Pill is still one of the most popular forms of contraception in the UK, taken by 3.5 million women (about one in four women of child-bearing age). But, it just might have a rival. Because the number of women with the hormonal IUS has more than doubled in recent years.

A survey of 1,000 women aged 16 to 45 by Telegraph Wonder Women and the British Pregnancy Advisory Service (BPAS) found that five per cent had an IUS (intrauterine system) fitted.

It might not sound like much. But six years ago that figure was less than two per cent.

The IUS is a LARC (long-acting reversible contraceptive). The plastic T-shaped device is inserted by a healthcare professional into a woman’s uterus through the vagina.

It releases progestogen, a synthetic version of the female hormone progesterone, and can stay in place for three to five years, before being removed by a health professional.

What’s more, it’s marginally more effective than the Pill – over 99 per cent. (The Pill is 99 per cent effective if used perfectly, but in real world terms it’s roughly 92).
Sounds too good to be true, right?

If the NHS is to be believed, the hormonal IUS is one of the best options for women. Indeed, the rise in its use has come, in part, after their intervention.
There is a pay-for-performance program within the NHS that provides incentives to doctors who hit targets. Since 2009, one of these has been to increase prescriptions of long-term hormonal options, like the IUS.

Medical professionals are receiving training on what they see as “the future of contraception” and ways in which an IUS might be presented to a patient.
And some sexual health charities receive support grants from pharmaceutical companies, such as Bayer who make the IUS, which are then used towards services and awareness campaigns.

Dr Helen Stokes-Lampard of the Royal College of GPs told the Telegraph: “The most popular form of contraception for female gynaecologists and female GPs is the Mirena IUS because you can ‘fit and forget’ it’.

“All us health professionals would like to see more women on long acting form of contraception because they are more reliable in the long term and cost less for the NHS.”

Indeed, the longer a woman waits to have her IUS removed, the more cost-effective it becomes. The coil costs £90 over five years, including insertion and removal. The Pill, however, requires multiple appointments and costs £3 to £6 pounds a month, on average, for the NHS.

But the NHS isn’t the only group pushing the IUS. Starting on Valentine’s Day this year Bayer pharmaceuticals, the company behind the Mirena and Jaydess IUS devices (the two most popular brands), began a Europe-wide promotional campaign called #YourPerfectMatch.

It offered free yoga classes, brunch, manicures and relationship advice to influential women, in cities from Dublin to Berlin. They were encouraged to 'own' their life decisions, including those about birth control. Bayer’s strategy was an attempt to create ‘IUS evangelists’ – who might go on to spread the word to their friends and social media followers.

It’s thanks to these sorts of promotional campaigns and incentive programmes that an increasing number of doctors believe the IUS is the answer to womankind’s problem with the Pill.

Well, I’m afraid it’s not. It can cause some women as many problems as the Pill, just in different ways. We don't hear as much, because fewer women are using it, and it's a newer option. As with every one of the 15 contraception options available, some women aren’t convinced, while others rave about the benefits.

In the Telegraph Wonder Women survey, Mirena users were the least likely to say they were unhappy with their contraception. “For many women the Mirena is an extremely good form of contraception. It’s long-lasting, you don’t have to remember to take a daily pill, and it reduces heavy periods,” explains Claire Murphy, spokeswoman for BPAS.

Many of these women will have been offered the IUS after difficult experiences with other hormonal methods, such as the Pill. It’s often promoted on the understanding that the dose of hormones is not only smaller, but localised in the uterus.

But is everything as rosy as it seems? With the NHS seemingly pushing the IUS as a strong alternative to the Pill, why aren’t even more women choosing it?
Asking your GP Clare Murphy explains that one reason is the “worry about having a form of contraception you have to rely on a healthcare professional to insert and remove.”

Studies have shown that half of women have their Mirena IUS removed before its lifetime is up. They’ve reported bleeding, abdominal pain, bloating, headaches, weight gain, breast tenderness, hairiness, greasiness of skin and lack of sexual interest, as outlined by a study of 160 women conducted by Dr Ayman Ewies, a Consultant Gynaecologist at Sandwell and West Birmingham Hospitals.

He argues that these side-effects point to the impact of the IUS being systemic: “The idea that Mirena works entirely as a local source of progestogen should be revised, and the recent concerns about Mirena should be made clear to women regardless of the marketing pressures.”

Meanwhile, research by Lesley Hoggart, Senior Lecturer in the Faculty of Health and Social Care at the Open University, has shown that, thanks to promotional campaigns, doctors are less likely to believe women’s health issues are side effects of the IUS and less likely to agree to early removal.

Some justify this on the basis of cost and their belief the side effects will subside. It’s also worth considering that Mirena has only been licensed in the UK since 1995 and Jaydess since April 2014. The truth is that we might not have seen the full impact of the IUS on women’s bodies yet.

But the high discontinuation rate does point to there being problem. And it seems that no one is listening. Adds Murphy: “It’s really important that women know they can get a device removed if it’s not working out for them. Doctors should reassure women that this will be the case.”

more information:
=> study by Dr Ayman Ewies
=> FDA letter ordering Bayer to stop misleading claims
=> Fake Advertising for Mirena

addendum: Bayer commissioned several studies on Mirena, for example on uterus perforation and on breast cancer risks. These studies were conducted by the German ZEG Institut. ZEG was founded and is led by former Schering employees (Schering brought Mirena on the market and is now a part of Bayer). Not quite an independent evaluation. ZEG was also commissioned by Bayer to conduct studies on thrombosis risks of Bayer´s Yasmin/Yaz pill. The investigation found that the hazard is comparable to other contraceptive pills. However, all independent studies found a two- or threefold risk of pills containing the hormone drospirenone.