Non Visible Threads Clinic

Download a PDF leaflet containing the information on this page.

This leaflet gives you information about coming to the Non-visible Threads Clinic. This clinic is a part of county-wide Sexual Health Service Nottingham and Nottinghamshire (SHSNN). The clinic for this procedure is based at Nottingham City Hospital.

In addition to seeing patients with non-visible threads, this clinic also sees patients who have experienced difficulty with coil fits in the past and may need an ultrasound scan at the time of the coil fit.

Most of the information in this leaflet applies to you to help you prepare for your appointment and advice about after care.

You may or may not need an ultrasound scan, your doctor will advise you on the day.

All coils have a single or pair of strings (threads) attached, which sit just outside of the neck of your womb (cervix) to allow the coil to be removed easily.

However sometimes the threads are not visible to the clinician when checking or trying to remove your coil. When this happens, we describe it as ‘non-visible threads’.

One of three things may have happened when there are non-visible threads:

The best way for your clinician to tell which of the three options has happened is an ultrasound scan.

If you would like to keep your coil and it is not due to be replaced, your clinician will refer you for an ultrasound scan to check it is in the right place. If it is it can be left until it needs replacing or you would like it removed.

The ultrasound scan may be an on top of the tummy (transabdominal) scan and/or an internal (transvaginal) scan. For a transvaginal scan, the scan camera (probe) is placed inside your vagina and is closer to the pelvic organs. This usually gives clearer pictures than a transabdominal scan. More information about ultrasound scans is given later in this leaflet.

You may eat and drink as normal. We advise a light meal or snack and non-alcoholic drink
about an hour before your appointment.

Unless you are unable to take pain killers, we advise you take paracetamol (1g by mouth) and ibuprofen (400mg by mouth, with some food to protect your stomach). We will also offer you pain relief (local anaesthetic) at your procedure to make it as comfortable as we can for you.

To ensure we are able to do your procedure on the day of your appointment and avoid a risk of pregnancy to you, please follow the advice below. If there is a risk of pregnancy, we may NOT be able to do your procedure.

Guidance on how to use your contraception correctly and information about the different types of coils can be found at www.nhs.uk/conditions/contraception

If you have periods, please know the first day of your last period when you come to your appointment.

You will be seen by a doctor trained to remove coils with non-visible threads and to fit coils. They will talk with you about your health and contraception needs as well as any concerns or questions with you before any procedure. The doctor will discuss the risks and benefits of the procedure and check it is safe to go ahead – this is called gaining your consent.

Risks: there is a small risk of pain, bleeding, infection and very rarely (1/1000) making a hole in the muscle of the womb (perforation). Your doctor will discuss these with you before your procedure and give you time to ask any questions.

A urine pregnancy test may be required

A health care assistant or nurse will also be in the room to support you and to assist the doctor.

An ultrasound scan may be needed if you have not already had an ultrasound scan, or if the scan was a while ago, to check the position of your coil.

The doctor will be able to do this scan for you at the same time as your appointment to remove the coil.

The ultrasound scan may be a transabdominal scan or transvaginal scan.

The transabdominal ultrasound scan is done using a probe over your tummy (abdomen and pelvis). This usually requires a full bladder.

The transvaginal ultrasound is performed by placing a lubricated scan probe inside the vagina and is closer to the pelvic organs being examined. This type of scan usually needs an empty bladder.

The probe can feel cold and stretchy but should not be painful. Your doctor will check you are comfortable. If you are not comfortable or would like them to stop, just ask and they will stop.

This type of scan is used to help provide clearer pictures of the coil, womb, ovaries and surrounding structures.

If you do not need a full bladder, the doctor will ask you to empty your bladder in a bathroom completely prior to the scan. If you are using a tampon, this will need to be removed before the scan and before any procedure.

The ultrasound machine is cleaned thoroughly between patients and a probe cover (latex or non-latex) is also used. The doctor will check if you have any allergy or sensitivity to latex.

You will be given privacy behind curtains or alone in the procedure room to undress your bottom half (including your underwear) and lie down on the examination couch.

The examination couch has leg rests to make it more comfortable to get in the right position for your procedure. You will be given a covering to ensure your privacy is maintained at all possible times.

The doctor will do the ultrasound scan if needed – if this is not needed they will not do one. To remove (and/or fit) the coil, a lubricated plastic tube (speculum) will be passed into your vagina to allow the doctor to see your cervix. This can feel stretchy and a little strange but should not be painful. They are usually made of plastic and the same as used cervical screening or routine vaginal examinations.

If a procedure is required, local anaesthetic spray will be used on your cervix to make the procedure more comfortable for you.

A local anaesthetic injection (cervical block) can also be used if needed.

We recognise that the experience of discomfort or pain for both coil insertions and removals is very individual and your doctor will discuss your individual needs before your procedure. The coil will be removed using special thread retrievers or a type of tweezer (forceps).

The doctor and health care assistant will explain your procedure to you each step of the way and ensure you are ok.

It is important to know that you only need to ask the doctor to stop and as long as it is safe to they will stop immediately, and let you choose whether you would like to carry on after a rest or stop completely.

Once the coil is removed, if you have chosen to have a new coil it will be fitted (please see coil fitting information leaflet for more information).

If you find the procedure too uncomfortable or prefer not to have it done whilst awake we or your GP can refer you to Gynaecology to have your coil removed under general anaesthetic

Usually no follow up is needed but the clinician you see will advise you for your individual
needs.

Most people feel fine after having their coil removed and or a new coil fitted.

A few people feel faint or nauseous. This usually passes quickly and the clinician looking after you will be able to give individual advice if you are not feeling well.

It is common to experience period-like cramps after your appointment. These usually pass within a few hours, and taking pain relief as described below may be helpful.

Most people are fine and able to drive after the procedure, although, some people prefer to have a friend/relative bring them to their appointment or take a taxi or bus.

Most people are able to go about their day as usual following the appointment; however we advise against planning any major commitments in case you are uncomfortable or do not feel able to do them.

You may experience abdominal cramps (like period pain) after your procedure, please have some paracetamol (1g up to four times per day by mouth) and ibuprofen (up to 400mg three times a day by mouth and with some food) at home in case you need them.

You will experience some light vaginal spotting, this is normal and usually settles within seven days (if you are having a hormone coil you may experience longer irregular bleeding whilst the coil settles). We will give you a sanitary pad or you may prefer to bring your own.

Generally, we suggest avoiding tampons in the first four weeks after a coil fit.

You may go back to having sex when you feel ready and able to. If you are having a new/replacement coil or switching to an alternative method of contraception you may be advised to use condoms or avoid sex until your chosen method is protecting you against pregnancy.

If you change your mind or the appointment is not convenient, please telephone us to either cancel or rearrange on 0300 131 7010.

PET is available to help with any of your compliments, concerns or complaints, and will ensure a prompt and efficient service:

Nottingham University Hospitals: 0800 183 02 04

Email: nuhnt.PALS@nhs.net

King’s Mill Hospital: 01623 672222

Newark Hospital: 01636 685692

Email: sfh-tr.PET@nhs.net

If you would like this information in an alternative format, for example large print or easy read, or if you need help with communicating with us, for example because you use British Sign Language, please let us know. You can contact the Patient Experience Teams using the details above.