To ask if your GP tries to ‘persuade’ you to have the coil

[Loveskating135]

Wondering if GPs are trained to push you in the direction of getting the coil. I’ve now found a pill I’m happier on, but the GP seems to still strongly recommend the coil. I haven’t had any unwanted pregnancies or anything but this seems to be what they want you to be on...

GPs are financially incentivised to fit the Mirena.
www.imperial.ac.uk/news/146546/gp-incentive-scheme-increases-long-term-reversible/

www.telegraph.co.uk/women/womens-health/11678916/IUS-hormonal-coil-The-troubling-truth.html

Yes they do push. And after DC2 I fell for it. I cannot wait for it to be removed! Went to GP last week and she couldn’t find it . Now bracing myself to go to clinic. Wish I never agreed.

I had a thread related to this the other day.

I've bled for 7 months on cerazette now and I'm miserable and I just get told to have a coil.

I have fibroids so not sure how it would work anyway but surely if I'm bleeding constantly on cerazette then the Mirena coil will be the same as it's the same hormone?! When I asked my dr about it he just said it will be different but couldn't really explain it.

I'm miserable but don't know what to do. It sucks.

Oh and I forgot in fact when the first GP (male) suggested it to me I said no as I felt I’d had enough poking around down below (I’d had a baby and then a smear within the few months previously) he sniggered at me! The cheek.

Every time I see my GP he pushes the Mirena coil.

I’ve seen him a few times this year for a completely different health issue but he brings it up at every appointment

Every time I tell him the same thing - my DH has had a vasectomy

God knows why he can’t just put it in my notes

@catalogueuniverse, are you sure they are incentivised to fit the mirena?

I quickly skimmed one of your links -

In 2009 the programme introduced targets for sexual health which focused on providing information on LARCS to women attending for contraceptive advice.

I thought current QOF was for providing advice. I didn't think fitting coils was incentivised though happy to defer to any practice managers/financial managers on the site.

Springers, I finally had to make a formal request to have it placed in my notes not to push that fucking Mirena on me or bring it up as my h had had the snip and I did not need contraception.

Yes, I had this repeatedly for years! And then when I finally agreed, because I couldn't take the pill any more, it was almost impossible to get an appointment to have it fitted! What's the point of hounding women when no one is trained and available to put the damn things in? It did work wonders for me once I finally got it put in though.

Yes they did with me. I wouldn’t have one, the thought freaks me out to be quite honest

Yeah and I'd never have the stupid thing again mainly because once it's in no fucker will take the bastard thing out again! Ended up pulling it out myself

Yes. It's because it works out the cheapest method. But I refuse every single time they offer.

I think I'm never going to move house.
I went to a review of the contraceptive pill a while back and asked about the coil while i was there.
I was told if you're happy with the pill why change

@jacks11

It was me who suggested drug reps incentivise doctors pushing the mirena coil, and it was just a lighthearted comment. I don't really believe they have a tracking device inserted either.

Everything you say makes sense (and can I say I always enjoy your wise and articulate posts, on a range of subjects) but the thing is that what you say doesn't chime with many, many women's experiences.

And of course if a woman says she doesn’t want a mirena having listened to the information given, then that’s the end of the matter.

It so often isn't the end of the matter, though. My GP, who knows me well and knows exactly how I feel about mirena, goes on and on and on about it. Randomly, irrespective of what I've made the appointment for. I am tempted to say I'll let him insert one in me if I can insert one in him.

And before anyone says it- yes, if you want it removed they should be able to do so in a reasonable timescale.

And this is the other problem. So many women report extreme problems with this, that anyone who's feeling a bit unsure about whether it's for them is naturally going to play it safe and say no if she thinks she'll be stuck with incessant bleeding, mood problems, pain or any of the other commonly reported side effects. I know several people - and clearly lots of pp on the thread do too - who have ended up having to pull their coil out themselves, which is completely awful and totally unacceptable.

It would be great if everyone's HCP were as reasonable as you, but the reality is that a huge number of women have multiple, frequent experiences of being hard-sold the mirena coil and multiple experiences of refusal to remove it, including women at high risk of, or already struggling with, side effects and women who don't actually need contraception. If we can agree that financial incentives are not the reason, then it's a bit of a mystery why and I would love to understand it better.

I recon that the gp surgery gets commissioned on how many people have a coil fitted. In my case, I do agree it's the only option but in other cases many people would be fine on the pill.

The FP woman refused to take mine out when I had a smear (I had already tried at home).

She wouldn't take it out unless I had another put in which I said no to, so a discussion followed in which I declared I had rights over my own body, I'm a grown woman, I know about contraception (I'm a midwife, I'm wise in the world, 45 and have children).
She wouldn't budge the coil so in the end I told her I wasn't in a relationship and was living a celibate life even though my husband was in the waiting room just to get the damn thing out.
It's wholly wrong that your choice is removed from you and you cannot have it out when you wish
In fact it's almost a violation of sorts refusing to remove a foreign object from your body when you no longer consent to it being there!

I have found personally and professionally that mirena coil is pushed heavily as a cure all for PMT, heavy periods, contraception, Menopause

Easy to have put in, murder to get out

Yes at my 6 week pp check up. Male doctor, very dismissive of my concerns about the coil effecting my MH and decided he knew what my body needed. He booked the appointment for me to have a coil fitted and I had to go home and ring my GP to cancel myself as he refused to do it because 'you really don't want another so soon at your age'.

Yes, I went a little while ago as I have been having issues with my cycle. My mum died ovarian cancer and I'm too young for peri apparently but instead of offering me any blood tests I was told I should first try the coil. I told her where she could poke it. I find gps very dismissive around this sort of topic. If I wanted a sodding coil I'd have asked for it.

I don’t understand why they are so keen on the Mirena but less on the implant?

I understand the benefits of the copper with no hormones but if Mirena and Implant both have the same hormone, surely it’s more risky having something in your uterus that could dislodge and harm you, than a rod in your arm?

The whole ‘the Mirena hormones only go in your uterus’ argument i here doesn’t really make sense to me, surely the hormones go into your bloodstream anyway?

My uterus is an odd shape and a coil won't fit, I don't know how many times I've had to explain this to various medical professionals.

I'd actually like a coil as you don't need to remember it every day, which is why they push it, along with the implant or depo injections, no 'forgetting' and unplanned pregnancy.

It is not your GP. They are doing their job as there is a national drive and national recommendations that more women should be offered long acting contraceptive methods like the coil or implant. That is because they are the most reliable methods.

Quote from the Telegraph article

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.

They are more keen on the mirena as you get less systemic absorption of the hormones compared to the pill or implant. That is, less hormones enter the bloodstream. Some do enter, but much less. Therefore there should be less side effects.

Catalogue... There are hundreds of targets set for doctors to meet. These are based on best practice and NICE guidelines etc. The reasons the targets are there, are to help doctors make evidence based decisions with their patients. Eg recommending a long acting method of contraception such as a coil (IUS or IUD).
Anyway that system of funding practices and hospitals is being gradually phased out.

I’m not disputing it’s being phased out.

The question was what’s behind the pushing. The answer is there is a financial incentive for hitting targets of prescriptions of LARCs. I’m totally aware of the pros of LARCs. I’m also aware they do not suit all women and from the responses on this thread the women who are being encouraged to take up the Mirena are not always being offered alternatives or sufficient explanation of the pros and cons of the choices available.

The lack of patient control about having an iud/implant/ius removed is a real concern. Some women react really badly to hormonal implants/Mirena and have both physical and mental health difficulties but they are at the mercy of the healthcare provider when it comes to having it removed regardless of how clearly they express their difficulties.

On a personal anecdote I’ve found family planning/sexual health service clinics staffed by very knowledgeable people who are incredibly helpful.

Regardless of funding, pay for targets, NICE guidelines

If a woman wants her coil removed she should not have to move heaven and earth to do so

She should not be refused