Fertility (Ovulation thermometer)

Digital thermometers are available (e.g. through NHS supplies) but are not included in the Drug Tariff and so cannot be prescribed on FP10. Refer to the Family Planning Clinic for advice.

Intrauterine Contraceptive Devices (IUDs)

IUDs are suitable for use in all women, including nulliparae.

The most effective IUDs contain at least 380mm² of copper and have banded copper on the arms e.g. T-Safe 380A QL, are thought to be the most effective. Alternatives are Nova-T 380 and Mini TT380 Slimline for women whose uterine cavity is of an insufficient size for the T-Safe 380A QL

All IUDs should only be fitted by those who have been appropriately trained

MHRA Drug Safety Alert (June 2015): Before inserting an intrauterine system (IUS) or intrauterine device (IUD), inform women that perforation occurs in less than 1 in 1,000 women and that the symptoms include:

• severe pelvic pain after insertion (worse than period cramps)
• pain or heavy bleeding after insertion which continues for more than a few weeks
• sudden changes in periods
• pain during sex
• not being able to feel the threads

Explain to women how to check their threads and tell them to return for a check-up if they cannot feel them (especially if they also have significant pain). Partial perforation may have occurred even if the threads can still be seen; consider this if there is severe pain following insertion.

An IUD fitted or re-fitted after a woman's 40th birthday, does not need to be changed. It can be removed one year after the last period

If a surgery is unable to provide an IUD insertion, patients can arrange a fitting by contacting:

• Devon Sexual Health (Barnstaple, Exeter, and Torbay) (electronic referral system available)
  • A patient can self-refer by phoning 0300 303 3989 for a consultation within 24 hours. Please give relevant treatment information to the patient to bring to clinics, i.e. results of previous cultures and any treatments.
• SHiP (Sexual Health in Plymouth)

Patient or GP must mention the appointment is for an emergency fitting.

T-Safe 380A QL

• Intrauterine device (£10.55 each)

Notes

1. Replacement every 10 years

Nova-T 380

• Intrauterine device (£15.20 each)

Notes

1. Replacement every 5 years
2. If the woman has a very tight cervical internal diameter, e.g. nulliparous or in young women, Nova T 380 may be preferred. Introducer diameter: 4mm

Mini TT380 Slimline

• Intrauterine device (£12.46 each)

Notes

1. Mini TT380 Slimline is for minimum uterine length 5cm. Replace every 5 years

Multiload Cu375

• Intrauterine device

Notes

1. Replacement every 5 years
2. The Multiload Cu375 causes greater cervical discomfort during insertion and removal and is associated with concerns when inserting through the cervical canal, as the device is not enclosed within a sterile inserted tube.

Vaginal Contraceptives

Caps and diaphragms are used infrequently. Advice on choice, prescription and fitting of caps and diaphragms should be obtained from a Specialist (primary or secondary care) in their use.

Diaphragms are usually used. They are normally replaced annually, have expiry dates and are used with spermicides.

Caps are used less often e.g. prolapse, poor muscle tone and urinary symptoms. They last longer than diaphragms, have expiry dates and are used with spermicides.

Type B diaphragm with coil spring

• sizes 60–90mm (rising in 5mm)

Type C arcing spring diaphragm

• sizes 60–90mm (rising in 5mm)

Vaginal contraceptive cap silicone

• Size 22mm, 26mm, 30mm (£15.29 each)