There’s A New Coil In Town, So What’s The Deal?

If you’re a fan of non-hormonal contraception or even looking for a new form of contraception to try, you may well have heard excited rumblings about a new copper coil, coming soon (maybe) to uteruses near you.

The Ballerine IUB (intrauterine ball) was developed by OCON Medical and launched in Austria in 2014. Much of Europe has had the IUB as an option for years and it’s also available in parts of Africa and the Middle East. Meanwhile, in the UK, it’s been available privately since March 2017. It was originally due to be rolled out on the NHS in 2020 but – like so many things – coronavirus stopped it in its tracks.

So what’s the deal? The basic principle behind the IUB is the same as the copper intrauterine device (IUD). It’s a non-hormonal copper coil but instead of the traditional T-shape, it’s spherical – hence the name – and about half the size, measuring 15mm in diameter.

"It’s a next-generation intrauterine device. It’s the first three-dimensional IUD and works along the same principle as a T-shaped copper coil, preventing pregnancy by releasing copper ions into the uterus. That’s the main technology of preventing pregnancy but having a foreign body inside the uterus is another way that it helps to prevent conception," explains Daniela Schardinger from OCON Medical.

"When the T-shaped coils were introduced, the uterus was looked at more as a flat triangle. If you insert a T-shape into a flat triangle, it fits perfectly. But the uterus is actually a three-dimensional cavity and it’s constantly contracting and moving, which can cause the IUD to turn and shift inside the uterus," she says.

"The Ballerine was invented to be totally spherical so no matter which way it turns, it will always relate to the uterus in the same way," Daniela adds. "It has a built-in safety mechanism to minimise the risk of perforating the uterine wall, and it’s also flexible. This means it adjusts to your contractions and is just a better fit to what we know of the uterus today."

The IUB lasts for five years and, like the traditional copper coil, OCON Medical says it’s more than 99% effective. In the less than 1% of pregnancies that do occur, Daniela says the spherical shape reduces the risk of ectopic pregnancies when compared to the IUD – the theory being that the arms of the T-shaped coil are more likely to block the fallopian tubes, causing the fertilised egg to implant outside the womb.

It’s inserted in a similar way to the IUD and has the same advantage that you return to fertility immediately after having it removed, with none of the side effects of hormonal withdrawal that some women experience when coming off hormonal contraception.

It all sounds very promising but does it live up to the hype? "There is a lot of buzz around the IUB whenever we post about it," says Alice Pelton, founder of contraceptive review website The Lowdown.

"I think partly that’s because people are just so desperate for new non-hormonal methods. There wouldn’t be this much hype if it was hormonal because there’s been so much more critical assessment of our contraception lately, and the side effects that can be associated with hormonal options," she adds.

Indeed, many of the options we use today have been in use – albeit with newer and updated versions – since the '60s and '70s, or even longer in the case of the humble condom. And as we know from the ongoing discourse of discontent surrounding the hormonal contraceptive pill, they don’t work for everyone. With the exception of fertility awareness method apps, like Natural Cycles, the IUB feels like the first real innovation in decades.

"Women are desperate," Alice says. "There’s been so little innovation and funding in this area for so long. Between 2017-2019 there were only 25 clinical trials on contraceptives, compared to 9,000 for cancer drugs and almost 2,000 for cardiovascular drugs. People are desperate for new, non-hormonal methods, and desperate to try them to see if they’re any better. It’s just such a shame that it’s taking so long," she adds.

No wonder, then, that there is so much excitement about the Ballerine IUB. But it’s also worth noting that the only clinical data so far available is from a small trial carried out by the manufacturers themselves. This suggested a 10% reduction in cramps and period pain for those using the IUB compared to the IUD but we need more data – as well as lived experiences from both patients and clinicians – to know if it’s really all it’s cracked up to be.

As most of us also know, from our own and friends’ experiences with the existing options, there is no one size fits all when it comes to contraception. One woman’s ideal solution is another woman’s heavy-bleeding-mood-swinging-acne-breakout nightmare, and there’s a lot of trial, error and compromise involved in finding what works best for you.

Twenty-seven-year-old Isabelle from Switzerland, who has already tried the IUB, confirmed this. "I had it fitted about two years ago because I’ve always been very sceptical about hormonal contraception. I’ve never had the T-shaped IUD so I don’t know how it compares, but my sister and a few friends already had the IUB and they were happy, so I thought it was worth a try," she says.

However, she adds, her experience wasn’t quite so positive. The IUB is no panacea. "Getting it fitted was very painful for me and then it just didn’t work for my body. I could always feel that it was there, and my periods were much heavier and more painful. After about six months I decided to get it taken out again," Isabelle explains. "I think it’s just very individual because friends of mine have had no problem at all."

Similarly, Alice says she’s heard from other overseas followers of The Lowdown who absolutely love their IUB so there’s no doubt it has the potential to become a popular option.

"There is always a small percentage of women who might not tolerate having a foreign body in the uterus," Daniela says. "This can cause heavier or longer periods. However, generally speaking, it is better tolerated than the T-shaped IUD."

The big remaining question, of course, is when it will become widely available in the UK. "In a nutshell, it’s not currently available for us to prescribe or use on the NHS, I haven’t had anyone ask me about it and I definitely haven’t fitted one yet," says Dr Naomi Sutton, a consultant physician in sexual health.

NHS England told me they can’t say when it’s likely to be rolled out, as sexual health services are commissioned locally, but OCON Medical is hopeful that it could be by the end of the year.

"We have a partner in the UK, who is in discussions with the NHS. Unfortunately, COVID has pushed us back, so we’ve had to put those plans on hold a little bit," Daniela says. "It’s very hard to say exactly how long it will take. It might be next month, it might be in the autumn – but we are in active discussions and we hope that we can launch it this year."