Referrals should not be made for the routine fitting of Mirena as this should normally be offered in primary care. These referrals with be cancelled.

Exceptions for referral are

1.       where fitting or removal has failed or

2.       where there are issues specific to an individual patient that require secondary care insertion. For example, during termination of pregnancy, or as part of an operative procedure such as hysteroscopy.

Where you are unable to remove a coil, please refer to the DIRECT ACCESS HYSTEROSCOPY CLINIC. Please attach with all referrals a pelvic ultrasound result showing that the coil is situated in the uterus.

If the coil has perforated the uterus, please refer urgently to GENERAL GYNAE, attaching the ultrasound report.

Where you are unable to fit a coil, please refer to the DIRECT ACCESS HYSTEROSCPY CLINIC. Pelvic ultrasound scans are not needed in this scenario.