Diane French-Finlay’s periods used to be so heavy and painful that for two to three days a month she was effectively housebound.

‘I was in agony,’ says Diane, 50, a mother of three from Leicester. ‘I took ibuprofen but it never really got rid of the pain. So I would lie on the bed or sofa with a hot-water bottle on my tummy to try and soothe it.’

If she had to leave her home to pick up her children from school she would need to use sanitary towels in addition to her usual protection to prevent any embarrassing leakages when she returned home.

‘It made my life a misery,’ she says.

Diane, in her late 40s, believed she knew the solution.

‘Both my older sisters had also suffered with heavy periods that virtually disappeared when they were each fitted with a coil,’ says Diane.

The coil, also called intrauterine devices (IUD), is a T shaped metal or plastic contraceptive that is placed inside the womb of a doctor or nurse who has been specially trained.

Diane French-Finlay’s periods used to be so heavy and painful that for two to three days a month she was effectively housebound

Diane French-Finlay’s periods used to be so heavy and painful that for two to three days a month she was effectively housebound

Hormone-based IUDs can prevent pregnancy by slowly releasing progestin. This thickens the mucus around your womb’s entrance, stopping sperm from entering. Non-hormonal IUDs contain copper, which acts like a spermicide.

The hormonal coil can be used to provide long-term contraception (the implants must be replaced every five to ten years). It is often recommended for women who suffer from heavy periods, such as Diane. The gradual release of hormones reduces thickness of the lining, which decreases bleeding every month.

But what Diane assumed would be a straightforward process — accessing NHS contraceptive services — proved anything but. After all, every woman in the UK is entitled to free contraception, whether it’s the Pill or long-acting implants.

It took almost a whole year for Diane to request the implant from her GP. In October 2019, she had an implant placed at another practice. Diane was shuffled between local authority-run sexual clinics and GP practices during that time. They either didn’t provide the service, did not have the funding or had the staff required to fit the implant.

‘It was incredibly frustrating,’ says Diane, a former recruitment worker. ‘I had assumed I would be able to get the coil more or less straight away.’

In fact, it’s thought thousands more older women are in a similar position because of changes in the way they are funded that led to clinic closures and a shortage of the trained staff needed to fit coils and implants.

Hormone-based IUDs prevent pregnancy by gradually releasing progestin to thicken mucus around the entrance to the womb, stopping sperm entering, while non-hormonal ones are made with copper, which acts as a spermicide

Hormone-based IUDs can prevent pregnancy by slowly releasing progestin. This thickens the mucus around your womb’s entrance, stopping sperm from entering. Non-hormonal IUDs contain copper, which acts like a spermicide.

Among those Good Health spoke to who have faced similar obstacles, one urgently needed her coil removed after it caused excessive bleeding — which can happen in the first few weeks and months after being fitted (thought to be as a result of the body adjusting to its presence).

She said: ‘I couldn’t get in anywhere and was bleeding horribly every day for nine weeks. In the end I had to pay privately to have it removed.’

Another told Good Health: ‘I’ve been waiting 15 months to have one fitted. Every time I ring the surgery or clinic they don’t have any appointments or have stopped doing them.’ And according to some experts, such as Dr Anne Connolly, a GP in Bradford and a leading member of the Primary Care Women’s Health Forum, the lack of access is almost certainly to blame for a rise in abortions in older women (defined as 35 and over) who ‘take second place’ to younger women when it comes to access to contraceptives such as the coil.

Recent Department of Health figures for England indicate that terminations in the 35-39 age group have increased by 27% since 2015. However, the number of over-50s has increased by 66%, although the actual numbers may be lower.

This coincides to a significant decline in the number of women in England and Wales fitted with long-acting contraception (coils or implants) for their reproductive health. Since 2015, they have fallen by 8% to 300,000.

This is despite long-acting contraception being regarded as the most effective form of birth control; while one in 100 women on the Pill will accidentally become pregnant, with long-acting arm implants it’s just one in 2,000.

‘Women are being bounced around the system and it’s having a big impact on their health,’ says Dr Connolly. ‘Abortion rates are going up and the contraception service is not working.’

But why is the situation so dire? The 2012 Health and Social Care Act is being blamed.

Previously, budgets for NHS contraception-fitting services were mostly in the hands of primary care groups — GPs — who decided how services in their area were funded.

GP surgeries were paid a fixed fee, usually around £100, every time they would fit, replace or remove an IUD or implant. This covered their time and cost of the equipment and gave practices an incentive to pay for one or two staff members to keep up-to-date with the training needed to be a qualified ‘fitter’.

But the 2012 Act split funding so that fitting coils and implants prescribed primarily for contraception — rather than for heavy periods — was carried out by community sexual health clinics, funded by councils.

Instead, GPs would be paid to perform them when there is an underlying medical need such as excessive bleeding. However, they are not obligated to do so if it’s not financially feasible.

In addition, out went the national fee of around £100 per patient, in favour of local authorities negotiating their own deals with GP practices. Some now get just £35 for each patient they treat, despite each coil alone costing up to £80 for the hormone versions.

This huge disincentive to GPs was compounded by long-term budget cuts at local authorities, which have forced many local councils to reduce contraception service.

Reports have indicated that some local authorities refused to treat women over 25 who wanted implants or coils because they were committed to reducing unwanted pregnancies in young females.

‘The Health and Social Care Act has been a big issue in this,’ says Dr Connolly. ‘It was focused on prevention of health problems [such as unwanted pregnancies] and so took contraception out of women’s health and made it a sexual health issue.

‘This was great for younger women and teenage pregnancy rates have fallen. But not so great for mature women who are just as concerned about gynaecological problems such as very heavy periods.’

And not so great either for the thousands of middle-aged women encouraged by the NHS to switch to coils and implants, instead of the widely-used ‘combined’ Pill, before they hit 50.

A higher risk of breast carcinoma has been associated with the combined Pill that contains progesterone and oestrogen.

‘The Act was flawed and I fear women are paying the price for it now,’ says Dr Connolly.

The All-Party Parliamentary Group on Sexual and Reproductive Health released a damning report in 2020. It found that almost one in two cash-strapped councils had decreased the number of contraceptive clinics in the past five years.

Those who remained saw staff reductions and shorter opening hours in an effort to save money. More than a tenth council also cut the number of contracts they signed with GPs to fit implants and coils.

One Exeter GP told the MPs’ inquiry people were travelling nearly 200 miles from London for their contraception services. ‘It’s easier for them to come for a long weekend to Devon and have their needs met here rather than try and find a service in London.’

Dr Connolly states that the thing that frustrates many women, she says, is that they don’t get from pillar-to-post.

‘If a woman goes to a community sexual health clinic because she has heavy periods, it won’t provide a coil or implant.

‘She will probably be told to go back to her GP. And if they don’t do it, she may get referred to another practice or to hospital.’

The Primary Care Women’s Health Forum wants a revamp of services, with a network of ‘hubs’ across the UK, each based at a GP surgery, providing coils and implants for both contraceptive and clinical reasons. All GPs would receive the same fee.

Dr Connolly says: ‘The service needs to be built around the needs of women — not the needs of whoever is controlling the purse strings.’

Diane’s heavy periods were well controlled by the Pill until she stopped taking it to have her family. Her doctor refused to let her go back on the Pill after she had her last child in 2014.

She used condoms for contraception but recalls: ‘I was having heavy and agonising periods.

‘When I asked my GP about it, he said heavy bleeding was to be expected at my age and there wasn’t much I could do.’

Diane, who was suffering from painful periods for years, visited her GP to request a second opinion about the coil in November 2018. The practice had stopped doing them, so she was referred by a Leicester city centre sexual health clinic. After months of calling them, she was told they didn’t fit coils for heavy bleeding and Diane would have to go back to her GP.

Her doctor was able to locate a long-acting contraceptive practice in Leicester in spring 2019. However, it had a six month waiting list.

Diane received a hormonal coil in October 2019. It made a big difference.

‘I felt so much better and I’ve not had a proper heavy period since,’ she says. ‘But nobody should have to face delays like that.’