SKIP AHEAD. . .
What is a copper IUD?
The copper IUD (brand name ParaGard in the United States) is a long acting reversible contraceptive (LARC) without hormones. That was a mouthful, let’s break it down. The copper IUD is a small T-shaped piece of plastic with copper coiled around it, which is inserted into the uterus, where it can stay for up to 10-12 years, depending on the model (1). That means that for up to 10-12 years, the IUD is over 99% effective at preventing pregnancy. And while it lasts for over a decade, you can have it taken out at any time. (But you must go to your provider! You can’t insert or remove it on your own)
how does it work?
The copper IUD prevents pregnancy in a few ways by creating a hostile environment for sperm. By emitting copper ions, the IUD alters the cervical fluid, creating a spermicide of sorts (2). So before the sperm even get to the uterus, many are killed. If sperm swim through this first barrier, the IUD has another line of defense.
The copper IUD causes inflammation in the endometrium, or lining of the uterus, because the body recognizes the copper ions and the T shaped device as a foreign body (1). Basically the body says “this doesn’t belong here” and sets off an inflammatory response which includes white blood cells called leukocytes. When sperm, which the body also recognizes as foreign, come along the leukocytes are already there waiting to attack the little swimmers (2). Researchers also think that, if all else fails and the sperm meets the egg, the fertilized egg won’t be able to implant in the inflamed uterus wall (2).
The copper IUD, like all LARCs, eliminates the inevitable user-error that comes along with other methods like the pill or condoms, so its effectiveness is with what experts call “typical use” is just as high as “perfect use”. There’s no remembering to take it at the same time everyday, or drunk, heat of the moment slip-ups. That being said, LARCs do NOT protect against STIs/STDs. And it is possible for the IUD to move out of place. When the IUD is inserted, you will notice that there are some strings that chill out in your vaginal canal. These strings help you to check that your IUD is in the right place. If you notice your strings are missing, or something feels off, get in touch with your provider.
Non-hormonal Birth Control
Among all the LARC options, the copper IUD stands out because it doesn’t contain any hormones. If your body doesn’t jive with hormones, you prefer non-hormonal methods, or you are chest/breastfeeding, the copper IUD is an option to consider.
Non-hormonal birth control doesn’t disrupt ovulation, so the ovary still releases eggs. Some people love this because ovulation, and the menstrual cycle’s accompanying hormones like progesterone, has benefits like building and maintaining strong bones (3). Yes, you read that right–your period does have benefits!
While rare, it is possible for your body to not react well to copper. So, if at any point something in your body feels off, remember you know best, and check in with your provider.
How is the copper IUD inserted? What can I expect?
IUD insertion is a non-surgical procedure that takes less than 5 minutes. Learn more here! To make insertion easier, providers often recommend patients schedule their IUD insertion during their period, which is when your cervix is most open. Further, this confirms, or nearly eliminates the possibility that you are pregnant. Providers will ask you to perform a urine pregnancy test regardless of the time of your menstrual cycle if you have sex with a person/people with penises. Pregnancy testing is important as an extra precaution because the IUD cannot be inserted when a person is pregnant.
Often, providers require an STI/STD test before insertion, and if there is a positive diagnosis, also require treatment (4). This is because, if STIs/STDs are untreated, there is a risk for pelvic inflammatory disease (PID), which can be worsened by the copper IUD (5). Some providers will still insert the IUD if there is a diagnosis the same day, though it depends on provider policy. If you’re only able to make one appointment, because hey, we’re all super busy and carving out time to get this done is already hard enough, it’s useful to call ahead and confirm. You can also take an at-home STI test ahead of time to have a sense of where you are at, and share the info with your provider.
A provider will begin by inserting a speculum into the vaginal canal, cleaning the vagina and cervix with an antiseptic, and measuring the depth of the uterus (4). Then the IUD is inserted using a thin plastic tube. The IUD is folded inside the tube, and when the tube is inserted through the cervix, and into the back of the uterus, a plunger pushes it out of the tube and into place. The clinician then removes the tube, and trims the strings attached to the IUD so they extend 2 to 3 centimeters into the vagina. Every month or so, you can insert your fingers into your vagina to feel for the strings to ensure the IUD remains in place. Most doctors have their patients come back for a follow-up to make sure the IUD is still in place 4-6 weeks after insertion.
Ok, but does it hurt? Yes, yes it does. Uterus-bearers report that the pain is mild to moderate, similar to menstrual cramps (4). You can expect cramping during and after insertion, and some folx experience dizziness and/or nausea. Hear what our community had to say about their insertion process here.
Providers often recommend taking around-the-clock NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin or ibuprofen 24 to 48 hours before the scheduled procedure. This reduces the hormone prostaglandin, which is responsible for the cramping and pain (4). After insertion, NSAIDs can also be used to manage pain.
If you are at risk for increased pain, such as if you have had a very painful IUD insertion in the past or need cervical dilation, your provider may recommend local anesthetic or sedation during insertion (4).
What happens to my period?
The copper IUD is not without its drawbacks. You will likely experience more pain, such as more severe cramps or back aches and significantly heavier bleeding than you normally do; for many uterus-bearers, these symptoms subside within a year, though this is not the case for everyone (6). Some people experience longer periods as well as spotting between periods (6). If you have heavy or painful periods, or a disease like endometriosis, the copper IUD may not be right for you. Further, heavy bleeding can worsen or potentially lead to anemia, or iron deficiency (7).
If you’re experiencing these symptoms and want to keep the IUD, talk to your provider.
The copper IUD can be used for emergency contraception?!
We know you’ve probably heard of Plan B for emergency contraception, but have you heard about the copper IUD? The copper IUD can be inserted up to five days after unprotected sex, and it is more effective than the pills like Plan B (8). You can keep the IUD to prevent future mishaps if you’d like, or you can schedule a provider to remove it.
Getting a copper IUD requires a visit with a medical provider. Obv, appointments can be hard to come by on short term notice, so your provider may be unable to perform this procedure in time. Not all providers are informed about this use (UGH), so it’s a good idea to call ahead to confirm they are willing to provide this service and have the copper IUD in stock. Learn more about emergency contraception with our ultimate guide!
Who are good candidates for the copper IUD?
If you have pelvic inflammatory disease (PID), endometriosis, cervical or endometrial cancer, large fibroids, experience painful or very heavy periods, we recommend you discuss other options with your healthcare provider. Additionally, if you have a copper allergy, Wilson’s disease, or a bleeding disorder, other LARCs may be better options (9).
With that being said, most uterus-bearers can safely use the copper IUD for birth control. If you are chest/breastfeeding, have not had a child or abortion within the past three months, you are good to go too!
What are the risks associated with the Copper IUD?
Serious complications are very rare, but it’s important that you’re fully informed of their potential.
During insertion, bacteria could be introduced to the uterus and result in an infection. Standard sterile procedure is very effective for preventing this complication (9).
The IUD can be expelled partially, or even fully, out of the uterus, which would require a provider to remove it. The IUD can also migrate and perforate into the uterine wall, which would require surgical removal (9).
Though the copper IUD is highly effective, if you do become pregnant you are at a higher risk for developing an ectopic pregnancy, which is outside of the uterus, and can be dangerous to you and the fetus (9). Doctors will typically advise removing the IUD if you become pregnant.
It is also possible for you to experience an increase in Bacterial Vaginosis infections.
Written by: Pam Rutherford
Medically reviewed by: Heather Bartos, MD
All content found on this Website, including: text, images, audio, or other formats, was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
1. “Non-Hormonal IUDs.” Planned Parenthood. Accessed September 16, 2019. https://www.plannedparenthood.org/learn/birth-control/iud/non-hormonal-copper-iud.
2. Higginbotham, Victoria. “Copper Intrauterine Device (IUD).” Embryo Project Encyclopedia, July 5, 2018. https://embryo.asu.edu/pages/copper-intrauterine-device-iud.
3. Seifert-Klauss, Vanadin, and Jerilynn C. Prior. “Progesterone and Bone: Actions Promoting Bone Health in Women.” Journal of Osteoporosis 2010 (2010): 1–18. https://doi.org/10.4061/2010/845180.
4. “Women’s Health Care Physicians.” American College of Obstetricians and Gynecologists. Accessed September 16, 2019. https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/LARC-Video-Series?IsMobileSet=false#iudpain.
5. Kennedy, Sara. “IUDs, STIs, and PID: What’s the Deal?” Bedsider. Accessed September 16, 2019. https://www.bedsider.org/features/272-iuds-stis-and-pid-what-s-the-deal.
6. Hubacher, David, Pai-Lien Chen, and Sola Park. “Side Effects from the Copper IUD: Do They Decrease over Time?” Contraception. U.S. National Library of Medicine, May 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702765/.
7. Sivin, Irving. “Utility and Drawbacks of Continuous Use of a Copper T IUD for 20 Years.” Contraception 75, no. 6 (June 2007). https://doi.org/10.1016/j.contraception.2007.01.016.
8. “Copper IUD as EC.” Beyond the Pill. University of California San Francisco . Accessed September 16, 2019. https://beyondthepill.ucsf.edu/copper-iud-ec.
9. “Is the IUD Safe?: See If the IUD Is Right For You.” Planned Parenthood. Accessed September 16, 2019. https://www.plannedparenthood.org/learn/birth-control/iud/how-safe-is-the-iud.