Everything you need to know about copper IUDs

When looking for a birth control method that doesn’t involve hormones, a copper intrauterine device (IUD) is likely to come up as an option.

It might feel like an appealing option because it’s highly effective, works for years without needing daily attention, and can be removed whenever you decide you want to switch up your method of birth control or try to get pregnant. 

But it’s completely normal to have questions before deciding if it’s right for you. Does insertion hurt? Will your periods change? How effective is it? And what happens if you decide you want it removed?

Here’s everything you need to know before choosing a copper IUD.

Key takeaways

• A copper IUD is a hormone-free form of contraception that’s more than 99% effective at preventing pregnancy.
• It can work for up to 10 years (depending on the type) but can be removed at any time.
• Because it doesn’t contain hormones, it won’t cause hormone-related side effects associated with some other contraceptive methods.
• You might notice heavier periods or stronger cramps during the first few months after insertion, although these may improve with time.
• The right contraception is different for everyone. Your doctor can help you decide whether a copper IUD is right for your health, lifestyle, and preferences.

What is a copper IUD?

A copper IUD is a small, T-shaped contraceptive device that sits inside your uterus to help prevent pregnancy.

Unlike hormonal IUDs, it doesn’t release hormones. Instead, it has a small plastic frame wrapped in copper, which is what naturally prevents pregnancy.

In the United States, ParaGard is currently the only copper IUD available, while other countries may offer different brands.

Once inserted, you don’t need to think about it every day. It simply works in the background until it’s time to remove or replace it.

How does a copper IUD work?

Here’s the quick science bit.

The copper on the IUD creates an environment inside the uterus that makes it very difficult for sperm to survive and reach an egg. The copper also makes it harder for sperm to move through the mucus in your cervix and reach the uterus. If sperm can’t fertilize an egg, pregnancy can’t happen.

Because it works without hormones, a copper IUD doesn’t stop ovulation. Most people continue to ovulate and have their normal menstrual cycle while using one.

How effective is a copper IUD?

Copper IUDs are one of the most effective forms of reversible contraception available.

They’re more than 99% effective at preventing pregnancy because, unlike methods that rely on remembering to take a pill or use contraception every time you have sex, there’s very little room for user error once the IUD has been inserted.

It’s also one of the few contraceptive methods that can be used as emergency contraception if inserted within five days after unprotected sex. 

Who might choose a copper IUD?

Some people might choose a copper IUD if they:

• Want long-term contraception without hormones
• Prefer not to take a daily pill
• Can’t or don’t want to use estrogen-containing contraception
• Are breastfeeding
• Want a reversible method that can be removed whenever you choose

That said, it isn’t suitable for everyone. Certain medical conditions may mean another contraceptive method would be a better choice. Your doctor can talk you through your options based on your individual health.

What are the benefits of a copper IUD?

For many people, the biggest benefit is its simplicity. Once it’s in place, you don’t have to remember anything each day or before sex.

A copper IUD offers several key benefits:

• It’s a highly effective pregnancy prevention method.
• It’s hormone-free.
• It works for up to 10 years (depending on the device).
• Your fertility can return quickly after removal.
• It’s suitable while breastfeeding.
• It can also be used as emergency contraception if inserted within five days of unprotected sex.

Some people also like knowing that because it doesn’t contain hormones, it won’t cause hormone-related side effects such as breast tenderness, mood changes, or headaches that some people experience with hormonal contraception.

Does getting a copper IUD inserted hurt?

This is probably one of the biggest questions people have. The honest answer is that everyone’s experience is different.

Some people describe insertion as feeling like a few strong period cramps that last a minute or two. Others experience more intense discomfort, while some find it much easier than they expected.

The procedure itself usually takes around 10 to 15 minutes. If you would like to, you can talk to your doctor about your pain relief options beforehand. These might include over-the-counter pain relief or a local anesthetic.  Afterward, it’s common to have cramping similar to period pain for a few hours or a couple of days. Over-the-counter pain relief, rest, and a heating pad are often enough to help manage this.

Some people return to work right away, while others prefer to take the rest of the day easy. Either option is completely normal.

What side effects can a copper IUD cause?

Copper IUDs can have side effects, particularly during the first few months after insertion. Some of the most common include:

• Stronger period cramps
• Heavier periods
• Spotting between periods
• Irregular bleeding while your body adjusts
• Cramping after insertion

These changes may gradually improve over the first three to six months as the uterus adjusts to the IUD. However, some people continue to have heavier periods while using a copper IUD. If your periods are already particularly heavy or painful, it’s worth discussing this with your doctor before choosing this method.

If your pain is severe, you develop a fever, have unusually heavy bleeding, or you’re worried that something doesn’t feel right, contact your healthcare provider.

Can a copper IUD move or fall out?

It’s uncommon, but it can happen. Occasionally, an IUD can partially or completely slip out of the uterus. This is known as expulsion, and it’s most likely to happen during the first few months after insertion or during your period. 

Your doctor will usually show you how to check the IUD strings. If the strings suddenly feel much longer or shorter than usual, or you can’t feel them at all, arrange an appointment to have the IUD checked.

In most cases, if the IUD stays in the correct position, you won’t notice it’s there.

Can a copper IUD perforate the uterus?

Perforation, where the IUD passes through the wall of the uterus, is rare, but it can happen during insertion. The risk is around 1 to 2 cases for every 1,000 insertions. In some cases, the IUD may become embedded in the wall of the uterus, while in very rare cases, it can pass all the way through it.

The risk of perforation is higher if you’re breastfeeding at the time of insertion.

If perforation does happen, you may experience sudden, crampy pain during or shortly after the IUD is inserted. You may also notice changes to your menstrual cycle, ongoing bleeding for several weeks, or that the IUD strings are no longer visible or can’t be felt.

If your doctor suspects that the IUD may have moved through the uterine wall, they can arrange an ultrasound to check its position. If perforation is confirmed, you’ll be referred to a specialist for further care.

While you’re waiting to be seen, use a barrier method of contraception, such as condoms, as the IUD may no longer be providing effective contraception.

Can your partner feel a copper IUD during sex?

Usually, no. The IUD itself sits inside the uterus, so neither you nor your partner should feel it during sex.

The thin strings extend through the cervix into the vagina so your doctor can remove the IUD later. Occasionally, a partner may notice the strings, particularly soon after insertion, but they usually soften over time. If the strings are causing discomfort, your doctor can often trim them.

What happens if you get pregnant with a copper IUD?

Pregnancy with a copper IUD is rare because it’s such an effective method of contraception. If you think you might be pregnant, contact your doctor as soon as possible.

Your doctor will usually recommend removing the IUD if it can be done safely. This can help reduce the risk of infection and other pregnancy complications.

What happens when a copper IUD is removed?

Removing a copper IUD is usually quicker and easier than inserting one. Your doctor gently pulls on the strings, and the arms of the device fold up as it’s removed. Most people experience only brief cramping during the process.

One of the advantages of the copper IUD is that fertility returns very quickly. If you want to become pregnant, you can start trying as soon as it’s been removed.

How much does a copper IUD cost?

The cost depends on where you live, your healthcare provider, and whether your health insurance covers the procedure. Some insurance plans cover both the device and insertion in full, while others require you to pay part of the cost. If you’re unsure, your doctor’s office or your insurance provider can usually explain exactly what’s covered before your appointment.

The bottom line

A copper IUD is one of the most effective hormone-free contraceptive options available. For many people, it’s a ”fit-and-forget” method that provides years of reliable pregnancy prevention without the need for daily pills or hormones.

Like every form of contraception, though, it isn’t the right choice for everyone. If you’re deciding between a copper IUD and another method, your doctor can help you evaluate the benefits, possible side effects, and what’s likely to suit your body and lifestyle best.

And remember: Every body is different, and a healthcare provider can help navigate the options and determine the best fit for your individual needs.