Copper IUD pros and cons – is it right for you?

24th November, 2022 • 14 min read

The copper intrauterine device (IUD) is a type of long-term birth control (contraception). Also known as a non-hormonal IUD, coil or loop, it can be used for emergency contraception, too.

In the US, research suggests that about 14% of contraceptive users aged 15 to 44 use an IUD (including both copper and hormonal IUDs). “Women who use IUDs for contraception tend to stick with them, as rates of satisfaction are high,” says Dr Adiele Hoffman, family doctor and Healthily expert.

With this vote of confidence from women, we want to make sure you get a chance to have an informed discussion with your healthcare provider, if it sounds like something that could work for you.

So if you’ve ever wondered about the pros and cons of a copper IUD, read on to find out more – including how it works, whether having it inserted hurts, if you can feel it when you’re having sex, how easy it is to remove, and whether you can still get pregnant.

What is the copper IUD?

A copper, or non-hormonal, IUD is a small, T-shaped device that can be fitted inside your womb (uterus) to prevent pregnancy. No longer than a paperclip, it’s made from flexible plastic and copper.

It also has 2 plastic strings that hang out of the neck of your womb (cervix) into your vagina, so you can check it’s in place – and to help remove it when the time comes.

Paragard is the only copper IUD licensed for use in the US.

Copper IUD pros and cons

“As with all forms of contraception, the non-hormonal IUD has pros and cons,” says Dr Adiele. “Keep reading to find out more information that will help you add your personal pros and cons to this list.”

Pros

  • more than 99% effective in preventing pregnancy
  • offers convenient, long-term birth control – once it’s fitted, you don’t have to think about contraception for up to 10 years (depending on your type of IUD)
  • quickly reversible – once it’s removed, you can try for a baby straight away
  • doesn’t contain any hormones – which can be useful if you want or need to avoid hormones (due to a medical condition, for example)
  • can be used whether you’re a teenager or adult woman, whether or not you’ve had had children
  • cost-effective in the longer term – there’s no cost after it’s been inserted
  • may protect you against cervical cancer
  • very effective form of emergency contraception

Cons

  • possibility of side effects – it can cause changes to your
    periods
    , including heavier, longer or irregular periods, more or worse cramps, or spotting between periods. These are more common in the first 3 to 6 months, and usually get better with time
  • can’t be used if you have a copper allergy
  • could be less cost-effective if you’re planning to have a baby in the near future – the initial cost is higher than other types of contraception
  • doesn’t protect against
    sexually transmitted infections (STIs)
    condoms
    are the only type of contraception that does this
  • not suitable if you have certain health conditions – including an unusually shaped womb, an STI, active pelvic infection,
    fibroids
    or unexplained vaginal bleeding

How does a copper IUD work?

Copper has a contraceptive effect because it changes the way sperm swim, so they can’t fertilize an egg.

The copper can also stop a fertilized egg from embedding (implanting) into your womb.

IUDs don’t end a pregnancy, like an

abortion
does – they stop pregnancy from happening in the first place, by preventing fertilization and implantation.

How effective is it?

An IUD can be as effective as sterilization, but without the surgery – and it’s quickly reversible, too.

“While it is possible to get pregnant with an IUD in place, this happens in less than 1 in 100 cases,” says Dr Adiele. “There’s less chance of things going wrong, as you don’t have to remember to take a pill or use a condom – or worry about a condom splitting.”

How does it work as emergency contraception?

An IUD can be used for emergency contraception if it’s inserted within 5 days of unprotected sex (sex without using effective contraception).

It’s the most effective form of emergency contraception, at more than 99% – higher than the

morning-after pill
.

It’s also a good option if you want long-term contraception afterwards.

How much does a copper IUD cost?

In the US, getting an IUD can cost up to $1,300. But it can last for up to 10 years with no annual costs, so it could end up saving you money in the longer term.

If you have health insurance, it’s likely that this will cover the costs – the Affordable Care Act (Obamacare) requires most insurers to include birth control, including the copper IUD.

How is the copper IUD different from the hormonal IUD?

There are a few key differences between copper IUDs and hormonal IUDs (such as Mirena), both in how they prevent pregnancy and their side effects.

With a copper IUD:

  • no hormones are released
  • you still have regular periods – though they may be heavier or longer, at least for the first few months
  • it can stay in place for up to 10 years

With a hormonal IUD:

  • hormones are used to prevent pregnancy
  • your periods can change, or even stop altogether
  • you may get other hormonal side effects, such as headaches or breast pain
  • it can stay in place for up to 8 years

Read more about the hormonal IUD.

Copper IUD risks

They’re uncommon, but risks of using a copper IUD include:

  • expulsion – this is when your IUD falls out of your womb. If it happens, it’s usually in the first week or so after it’s inserted. Read more about expulsion
  • perforation – rarely (in up to 2 in 1,000 insertions), an IUD can make a hole in your womb. Read more about perforation
  • pelvic inflammatory disease (PID)
    – an IUD itself doesn’t cause PID, but having an IUD inserted when you have an untreated STI can increase the risk of developing PID
  • an increased risk of
    ectopic pregnancy
    if you do get pregnant
    – like all contraception, the IUD isn’t 100% effective. And if you do get pregnant, there’s an increased risk of ectopic pregnancy. Although overall the chances of an ectopic pregnancy with an IUD in place are lower than without any contraception at all. Read more about what happens if you get pregnant with an IUD

12 key questions about the copper IUD – answered by a doctor

Dr Adiele Hoffman
answers frequently asked questions about non-hormonal IUDs, to bust some myths and help you think through the pros and cons.

Can I use a copper IUD if I haven’t had a baby?

“Yes, you can – the IUD is suitable for women of all ages (including teenagers), whether or not you’ve had children.

“There’s still a lot of confusion about this because in the past, an IUD was only recommended if you’d had at least one child. But after research findings were published, the advice changed.”

Research shows women who haven’t had a child:

  • find IUDs to be a good form of contraception
  • may report more pain when the IUD is first inserted

Is IUD insertion painful?

“Lots of women worry about having an IUD because they think having it fitted will hurt – and it’s true that some women do report high levels of pain.

“However, women also tend to say that the pain is fleeting – like a short spasm – which then turns into a dull ache for the rest of the day, rather than anything more severe that drags on.”

Here’s what you need to know about IUD insertion:

  • if pain relief hasn’t been mentioned and it’s making you anxious, ask your doctor or nurse about it before the IUD is inserted
  • it should take around 5 minutes to insert the IUD through your vagina and cervix and into your womb
  • you may feel some pain or cramping – this is worse for some people than others
  • the pain usually lasts about 1 to 2 minutes
  • some doctors advise taking painkillers beforehand, such as acetaminophen (
    paracetamol
    ),
    ibuprofen
    or naproxen
  • your doctor can inject a numbing medication (
    local anesthetic
    ) around your cervix to make it more comfortable
  • some research suggests that if you haven’t had children you may have a slightly higher chance of pain or bleeding, but this varies

What other women say about IUD insertion pain:

  • during the procedure – the website
    self.com
    interviewed 17 women about what insertion feels like, and the results were mixed. Comments included: “like a longer, pinchier pap smear”, “it didn't hurt as much as I thought it would”, “uncomfortable, like a cramp”, “definitely the worst pain I’ve ever felt”, “if toothache is a 10, I’d say the pain was an 8” and “the long-term peace of mind far outweighs the few seconds of discomfort”
  • after insertion – a study of 59 women who had an IUD inserted found that 86% needed to take painkillers for cramping symptoms, but only 11-13% needed the medication for more than 5 days
  • recovery – in the
    self.com
    interview, women reported a variety of experiences, ranging from “feeling completely fine and going to work afterwards” to “pretty severe cramps for the first few weeks” and “3 months of terrible periods”. Some reported that conditions such as painful periods and
    polycystic ovary syndrome (PCOS)
    dramatically improved after the first few weeks or months, and that they were very happy with their IUD. The consensus from this snapshot of experiences seems to be: short-term pain for long-term gain

Is IUD removal easy?

“IUD removal should be straightforward. Your doctor or nurse will pull on the string, and the IUD folds together and comes down through your cervix.

“This might cause slight cramping pain for a minute or so, and you may have some light bleeding afterwards. If you’re nervous about the pain, you could take pharmacy painkillers beforehand.

“In a small number of cases, the IUD may not come out as easily, so your healthcare professional may need to use instruments. If this happens, they’ll usually ask if you want the area numbed, so it won’t be painful.

“Rarely, you may need to have a scan to find the IUD, or surgery to remove it. But if this happens, you’ll get the necessary pain management and aftercare.”

Can you feel an IUD during sex?

“After insertion, you shouldn’t be able to feel the IUD itself at all, and nor should your partner. But sometimes your partner may be able to feel the 2 plastic strings that hang down through your cervix into your vagina.

“These are there so you can check if the IUD is still in place, and your doctor or nurse can pull on them to remove the IUD.

“If the strings do get in the way, you can ask your doctor or nurse if they can trim them so they don’t hang down as much. IUD strings also soften over time – usually within 3 months – so they’ll become less noticeable.”

Does the copper IUD cause weight gain?

“This is another myth. The copper IUD isn’t associated with weight gain, and it’s not listed as a side effect.”

Does the copper IUD cause heavier bleeding?

“Yes – but in most cases, this will settle down after a few months. If you’re considering the copper IUD, your doctor will explain that your periods may be heavier, longer or more painful, particularly in the first few months.”

What the research says:

  • in a study of 3,800 women who had copper or hormonal IUDs, those with copper IUDs had more cramping and increased bleeding volume and frequency after 3 months. After 6 months, however, the differences settled down, with copper IUD users having similar levels of cramping pain, and only slightly more bleeding, than those using hormonal IUDs
  • a review of 41 research studies found bleeding was cited as one of the main reasons for a small number of women getting their IUDs removed

Does an IUD affect fertility?

“Having an IUD doesn’t appear to affect your future fertility – after it’s been removed, your fertility should return to what’s normal for you almost immediately.

“Research has found that copper and hormonal IUD users have similar pregnancy rates as non-users, after their devices are removed.”

Can an IUD fall out?

“Known as expulsion, this can happen in a small number of cases – about 1 in 20. It may cause some pain and discomfort, and sometimes cramping and bleeding.

“If your IUD does fall out, don’t try to push it back in. Call your doctor for advice and use another form of contraception, such as a condom, until you decide whether to have it reinserted or try another type of birth control. You may also need to consider emergency contraception.

“It’s important to know that having sex won’t dislodge your IUD. Expulsion is most likely to happen in the first 3 months after insertion.”

It’s also more likely if:

  • you’re under 25 – especially if you’re in your teens
  • you have heavy menstrual bleeding
  • you have an IUD fitted soon after giving birth

Can you use tampons with an IUD?

“It’s fine to use tampons and pads with an IUD – the IUD is in your womb, while a tampon sits in your vagina.”

Can I use a menstrual cup with an IUD?

“Yes, you can. You may have read that a menstrual cup can dislodge an IUD, but there’s no clear evidence that using a cup leads to an increased risk of expulsion. Speak to your doctor for advice if you’re concerned.”

How do I know if my IUD has moved?

“Your IUD moving into a different place could mean a few different things. It could have fallen out (expulsion) into your vagina, which you or your partner might feel or see. Or you may just notice you can’t feel the strings anymore.

“Another possibility is that it’s moved higher up into your womb, so you can’t feel the strings coming out of your cervix. If this has happened, it will still work, but might be a bit trickier to remove when the time comes. Your doctor will also want to check that it’s still in the right place for it to be working.

“More rarely – in up to 2 in 1,000 insertions – an IUD can create a small hole in your womb and move into your pelvis. This is called perforation. It can be more likely if you’re breastfeeding. It doesn’t always cause symptoms, but can be serious and cause symptoms including pain or heavy bleeding that persist for more than a few weeks after insertion, sudden period changes, or pain during sex.

“Not every woman will be able to feel her strings. But if you used to be able to and realize you can’t, see your doctor, who will check if they can see them. If they can’t, they will likely do a

pregnancy test
and try to locate the IUD using an
ultrasound scan
and
X-ray
, if needed.

“If you think your IUD has moved, contact your doctor for advice, do a pregnancy test, and use another type of protection if you don't want to get pregnant.”

What happens if I get pregnant with an IUD?

“It’s very unlikely – a less than 1% chance – but pregnancy is still possible while using an IUD.

“If you do get pregnant, you have a higher risk of an

ectopic pregnancy
– when a fertilized egg implants outside of the womb. This is an emergency, so get urgent medical attention if you have a positive pregnancy test, especially if you have tummy pain or vaginal bleeding.

“If an IUD is kept in place during the pregnancy, there’s a higher risk of second-trimester

miscarriage
, premature delivery, and infection, which can be life-threatening. Removing the IUD reduces these risks, but there’s a small risk of miscarriage after removal.”

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.