The copper intrauterine device (Paragard) consists of a small, T-shaped piece of plastic with fine copper wire wound around it. After insertion into the uterus by a doctor, the device can remain in place for up to 10 years. The IUD is highly effective in preventing pregnancy. Less than 1 percent of women using an IUD will get pregnant during the first year of use, according to the Centers for Disease Control and Prevention. The copper IUD prevents pregnancy primarily by preventing sperm from reaching and fertilizing a woman's egg. While the copper IUD is a safe form of birth control, side effects are possible -- such as irregular bleeding, infection or displacement of the device.
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Menstrual problems are the most common side effect you might experience after insertion of a copper IUD. You might have longer periods and heavier bleeding, up to 50 percent more blood loss according to the medical text "Clinical Gynecologic Endocrinology and Infertility." Spotting between periods may occur as well. Menstrual cramping and pain increase for some women, and this is often relieved by nonsteroidal antiinflammatory drugs such as aspirin (Bayer, Excedrin), ibuprofen (Advil, Motrin) or naproxen (Aleve). Menstrual side effects are most common and troublesome during the first few months after insertion of the copper IUD and tend to decrease over time.
The copper IUD normally sits with the top of the "T" at the top of the open space inside the uterus. According to the American College of Obstetricians and Gynecologists, the IUD comes out of place during the first year in approximately 2 to 10 percent of women, sometimes becoming completely dislodged and passing from the body through the vagina. This displacement is most likely to occur within the first few months, especially if the IUD is inserted immediately after childbirth. If the device is partially displaced or completely expelled, it is no longer providing protection against unintended pregnancy. Another form of contraception is necessary until you can see your doctor.
The cervix -- the opening of the uterus at the top of the vagina -- normally prevents vaginal bacteria from entering the uterus. But because an IUD is inserted through the cervix, there is a slight risk of infection during the first month because bacteria may be inadvertently introduced into the uterus during the insertion procedure.This can lead to a condition called pelvic inflammatory disease, or PID, which is an infection of the internal female reproductive organs. Left untreated, PID can damage the reproductive system. Beyond the first month, however, the risk of PID is no higher in women with an IUD compared to those without the device.
Perforation and Migration
Partial or total perforation -- puncture of the uterine wall -- may occur during the insertion of the device. Perforation of the uterus is very rare, occurring fewer than 1.5 times out of every 1,000 IUD insertions, according to the U.S. Agency for International Development. While perforation most often occurs during the insertion procedure, it can sometimes occur later. The device may spontaneously migrate over time, perhaps aided by uterine contractions. The IUD might become embedded in the wall of the uterus or slowly migrate completely through the uterine wall. If this happens, the device could possibly damage nearby internal organs.
When to See a Doctor
The copper IUD has two thin strings attached to the lower end that thread through the cervix into the vagina. They are used to remove the device. It's recommended that you check for the strings monthly to ensure the IUD is still in place. If you cannot feel the strings or if you feel the plastic tip of the device, contact your doctor and use another form of birth control until the placement of the device is confirmed.
Contact your doctor if you experience pain in your lower abdomen, fever, abnormal vaginal discharge or pain during sex, all of which might signal PID. Also talk with your doctor if you experience extremely heaving bleeding. If you miss a period and suspect you might be pregnant, see your doctor as soon as possible because women who become pregnant while using an IUD are at increased risk for miscarriage or ectopic pregnancy in which the pregnancy implants outside the uterus.
- Merck Manuals Professional Version: Intrauterine Devices (IUDs)
- American College of Obstetricians and Gynecologists: Practice Bulletin, Long-Acting Reversible Contraception: Implants and Intrauterine Devices
- DailyMed: Paragard T 380A - Copper Intrauterine Device
- Centers for Disease Control and Prevention: U.S. Selected Practice Recommendations for Contraceptive Use, 2013: Adapted From the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition
- Clinical Gynecologic Endocrinology and Infertility, 8th Edition; Marc A. Fritz and Leon Speroff
- Contraception: Side Effects from the Copper IUD: Do They Decrease Over Time?
- U.S. Agency for International Development: IUD Toolkit: Up-to-Date Evidence and Best Practices Related to the Intrauterine Device
- RadioGraphics: Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient Care