The Pros and Cons of the Copper IUD (ParaGard)

Copper IUD or ParaguardThe copper IUD or coil (ParaGard) is a non-hormonal method of birth control. Its main advantage over hormonal methods is that it contains no contraceptive drugs and permits natural ovulatory cycles.

Pros of the copper IUD:

The copper IUD permits normal, healthy ovulation, and that’s good because ovulation is how women make hormones.

👉 Read The secret powers of ovulation (it’s not just for making a baby).

It is highly effective, with a failure rate of just 0.6 percent.

After insertion, you don’t need to do anything or take anything, and it can last up to ten years.

Fertility returns to normal as soon as you remove it.

It’s the most popular method of birth control in the world.

It has the highest rate of user satisfaction of any method.

It is suitable for women of any age, including teenagers and women who have not yet had children.

It’s effective as emergency contraception.

Cons of the copper IUD:

You might have to pay. The device costs about $150 (one-time cost), but your insurance may cover it.

Insertion can be painful. To manage pain, your doctor may use a local or general anesthetic or ask you to take a painkiller before your appointment. One woman described IUD insertion this way:

“It’s like a PAP smear test but a little weirder and more uncomfortable.”

IUD insertion is an in-office procedure that takes just a few minutes—not surgery.

It may cause cramping for a couple of weeks after insertion and more pain with your periods. More than 30 percent of IUD users report more period pain at first but then find that it reduces over twelve months.

It will probably make periods heavier and could cause spotting between periods. Copper IUDs increase flow by 20–50 percent for the first 12 months after insertion. Heavy flow can be managed with ibuprofen and natural treatments.

It’s bad for the vaginal microbiome and doubles the risk of bacterial vaginosis.

It might come out. The risk of expulsion is highest during the first month following insertion (5.7 percent), then decreases to 2 percent per year. Signs of expulsion include pain, spotting, and the absence or lengthening of the string. A new “frameless” IUD called GyneFix (available in Europe) is easier to insert and has a lower risk of expulsion.

It might cause pelvic inflammatory disease (PID), but only if you have a pre-existing infection with gonorrhea or chlamydia. That’s why your doctor should screen for those common conditions before inserting an IUD.

Dark memory of the Dalkon Shield. A poorly designed IUD in the 1970s caused 18 deaths and thousands of complications for its 2.8 million users. The problem was the string of that particular IUD, which was multifilament and grew bacteria. Modern IUDs have a safer design and carry no significant risk of infection.

It carries a small risk of uterine perforation, which could lead to surgery. Perforation occurs in 0.1 percent of users (1/1000) but is more likely if you are breastfeeding.

It might cause copper excess. The amount of copper potentially released from a copper IUD is small compared to the amount we obtain from foods such as dark chocolate. Nevertheless, some IUD users report anxiety and attribute it to possible copper toxicity. There’s very little research (like so many things in women’s health), but one study did find that IUD users have higher serum copper compared to non-users.  Copper excess is more likely to be a problem if you are deficient in zinc, so your doctor may want to test your zinc and copper levels before inserting an IUD. Users of hormonal birth control also have higher serum copper because synthetic estrogen causes the body to retain copper. (IUD-induced anxiety could also be a vagal nerve response to the IUD or the string.)

If and when you want it out, you will need to see your doctor. Officially, you should not attempt to remove an IUD yourself. In practice, many women do successfully manage self-removal, and one study found “little health risk from a woman removing her own intrauterine device”.  The authors point out that IUDs would be more popular if women had the agency to remove them without seeing a doctor.

Your partner might feel the string but probably won’t.

An IUD cannot protect against STIs (sexually transmitted infections).

The bottom line about the copper IUD or ParaGard

The copper IUD does not contain contraceptive drugs or suppress hormones and is one of the few non-hormonal birth control methods currently available.

Next, read The pros and cons of hormonal IUDs.

Dr Lara Briden

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