The Pros and Cons of the Copper IUD (ParaGard)

Copper IUD or Paraguard

The 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 therefore permits natural, ovulatory cycles.

Pros of the copper IUD:

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

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

It’s more effective than almost any other method, with a failure rate of just 0.6 percent.

After insertion, you don’t need to do anything or take anything, and it lasts 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 now officially deemed 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 itself 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 may simply 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—it’s not surgery.

The cramping may continue for a couple of weeks after insertion, and then you may experience more pain with your periods. More than 30 percent of IUD-users report more period pain at first, but then say it reduces over 12 months.

Your periods will probably be heavier, and you might experience spotting between periods. Copper IUDs increase flow by 20–50 percent for the first 12 months after insertion. Periods then return to normal in some women, but not all. Heavy flow can be managed with ibuprofen or the herbal medicine turmeric. Read How to treat heavy periods with diet and natural progesterone.

It’s bad for the vaginal microbiome and doubles the risk of bacterial vaginosis, which causes a fishy-smelling vaginal discharge.

It might come out. Risk of expulsion is highest in the first month after insertion (5.7 percent), and then decreases to 2 percent per year. If it comes out, and you don’t realize, then you could become pregnant. 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 badly 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 but for a different reason. 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. In theory, you cannot remove it yourself, but actually many women do successfully manage self-removal, and one study found “little health risk from a woman removing her own intrauterine device”.  The authors go on to say that IUDs would be more popular if women had the control to remove it themselves.

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

It doesn’t 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 available non-hormonal methods of birth control.

Dr Lara Briden

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