If you’re considering a copper IUD, you likely have questions. Here’s everything you need to know about this birth control method.

The copper IUD is a long lasting, nonhormonal birth control placed into the uterus by a doctor, explains Kecia Gaither, MD, MPH, FACOG, double board certified in OB-GYN and maternal fetal medicine and the director of perinatal services at NYC Health + Hospitals/Lincoln.

ParaGard — which is the only brand that currently manufactures copper IUDS — is a plastic T-shaped device that’s about the size of a quarter.

Unlike hormonal IUDs, ParaGard is wrapped with a coil of copper which prevents pregnancy.

How does it work?

The copper stops sperm from meeting an egg in a few different ways, says Felice Gersh, MD, author of “PCOS SOS: A Gynecologist’s Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness.”

“What it comes down to is that copper creates a toxic environment for the sperm,” says Dr. Gersh.

The copper releases copper ions locally, which changes the lining of the uterus and the makeup of the cervical mucus, she says. Both of which make the environment less hospitable to the little swimmers.

Sperm is repelled by copper, so the copper ions also change the swimming pattern of the sperm.

“As the sperm nears the uterus, the copper causes it to change direction and swim away from the uterus,” says Gersh.

“Copper also changes the natural microbiome of the vagina, which again, makes the environment less optimal for sperm survival,” she adds.

How is it inserted?

First, a healthcare professional will insert a speculum into your vagina with the help of lubricant.

Your doctor will then prepare the IUD device by folding the “T” arms down into the IUD tube. Then they will place the IUD tube through the cervix into the uterus.

When they remove the tube, the arms will release into place.

All IUDs have a string that hangs down from the uterus into the vagina — your doctor will snip the string so it’s no more than an inch (ortwo) long.

This process usually takes less than 5 minutes.

How long does it take your body to adjust?

Many people experience cramping for a few hours to a few days after insertion. “Inserting an IUD requires opening the cervix and some cramping is a common reaction to that,” says Gersh.

This cramping is more common in folks who experience cramping leading up to or during their menstrual cycle.

The most common side effect of the copper IUD is heavier and longer periods — especially the first 3 to 6 months after insertion, says Dr. Gaither.

Other side effects include:

  • spotting
  • irregular bleeding
  • increased or worsened cramping

“Because copper causes an inflammatory response in the body, and period cramps are a symptom of inflammation, the copper IUD can also worsen cramps,” says Gersh.

Copper IUDs are highly effective at preventing unwanted pregnancy. Within the first year of use, it’s over 99 percent effective. By the 10th year, it’s closer to 98 percent effective.

Depending on the type of insurance coverage you have, a copper IUD can either be completely covered by your plan or can cost up to $1,300 out of pocket.

If you can’t afford the cost, are over 18 years old, and have a gross annual income at or below 200 percent of the poverty guideline, check out the ParaGard Patient Assistance Program, which will provide you with the copper IUD for free.

You can also reach out to your local health department, clinic, or Planned Parenthood to discuss your options. Many locations offer services at a sliding scale.

As with any type of birth control method, there are various benefits and risks to weigh before deciding if a copper IUD is right for you.

Potential benefits

The copper IUD’s main benefit is that it majorly reduces the risk of unwanted pregnancy without the use of hormones.

“There are a number of reasons someone might want to avoid using a birth control method with hormones,” says Gersh.

With a nonhormonal contraceptive, you can still have a regular menstrual cycle, which is the fifth vital sign for uterus owners, according to The American College of Obstetricians and Gynecologists.

Nonhormonal options also allow you to avoid hormones, which have been linked to several symptoms.

This includes:

  • reduced interest in sex
  • nausea
  • mood swings
  • sore breasts

Gersh adds that because copper IUDs are nonhormonal, they pose no risk to your bone and ligament health.

Potential complications

“Complications with the copper IUD are rare but possible,” says Alyssa Dweck, MD, OB-GYN, author of “The Complete A to Z for Your V” and INTIMINA sexual health expert. These include:

Perforation

This is when the IUD punctures the uterine wall, which occurs in about 1 in 1,000 insertions.

Symptoms of perforation include:

  • pelvic or lower abdominal pain
  • fever
  • severe bleeding
  • nausea
  • vomiting

Expulsion

Expulsion occurs when the IUD falls out of the uterus, either partially or fully. When this happens, it needs to be removed entirely so a new one can be inserted.

Symptoms of expulsion include:

  • severe cramping
  • heavy bleeding

Infection

This is more rare, but if infection happens with an IUD, it could reach the uterus or pelvis and cause scar tissue that can lead to fertility issues down the line, says Dr. Dweck.

Symptoms of infection include:

  • abdominal pain
  • discharge
  • pain during penetration
  • pain during urination
  • fever

“[This] is why IUD-havers are advised to use condoms and barriers to prevent STI transmission,” she says.

They’re not for everyone

People with active pelvic infections cannot have an IUD inserted. Those with abnormalities of the uterus such as fibroids may want to avoid IUDs, depending on the degree of the abnormality.

Anyone with a copper allergy, intolerance, or a copper metabolism disorder called Wilson’s disease should also avoid getting a copper IUD.

Aside from that, “The copper IUD has an excellent safety profile for most uterus owners,” says Dweck.

Both the nonhormonal copper IUD and hormonal IUD are very effective at preventing pregnancy.

Neither protects against the transmission of sexually transmitted infections (STIs).

Ultimately, which option is right for you comes down to whether you have other menstrual symptoms you’re trying to solve. If you do, you may prefer a hormonal IUD.

If you don’t feel comfortable adding synthetic hormones into your body, the nonhormonal copper IUD is an effective option that comes without the symptoms of hormonal IUDs.

A copper IUD is not permanent, but it’s currently approved for up to 10 years in the United States.

If you decide you want to remove it for any reason before the decade is up, a healthcare professional can take it out. At that point, your fertility goes back to what it was before the IUD was inserted.

Copper IUDs are associated with heavy bleeding, particularly in the first 3 to 6 months after insertion. After 6 months, many people find that their periods return to their pre-IUD state.

If your bleeding is heavy or happening at other times in your cycle, talk to your healthcare professional. Your doctor may need to evaluate if there’s another underlying cause that needs to be addressed.

IUD removal is quick and easy. Your doctor will grasp the IUD’s string with a medical instrument to pull it down. As they pull, the arms of the device will be drawn upward, making exertion smooth.

“It literally takes just a few seconds,” says Gersh.

Occasionally, the string will be too short to grab, or it will be up in the uterus. In that case, your doctor will use a smaller medical tool to reach it.

“If the patient can’t tolerate the discomfort of getting the string with a hook, then you would have to do a hysteroscopy, which is an invasive procedure that involves anesthetics… but this is very, very rare,” says Gersh.

If you want something you can mostly set and forget, talk to a doctor about your options for IUDs or other long-term contraception. They can answer any questions you may have and advise you on next steps.

If you try a copper IUD and later decide that it isn’t for you, you can meet with your provider to have it removed. You can then work with your doctor to find another birth control method that better suits your needs.


Gabrielle Kassel is a New York-based sex and wellness writer and CrossFit Level 1 Trainer. She’s become a morning person, tested over 200 vibrators, and eaten, drunk, and brushed with charcoal — all in the name of journalism. In her free time, she can be found reading self-help books and romance novels, bench-pressing, or pole dancing. Follow her on Instagram.