When you’re ready for an intrauterine device, or IUD, it can feel like an exciting and empowering contraceptive commitment, right? But while you’re dreaming of your new life with an IUD (hello, whole entire years of pregnancy prevention), you also have at least one other major choice to make: copper vs. hormonal IUD.
IUDs are small devices inserted into your uterus, and they’re one of the most reliable forms of long-lasting birth control available. And there are two very different kinds. You could opt for a hormonal IUD like Mirena, Skyla, Liletta, or Kyleena, which all use progestin to thin your uterine lining and thicken your cervical mucus so it’s more difficult for sperm to reach an egg. Or you could go with the copper IUD, manufactured under the name Paragard, instead, which seems a little more mysterious than other forms of birth control. Here’s what you need to know about the copper IUD.
1. The copper IUD changes the environment in your uterus to make it toxic to sperm and eggs.
It sounds like magic, but it’s just science. So, how does the copper IUD work, exactly? Paragard is a plastic, T-shaped device that, like other IUDs, fits snugly inside your uterus. The difference is that while hormonal IUDs emit progestin, Paragard has copper wire coiled around it. That copper produces an inflammatory reaction that interferes with sperm movement, thus preventing pregnancy, according to the Mayo Clinic. You can think of it kind of like a long-lasting spermicide, Brett Worly, M.D., an ob/gyn at the Ohio State University Wexner Medical Center, tells SELF.
2. You can use the copper IUD for pregnancy protection for up to 10 years. (!!!)
In terms of longevity, the copper IUD is the epitome of this “set it and forget it” form of birth control, offering a full decade of pregnancy protection.
3. The copper IUD effectiveness is seriously impressive.
The copper IUD is over 99 percent effective at preventing pregnancy. A 2017 literature review published in Perspectives on Sexual and Reproductive Health looked at birth control failure rates between 2006-2010 and found that IUDs, both hormonal and non-hormonal, have the lowest failure rate of all contraceptive methods. Additionally, earlier research from 2011 shows that the copper IUD fails (meaning people get pregnant while using it) just 0.8 percent of the time. That boils down to fewer than one out of 100 women getting pregnant in the first year of using the copper IUD, which is a pretty excellent success rate.
It makes sense when you think about it. Unlike birth control methods like the pill, you don’t actually have to do anything with your copper IUD besides getting it inserted (and then removed when you should), so the opportunities for user error go way down.
4. The copper IUD doesn’t protect against sexually transmitted infections.
When it comes to birth control, only internal and external condoms can prevent the spread of sexually transmitted infections. So, if you’re using the copper IUD and are at risk for STIs (like if you have partners whose STI status you don’t know), you’ll still need to use some form of protection like condoms or dental dams. You should also get tested regularly. In fact, the CDC has recommendations for your STI screening schedule depending on your circumstances.
5. Your insurance may cover the full cost of the IUD, which is good, since it can be upwards of $1,000.
Depending on your insurance provider, the out-of-pocket copper IUD costs can be up to $1,300, which includes the fees for the device itself and any costs associated with insertion (like that of your visit).
Luckily, many insurance companies currently cover these costs in full, though that may change in the future. Call your insurer or discuss the potential costs with your doctor’s office to be sure.
6. You may not be able to get the copper IUD if you have certain health issues.
Some people aren’t the best candidates for the copper IUD. Those include people who have uterine issues, like large fibroids, that might affect the IUD’s placement. Having an infection like pelvic inflammatory disease (a condition in which sexually transmitted bacteria infects the reproductive organs) is also a contraindication, as is abnormal vaginal bleeding that hasn’t been diagnosed, along with a few other issues. If you have concerns about how the copper IUD might work with your existing medical condition, be honest about it with your doctor. They’ll either be able to reassure you that it should be just fine or help you find a different birth control method that makes more sense for your situation.
7. Insertion can vary from feeling like an uncomfortable pinch to being very painful, but removal is generally a breeze.
During your IUD insertion, your medical practitioner will insert a speculum into your vagina, clean your vagina and cervix, then place the IUD, according to the Mayo Clinic. They do this by putting the device into an applicator tube, pushing the tube into your vagina and through your cervix, then releasing the IUD into your uterus. Once the IUD is in there, its wings will extend so it can assume its T shape, and it will start its pregnancy-preventing ways. Like all IUDs, the copper version has little fishing wire-esque strings that hang down through your cervix.
People can experience a wide range of sensations during IUD insertion. Some have described the process as “[a] few seconds of discomfort,” others like “sharp, intense, nausea-inducing pain.” You can ask your doctor about which pain medication they recommend taking before and after the procedure, since you may experience some residual cramping. Your provider may also be able to offer medications to help your cervix open or to try to numb it instead, although getting those drugs doesn’t necessarily mean you’ll completely bypass any pain or discomfort.
The removal process simply involves your medical practitioner grasping onto your IUD’s strings with forceps, then pulling out the device. As the IUD leaves your body, its arms will fold in. You might experience some light bleeding and cramping during this process and afterward, according to the Mayo Clinic. Once the IUD is out, your fertility should get back to normal pretty much immediately, so if you’re not ready to get pregnant, you’ll either need a new IUD or another form of birth control.
8. After you get the copper IUD, you might have worse periods than before, and this effect may or may not last.
So, let’s talk about possible copper IUD side effects. The copper IUD might increase your period pain and bleeding or cause bleeding between periods, the American College of Obstetricians and Gynecologists (ACOG) says. That’s why it’s not recommended for people with conditions like endometriosis that can already cause heavy and painful periods, Taraneh Shirazian, M.D., assistant professor in the department of obstetrics and gynecology at NYU Langone Medical Center, tells SELF.
Some methods of birth control only seem to make your period worse because they’re not improving it, but the copper IUD can actually drive up bleeding and pain in some people. This is because of the local inflammation it causes in your uterus, Dr. Shirazian says, which can lead to extra irritation and blood.
Everyone is different, and if you experience this copper IUD side effect, it’s hard to predict how long it will last. The good news is that for many people, this issue goes away or at least decreases after using the IUD for a year, ACOG says. If you’re at all concerned about how your period might change with the copper IUD, this is definitely something to bring up with your doctor.
9. The copper IUD is hormone-free.
Since the copper IUD doesn’t contain hormones, you can use it in situations where other kinds of birth control may not be a fit. For instance, it might be a good choice for [breastfeeding people], Dr. Shirazian says. This is because there’s a slight chance that estrogen, which is in forms of combined hormonal birth control like the pill, patch, and ring, may impact your milk supply, according to the ACOG.
Due to its lack of estrogen, the copper IUD may also offer an advantage for some people who have health conditions that can get worse when exposed to this hormone, such as people with a history of blood clots, or high blood pressure (estrogen can raise it further), Dr. Shirazian says.
If you’re not able to tolerate hormones for some reason, definitely mention that to your doctor when trying to find which type of IUD is right for you.
10. Your partner shouldn’t be able to feel your IUD strings during sex, but if they can, you should talk to your doctor.
“Usually your partner cannot feel the strings,” Dr. Worly says. That doesn’t mean this can’t happen, though. It’s also worth mentioning that, if your partner can feel your strings or they appear longer than usual, this could be a sign that your IUD has moved and needs to be adjusted, according to the Mayo Clinic. If your IUD is firmly in place, you can also talk to your medical practitioner about trimming the strings, Dr. Worly says.
11. The risks of expulsion (your IUD coming out) and perforation (your IUD piercing your uterus) are very low, but it does occasionally happen.
IUDs come with a small risk of expulsion, which is when your body starts to push the IUD out of you. There isn’t a ton of research on this out there, but the average expulsion incidence rate is between 2 to 10 percent of users, ACOG says. Risk factors include recently having had the IUD inserted, getting it placed right after childbirth, and history of heavy or prolonged periods, among others. Though you don’t really need to stress about this possibility, if it were to happen to you, you might experience symptoms like bleeding and cramping, feel something hard coming from your cervix, or see the IUD somewhere outside of your body; however, it is possible to experience an expulsion without any major symptoms.
IUDs can also cause perforation, which is when the device pushes through the wall of your uterus. It sounds alarming, but again, the risk is really low. According to a 2015 study published in the journal Conception, out of 61,448 people who had an IUD, only 20 with the copper form experienced a perforation. In fact, perforation most often happens due to an error during placement. Much like with expulsion, this isn’t something that needs to keep you up at night, but if you were dealing with perforation, you would potentially experience pelvic pain (which can be a symptom of a ton of things), though you might not experience any major symptoms at all.
12. You can check the strings periodically, but don’t stress about it.
If you can feel your strings protruding from your cervix, that’s a pretty clear sign your IUD is where it should be. But if you can’t, it’s not a reason to immediately assume you’re dealing with an IUD complication like perforation or expulsion. Over time, the strings often soften and curl up around your cervix, so you might not be able to feel them. (This is another reason why your IUD may be a non-issue during sex.
Even if your ob/gyn doesn’t see the strings when you’re looking to remove your IUD, they can use tools like an ultrasound to find the device, so they’re able to take it out.
13. You can actually use the copper IUD as emergency contraception.
Many people don’t realize this, but the copper IUD is an effective form of emergency contraception as long as it’s inserted within five days after unprotected sex, according to ACOG. A 2012 meta-analysis of published in the journal Human Reproduction looked at 42 studies and found that the copper IUD had a pregnancy rate of only 0.09 percent when it was used as a form of emergency contraception.
“The copper IUD causes inflammation in the uterine lining and may prevent implantation of the developing embryo,” Dr. Worly explains.
Of course, this isn’t necessarily the most convenient form of emergency contraception. If you weren’t planning on getting an IUD, pill-based forms may make more sense for you depending on how easily you’re able to access them vs. an intrauterine device.
If you’re interested in joining the copper IUD club, talk to your doctor.
It might feel like there’s a lot of information to take in about the copper IUD, not to mention all the other [birth control](https://www.self.com/topic/birth-control options at your disposal. If your head is spinning, you don’t have to go it alone—that’s what doctors are for. Or, if you have nary a question and are just really excited to get that thing in there, well, that’s what doctors are for, too.
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