Photo via Shutterstock
Copper IUD Illustration
The copper IUD, Paragard, is wrapped in a copper coil and about the height of a strawberry. Spoiler alert: It's not purple.
Though it’s been around for more than 30 years, the copper IUD is getting buzz of late among millennials and Gen Z-ers, who tend to lean toward natural health care treatments and are curious about hormone-free birth control. Steering clear of hormones was top of mind for me—a health-conscious Gen Z-er—as I started my own contraceptive search a few months ago. (My existing hormones are quite the fun ride and I’m not looking to pump more through my body, thank you very much.)
Paragard is the only copper IUD approved in the U.S. (actually the only IUD that’s been FDA-approved for that long). There are a handful of IUDs on the market—Mirena, Skyla, Kyleena—that use hormones to thicken cervical mucus and thin the uterine lining, preventing sperm from reaching eggs. Mirena has the highest dose and is effective for six years, Skyla and Kyleena offer lower doses of progestin, but are shorter-acting.
“After the IUD is inserted, it sits inside the uterus and slowly releases copper, which helps to prevent pregnancy,” says Dr. Amy Hertz, OB-GYN at Allina Health’s Eagan Women’s Health Clinic. The IUD’s copper exterior produces a toxic inflammatory reaction in sperm and eggs.
For me, the copper IUD checks a multitude of boxes in the BC realm. Hormone-free? Yup. Therefore, nixing side effects like weight gain, acne, and increased (shall we say) emotionality. Minimal maintenance? Lasting up to 10 years, my doctor refers to this as the “get it and forget it” option. And what really counts: Paragard is more than 99 percent effective.
The pill, too, has an effectiveness rate of 99 percent, but that’s if taken perfectly—every day, never forgetting. The reality is that “typical use” of the pill renders it about 91 percent effective.
What to Expect (and What I Wasn’t Expecting)
When I was doing my research not long ago, I had a lot of questions and, thankfully, I had trusted friends I could tap. Despite all their advice and honesty, I still spent the first few months after my procedure wondering every few days if something was wrong with me or my IUD.
So, lady to lady, let’s talk about what to expect.
I tapped local OB-GYNs for FAQs and expectations so you don’t spend 10 minutes frantically googling your symptoms in the bathroom, in the hopes that someone, somewhere will say what you’re experiencing is normal.
The procedure is, in a word, uncomfortable. It’s not the worst thing ever and if you’ve had a pap smear, you know what you’re signing up for. But alas, that’s just the beginning.
Like the other IUDs on the market, Paragard is a T shape, which is how it stays put in the uterus, and is about the height of a strawberry. When inserted, those little T arms held against the middle rod are opened in the uterus. “And, boy, is that crampy,” says Dr. Matthew Bigos, OB-GYN at OBGYN West.
Medical professionals will tell you to pop a couple Ibuprofen before your appointment to help with the cramping during and right after the procedure. I can’t say that it helped all that much, but I also wouldn’t tell you to skip the Ibuprofen. I walked out of my appointment feeling fine, as if I had just had a regular check-up.
And then, it hit me like a two-by-four.
I drove myself (mistake number one—it’s imperative to assign a driver, y’all!) to my early morning appointment and had to drive myself home. Longest 20 minutes of my life. I have never white knuckled the steering wheel so hard—and not because of traffic or an ice-snow-combo. It was a blackout-inducing, paralyzing kind of full-body pain. I think of myself as having a pretty high pain tolerance and I used to think I had bad cramps (pre-IUD). HA!
Friends, do not think you will work or go to the gym or meet up with your beau for at least 12 to 24 hours after your appointment. I did these things and let me tell you. Consider the day a wash and lay in bed, taking hefty (yet safe!) amounts of Ibuprofen, eating rice, and bingeing Gilmore Girls. The very last thing you want to do three hours after getting your IUD is hop on a Zoom.
That cramping can persist for a few days and up to a week, Bigos and Hertz say. “I usually describe it to my patients as cramping associated with a pretty rough menstrual cycle,” Bigos says. “They're going to be pretty strong and pretty intense, at least for the first couple of days.”
Ibuprofen or another nonsteroidal anti-inflammatory works well to quell the pain. I also found that moderate exercise improved my pain and reduce cramping—that’s not a medical recommendation, but a little movement could help (especially if your body is used to frequent exercise).
"Because of the heavier periods the copper IUD can cause, it’s often not the best choice for women who already have very heavy periods." —Dr. Amy Hertz, Allina Health
For women who have given birth, the cramping may be less severe, Bigos says, because their uterus has expanded around a growing baby and is more flexible.
Light bleeding (AKA spotting) is very normal after insertion, Hertz says, and could last for even a few months as your body adjusts.
The good news around all this insertion pain is that Paragard lasts for up to 10 years. And—and—taking it out is relatively painless (whew!). A doctor pulls on those strings, the arms collapse, and the IUD slides out. (If you’re not careful checking your strings, it is possible to dislodge the IUD by tugging at those strings yourself—but please do see a medical professional to get it safely removed.)
The First Six Months
The standard adjustment time for an IUD is about six months. In that time, expect varied cycles and heavier bleeding, plus more intense cramping. Those first two to three months drag on like a Minnesota January, and it seems as if your body will never adjust, and your symptoms and pain will never improve. Trust me, things will improve—and suddenly you’ll realize that you’ve reached somewhat normal again.
“One study that looked at a year of bleeding diaries of women with the copper IUD found that most women had 16 days of bleeding or less in the first month after placement,” Hertz says. “This seemed to balance out after the first few months and by the six-month mark, the average reported bleeding time was five to six days per month, with most women reporting about eight days.” Those numbers continued to be similar over the next six months as well, she notes.
Though some doctors hold that there are no long-term significant changes to a woman’s cycle, many women experience changes that endure for the duration of the IUD’s use. “Because of the heavier periods the copper IUD can cause, it’s often not the best choice for women who already have very heavy periods,” Hertz says.
Expect your cycle to be one to four days longer and heavier, especially for a few months after insertion, Bigos says. If you have a four- or five-day cycle, five to seven days of heavier flow would be totally normal. (Hear that, ladies. Totally normal!)
“Most women are going to continue to have heavier, more crampy cycles throughout the time that their copper is in,” he says. “For some women it does settle down and their cycles are close to what they were before, but almost to a T based off of the way that this works, … you’re going to have heavier, crampier cycles. And that is pretty much the only drawback to this form of birth control.”
"There’s two people who are the loudest about their experience. The person who it changed their life for the better is going to tell everyone about it. And the person who had a bad experience is going to tell everyone else about it." —Dr. Matthew Bigos, OBGYN West
How heavy is too heavy?
The short answer: “If you’re soaking through multiple pads or tampons each hour, you’re feeling lightheaded or dizzy, or even if you just feel like this bleeding seems like too much for you to handle, then it’s a good idea to reach out to your doctor,” Hertz says.
If the pain and cramping you experience initially doesn’t subside, go back to your doc. “Significantly heavy bleeding should prompt you to come back and see me,” Bigos says. “If you check your own strings and you’re not having pain, you’re fine. But pain or not being able to feel your strings should prompt you to come and see me.”
Bottom line: don’t be shy with your doc, he says. “Not normal for you should prompt you to call the doctor because if you’re concerned that your bleeding is too heavy, I want to hear about it.”
Bleeding (even daily!) for a few months after insertion is within the realm of possibility, Hertz says, but watch for bleeding outside your period several months after insertion, as this could be cause for concern. “If anything doesn’t seem right to you, reach out to your provider for help—it’s what we’re here for,” she says.
What can go wrong?
Now, for the cringe-inducing potential complications: perforation, expulsion, fracture, and the very slight chance of pregnancy. These hitches are very rare, but good to be aware of—even just to rule them out as your body adjusts.
- Perforation is when the IUD breaks the uterine wall (ouch!). Usually, Bigos says, women who experience perforation have significant pain during placement, “well outside the realm of normal.”
- Expulsions (when the IUD essentially falls out) are a little mysterious. “Most women have no clue and they just all of a sudden say, ‘I can’t feel my strings,’” Bigos says. Doctors recommend periodically checking for the two thin, short strings just outside your cervix. If you can’t feel them, your doctor will check the strings. If they can’t feel them either, they can do an ultrasound and X-ray to double check. “And if it’s not there, it fell out,” he says. “It would be surprising, especially seeing the size of them, to think ‘This can fall out me and I not know?’ But unfortunately, it does happen at times.”
- A fractured IUD is another infrequent occurrence. This is when the IUD is broken or cracked upon insertion, removal, or sometime in between—and usually, it’s hard to pinpoint exactly when it was fractured, Bigos says, “but it doesn’t affect the effectiveness of it.” With a fractured IUD, it’s very rare, but sometimes “when you go to take it out, a portion is left behind,” he says, which requires surgery.
- Because no BC is 100 percent effective, there is still a small chance you may get pregnant. “That means 1,000 women with the copper IUD, someone’s going to get pregnant,” Bigos says. “But that’s physicians, what we see, often times, is the unusual—that one percent.”
After placement, doctors will sometimes schedule a follow-up for six weeks later. (This would have been a helpful time to get all my questions addressed. So, take the opportunity or request a follow-up with your provider—even just for your own peace of mind.)
Read the Reviews
Most of us turn to the internet to get the nitty gritty deets on everything from trendy products and new restaurants to medical treatments.
But as you Google around all the potential symptoms, successes, and stories on the copper IUD, remember one fundamental principle of online reviews. “There’s two people who are the loudest about their experience,” Bigos says. “The person who it changed their life for the better is going to tell everyone about it. And the person who had a bad experience is going to tell everyone else about it.”
In most cases, the average Janes—those with an IUD who are relatively happy with it and tolerate the side effects—don’t say anything, he says. “Like if you read a review about a restaurant. You read a five-star review and you read a one-star review and you know the truth is somewhere in the middle.”
