One day not long ago, my dad asked me what stories I was working on. When I told him I was writing about copper IUDs, he said, “But aren’t those, like, bad?”
I laughed, only because he was encapsulating the motivation behind this story so perfectly.
My mom had a copper IUD for years after I was born because hormonal birth control caused her to have severe migraines. And yet my father — an educated, open-minded person who cares deeply for the women in his life — was only able to conjure the association that copper IUDs were simply “bad.”
Sure, he’s a straight man in a long-term marriage, so he has generally had the luxury of not paying attention to available birth control methods. However, that way of thinking has long been due for a reset, and the overturning of Roe v. Wade makes it officially defunct.
So this message is for literally everyone: Don’t believe everything you hear about the copper IUD. It’s a good option if you’re looking for a nonhormonal, long-acting, effective, and reversible contraceptive that can also be used for emergency contraception instead of Plan B or other options.
How does a copper IUD work?
An IUD (intrauterine device) is a T-shaped piece of flexible plastic or metal that either releases a small amount of the hormone progestin or is wrapped in a bit of copper.
Copper is used because it can incapacitate sperm, according to Dr. Alyssa Dweck, a board-certified OB-GYN in New York.
Essentially, sperm can’t swim normally when they encounter the IUD, which prevents them from reaching an egg to fertilize in order for pregnancy to occur.
Dweck also said that the copper IUD, like hormonal IUDs, is 99% effective, which is better than birth control pills and many other forms of contraception. (No birth control method except for skipping sex completely is 100% effective.)
Does a copper IUD insertion hurt?
The insertion process is the same for any IUD, though it may vary slightly depending on your practitioner’s procedure. Most prefer to insert the IUD when a patient is menstruating, Dweck said, when they’re most likely not pregnant and the cervix will already be slightly open.
Dweck said her placement involves inserting a speculum into the vagina, and applying a numbing gel on the cervix and lateral vaginal wall. She then uses a type of forceps called a tenaculum to steady the cervix and an instrument known as a cervical dilator to open it up. The IUD is then inserted inside the uterus.
“The applicator is removed and the string is trimmed, and then all those instruments I just talked about are removed, and that’s pretty much it,” Dweck said. “I usually instruct my patients to take some Advil or Motrin or Tylenol 20 minutes prior to the visit, and they can use it after the fact as well as needed. So with different little teeny nuances, that’s the insertion process, and most people do just fine with it.”
You typically have an ultrasound about six to eight weeks after insertion to make sure everything is where it’s supposed to be.
Although you may have heard horror stories about IUD insertions, that wasn’t my experience. My periods around the time of insertion were quite unpredictable, so I was not menstruating when I had mine put in.
The whole process was no more uncomfortable than a regular pap smear. However, your experience depends on your body, pain tolerance, and whether your doctor uses the numbing gel. Ask for the numbing gel.
What are the side effects of a copper IUD?
For some reason, it’s a commonly held assumption that copper IUDs are bad (not just by my dad) and/or significantly worse than hormonal IUDs. When I was thinking about getting mine, nearly everyone tried to talk me out of it. If I hadn’t been so desperate to find a reliable nonhormonal form of contraception, I might have just listened to them and moved on. I’m glad I didn’t.
I did experience some of the known side effects — longer, heavier, crampier periods. However, I knew from researching and consulting with my own doctor that those side effects would likely become less severe over time. And they did.
My first few periods after my copper IUD was placed were much heavier than I’d ever experienced. I won’t sugarcoat it. They sucked. I had never bled that much or had such uncomfortable waves of cramping.
Granted, I’d been on hormonal birth control pills for the majority of my menstruating years, so my periods had been barely there for as long as I could remember. But I just finished my sixth or seventh period PC (post-copper), and it was pretty average (around five or six days of bleeding, two on the heavier side, some light cramping but nothing major).
My cycle has also become extremely regular, like every 28 to 30 days on the dot, which has given me some small comfort. I appreciate predictability. Considering that these IUDs are safe to keep in for 10-plus years, a few months of discomfort seemed well worth the long-term peace of mind.
Studies have shown that many women have similar experiences as mine, so you don’t have to rely on my journey alone to guide you. One monitored the periods and IUD satisfaction of over 70 women through their first six months with the copper IUD and found that, over time, bleeding decreased and satisfaction with the IUD improved.
The only other potential side effects that I could find were universal for any IUD insertion, both hormonal and nonhormonal. Uterine perforation, pelvic inflammatory disease, and other sorts of infections are all possible but extremely rare.
The risk of an ectopic pregnancy — a tubal pregnancy that is life-threatening and requires an immediate abortion — is higher with IUDs than with some other forms of birth control, but the risk of any pregnancy at all with an IUD is so low that they are still very rare. One 2021 study estimated the risk of an ectopic pregnancy among those who had the copper IUD was 0.46 per 1,000 women per year, compared with 6.9 per 1,000 women per year with no contraception or condom use.
Copper IUDs are the most effective form of emergency contraception
Another little-known fact about the copper IUD is that it can also serve as a very reliable contraceptive that can be used after unprotected sex or when another type of birth control fails. While emergency contraception is sometimes referenced with phrases like “morning after” or “day after,” copper IUDs work if placed three to five days after unprotected sex.
As with any emergency contraception, the sooner it’s placed, the better. However, a 2019 study of 134 people who had a copper IUD inserted 6 to 14 days after unprotected sex found that none of them became pregnant.
In a world where abortions and even emergency contraceptives aren’t available to millions of people in the US, we should be screaming this information from the rooftops. There are also other issues with the better-known emergency contraceptives that can be taken orally that may make a copper IUD the better, safer option for some.
For example, a 2014 Canadian safety alert suggested that Plan B and other products are less effective in women weighing 165 to 176 pounds and ineffective in women over 176 pounds. (Just for the record, Plan B and similar over-the-counter products that contain levonorgestrel are just essentially a packaged version of high-dose, regular birth control pills.)
One 2011 study in the journal Contraception found that women with a BMI of 30 or higher who took levonorgestrel as emergency contraception had a pregnancy risk more than four times higher than that of women with a lower BMI. (Someone who is 5’5” tall and weighs 180 pounds would have a BMI of 30.)
Dweck said Plan B may not be absorbed well enough to provide adequate emergency contraception for some women. We reached out to Plan B, which directed us to its FAQ section, which states that “all women, regardless of how much they weigh, can use these products to prevent unintended pregnancy following unprotected sex or contraceptive failure.” The brand considers the data “limited and inconclusive.”
If taken within 72 hours, levonorgestrel-containing emergency contraception should be 75%–89% effective at preventing pregnancy,…