Copper IUDs (intrauterine devices) are a safe and effective type of birth control. It works by preventing sperm from fertilizing any eggs. Learn more about how to determine whether it’s right for you.

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 is the only brand currently manufacturing copper IUDs. They are plastic T-shaped devices about the size of a quarter.

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

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 stops sperm from meeting an egg in a few different ways, explains 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,” said Gersh.

She explains that the copper releases copper ions locally, which changes the lining of the uterus and the makeup of the cervical mucus — both of which make the environment less hospitable to sperm.

Copper repels sperm. The copper ions 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,” said Gersh.

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

How is it inserted?

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

A doctor then prepares the IUD device by folding down the “T” arms into the IUD tube. Then, they place the IUD tube through the cervix into the uterus.

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

All IUDs have a string that hangs down from the uterus into the vagina. A doctor will snip the string so it’s no more than an inch (or two) 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,” said Gersh.

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

How effective is a copper IUD?

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

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

Depending on the type of insurance coverage you have, a copper IUD can either be completely covered by your plan or cost up to $1,800 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% 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 on a sliding scale.

As with any type of birth control method, there are various benefits and risks to weigh before deciding whether 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,” said Gersh.

She 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,” said Alyssa Dweck, MD, OB-GYN, author of “The Complete A to Z for Your V.” These include:

  • Perforation: This is when the IUD punctures the uterine wall, which occurs in about 1 in 1,000 insertions and can lead to severe bleeding.
  • Expulsion: This 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.
  • Infection: This is rarer, 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 Dweck.

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 disease should also avoid getting a copper IUD.

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

A copper IUD is not permanent, but it’s currently approved for use 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.

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

“It literally takes just a few seconds,” said 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 you want something you can mostly set and forget, talk with 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 it’s not for you, you can meet with a healthcare professional to have it removed. You can then work with a doctor to find another birth control method that better suits your needs.