Precautions and Warnings With the Copper IUD

Before using the copper IUD, your healthcare provider needs to know your medical history, particularly if you have a history of unexplained vaginal bleeding, an ectopic pregnancy, or uterine cancer. Other precautions for using the copper IUD safely include warnings for women who have an abnormally shaped uterus or a pelvic infection. It is also important to know how to make sure the device is in place.

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to using the copper IUD (ParaGard®) if you have:
  • A history of pelvic inflammatory disease (PID)
  • Had a serious pelvic infection
  • Uterine cancer or cervical cancer
  • Unexplained vaginal bleeding
  • Had an ectopic pregnancy (a "tubal" pregnancy) or are at high risk for an ectopic pregnancy
  • An intrauterine device (IUD) still in place
  • An abnormally shaped uterus or uterine fibroids
  • Any allergies, including to medications, foods, dyes, or preservatives.
Also, let your healthcare provider know if you:
  • Are pregnant or thinking of becoming pregnant
  • Are breastfeeding
  • Have recently had a baby.
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Specific Copper IUD Precautions and Warnings

Some warnings and precautions to be aware of prior to using this contraceptive include the following:
  • Although pregnancy is quite rare in women using the copper IUD, pregnancies that occur with an IUD in place are more likely to be ectopic (occur outside the uterus). These pregnancies cannot survive, often require surgery, and can result in permanent damage that can lead to infertility. Be watchful for any signs of ectopic pregnancy, such as severe abdominal (stomach) pain accompanied by unusual vaginal bleeding. You should not use the copper IUD if you have ever had an ectopic pregnancy or if your healthcare provider feels that you are at risk for an ectopic pregnancy.
  • For pregnancies that are not ectopic (otherwise normal pregnancies within the uterus), problems can occur. Leaving the copper IUD in place increases the risk for miscarriages, premature birth, and severe infection. Removal of the device is recommended, but this can also result in a miscarriage (see ParaGard and Pregnancy for more information).
  • In rare cases, the insertion of the copper IUD can cause a serious infection. Let your healthcare provider know immediately if you develop severe pain within hours after the insertion of the device, as immediate treatment is essential.
  • Intrauterine devices (IUDs), such as the copper IUD, may increase the risk of pelvic inflammatory disease (PID), a condition that can increase the risk of ectopic pregnancies and infertility.
  • It is common and normal for the copper IUD to cause heavier and longer periods, especially for the first few months. In some cases, bleeding may be severe enough or bothersome enough to require removal of the device.
  • It is possible for the copper IUD to become embedded in the uterus. This can make it more difficult to remove. Sometimes, surgical removal might be required.
  • It is possible for the copper IUD to perforate the uterus. This usually happens during insertion. It can be severe enough to require surgery and can cause serious problems. The risk of perforation is higher if the device is inserted during the first month after childbirth; instead, it should be inserted either immediately after delivery or more than a month after birth.
  • The copper IUD can accidentally come out. This usually happens within the first few months. If this goes unnoticed, unintentional pregnancy may occur. It is a good idea to check to make sure it is in place (by feeling for the threads) at least once a month.
  • You should not use the copper IUD if you have Wilson's disease, a rare genetic condition that affects copper excretion in the body.

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Last reviewed by: Kristi Monson, PharmD
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