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, but that’s less effective than other methods, so avoid using it as your primary method of birth control, Dweck said.
There are other pills for postcoital contraception, including Ella, which contains the drug ulipristal rather than levonorgestrel and requires a prescription. It's thought to be more effective than levonorgestrel, including for people who weigh more, but it could also be less reliable if you’re above a certain weight.
How to choose the right birth control for you
There was a lot of trial and error involved in my decision to avoid hormonal contraceptives.
For one, after eight years on the Pill, I wanted to see what my body would feel like without any supplemental hormones. My stomach issues cleared up immediately, which did not feel coincidental. I needed to find an alternative since I do not want children right now but knew nothing about the other options. When I was 18 and first inquiring about birth control, I don’t remember IUDs being mentioned at all.
“This is not your grandma's IUD,” Dweck said. She told me that some women accompany their daughters on a visit to help them choose birth control and think that IUDs are more of an option for people who have already had children.
“That is no longer the case,” Dweck said. “We in the OB-GYN world consider IUDs perfectly appropriate for somebody who has not had children yet, but we choose the right IUD based on their individual circumstance.”
Most people who have had a history of breast cancer or some other forms of precancer will not be candidates for hormonal birth control, including hormonal IUDs. There are other rare nuances, like genetic bleeding disorders, that might put someone at a higher risk of developing a blood clot, in which case nonhormonal contraception in general would also be best.
Those who have very heavy or crampy periods would not be ideal candidates for the copper IUD since it can exacerbate those symptoms, she said. Wilson disease is a rare condition that prevents people from properly metabolizing copper, so Dweck said that a copper IUD is not recommended for those individuals.
When I eventually started seeing someone in June 2020, I decided I needed to find another birth control option ASAP. I tried the patch since my OB-GYN thought ingesting the pills might have been contributing to my gastrointestinal problems; after three days of debilitating nausea in my second month, I realized the patch was a problem too and I had to take it off.
Finally, I just went back on the Pill since most doctors I spoke with told me it was unlikely to be affecting my intestinal health. Several months in, my stomach issues were worse than ever. I decided to listen to my body regardless of what anyone said and vowed to find a nonhormonal alternative.
That’s when I learned that the pickings were slim.
There are progesterone-only birth control pills if it’s only estrogen that you need to avoid. The failure rates for these pills are higher if you’re not taking them at the same time each day, which was a deterrent for me, but they're still a valuable estrogen-free option for lots of people, including those who smoke, are lactating, or have high blood pressure.
“Other nonhormonal forms of birth control would be all of your barrier methods, so condoms, spermicides,” Dweck told BuzzFeed News. “There's a new vaginal insert called Phexxi. This is a vaginal gel that's inserted with an applicator before sex. Basically the main ingredient is lactic acid, so it incapacitates sperm because sperm doesn't really like that type of pH.”
I do not have Wilson disease, nor do I have a history of long, crampy, heavy periods. None of these reversible, nonhormonal options are as effective at preventing pregnancy as copper IUDs, so it was an easy choice for me.
Of course, I am not a doctor, and I also know that what’s right for me will not be right for everyone. But as someone with firsthand experience in the world we are currently living in, I felt that it was my duty to debunk some of the rumors that may have prevented you from seriously considering a copper IUD. Do with this information what you will.