Information for the patient

A copper-bearing intrauterine device (IUD) is a small flexible plastic device with a copper wire wrapped around its vertical shaft that is inserted into the uterus through the vagina and cervical canal during a gynaecologic visit to prevent pregnancy.

Some types do not have a plastic frame. Some others also have copper sleeves on the horizontal arms. But all of them have a knotted thread on the vertical shaft that hangs from the cervix towards the vagina to control its position and presence, as well as for its removal.

The copper IUD is an ideal contraceptive method for most women of childbearing age, regardless of whether they have had children, and can be used until menopause is established.

The copper IUD uses one single active and natural ingredient (copper) to prevent pregnancy, and it is a long-lasting contraceptive method.

The mechanism of action of copper IUDs is local and is mainly produced by copper, which is a natural spermicide, so it limits the motility of the spermatozoa, thus preventing it from fertilizing the egg.

Copper IUDs also cause a normal inflammatory reaction in the uterine mucosa that may prevent implantation.

In most cases, a copper IUD can be inserted at any time as long as there is no pregnancy. Usually, it is done during menstruation because the cervical canal is naturally dilated, which facilitates insertion.

The gynaecologist performs an examination to assess the size and position of the uterus and thus determines the appropriate IUD type and size.

Insertion of an IUD is usually painless, although it may cause some discomfort that can be prevented by taking pain killers 30 minutes before insertion.

In the first few months after insertion, changes in menstrual patterns such as heavier and longer bleeding, irregular bleeding, intermenstrual spotting, and increased abdominal and sacral pain during menstruation may occur. These symptoms are normal and tend to subside over time once the body gets used to its presence.

Its removal is usually very simple and fast and can be done at any time with an immediate return to the existing fertility before its use. However, it is convenient to remove it during menstruation because the cervical canal is naturally dilated.

If a new copper IUD is not inserted immediately after removal, contraceptive protection disappears.

Like insertion, removal is usually painless.

Both procedures are performed during a gynaecologic appointment.

• They are a contraceptive method of long duration and low rate of complications
• Women return to previous fertility immediately after removal
• Do not interfere with sexual intercourse, ovulation, or breastfeeding
• Do not contain hormones and do not require rest periods
• Do not cause side effects typical of medicalized devices (hormones)
• May help protect against endometrial or cervical cancer
• Reduce the risk of ectopic pregnancy
• No daily or nightly routines are required. It is enough with a simple monthly auto-check and periodic check-ups with the healthcare provider

The copper IUD has a very low rate of complications. Still, they can happen. Expulsion, pregnancy, uterine or cervical perforation, embedment or certain infections are some of them. Additional medical treatment may be needed if any of these risks or complications occur.

You should always go to your doctor in case of any doubt or sign of an anomaly, especially if:

• You have a lack of menstruation or you could be pregnant
• Post-insertion symptoms worsen
• You have persistent abdominal pain, fever of unknown cause, or unusual or foul-smelling vaginal discharge
• You or your partner feel pain during intercourse
• You notice the thread is too long or you don't notice it, or you notice any other part of the IUD in your self-checks
• You feel itching or hives in genital area

Miscarriage, preterm birth or infection in the rare case that a pregnancy occurs may also happen if the IUD is kept in place during the pregnancy.

The common side effects are related to the changes in bleeding patterns. Prolonged and heavy menstrual bleeding, irregular bleeding, and more cramps and pain during monthly bleeding usually subside after the first few months after the insertion.

Copper IUDs may contribute to anaemia if there is already a low iron blood store before insertion and the IUD causes heavier monthly bleeding.

Remember that:

• The copper IUD does not protect against STIs including HIV
• If you have any questions or concerns, you must contact your doctor
• You must go to your periodic check-ups
• You must perform the self-checks to control the thread of the IUD

There are two threads attached to the bottom of the IUD that sit high up in the vagina. These threads allow your doctor to remove the IUD when necessary, and also you to check that the IUD remains correctly in place, since it is possible for your IUD to slip out or lose its correct position without you to notice it. Therefore, it is important for you to check your threads regularly, and very specially after each menstruation.

• Clean your hands with soap and water
• Either sit or squat
• Insert your index or middle finger into your vagina until you touch the cervix (which should feel firm like the tip of your nose)
• If the threads feel longer or shorter than the last time, or you cannot feel them, it is possible that your IUD may have moved

If you cannot touch the threads, you should check your pads or tampons. Get in touch with your doctor and use a backup birth control method in the meanwhile. If the IUD had been expelled without you having noticed it, contraceptive protection may be impaired.

• Can be used at any time of childbearing age whether or not the woman has had children
• Do not increase the risk of contracting STDs or HIV
• Do not increase the risk of miscarriage when a pregnancy occurs after removal
• Do not produce sterility
• Do not cause birth defect
• Do not cause cancer
• Do not travel to other sites in the body such as the heart or brain
• Do not increase the risk of ectopic pregnancy