The Copper IUD: When hormone-free doesn’t mean side effect-free

Analysis·By Anne Marie Williams, RN, BSN

Even Cosmopolitan has joined the growing chorus of media voices — like the Washington Post and the New York Times — in admitting that women are increasingly ditching hormonal birth control, though they can’t seem to agree on the reasons why. But what are they turning to for family planning instead?

As women ditch the pill, many are turning to LARC

A growing but overall relatively small percentage of women are relying on fertility awareness methods. But, according to data from the National Health and Nutrition Examination Survey (NHANES, 1999–2016) and the National Survey for Family Growth (NSFG, 2006-2017), even as hormonal birth control use is declining, uptake of long-acting reversible contraception (LARC) is on the rise.

This is not by accident. For years, the Centers for Disease Control and Prevention (CDC) has urged primary care doctors, pediatricians, and OB/GYNs to promote long-acting, “set it and forget it” LARC, including IUDs and the arm implant. The American College of Obstetricians and Gynecologists (ACOG), the professional organization of OB/GYNs, emphasizes LARC as a cornerstone of teen pregnancy prevention.

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The overturn of Roe v. Wade kicked LARC advocacy into high gear

The push to get women on LARC has only accelerated in the wake of the overturning of Roe v. Wade, with ready access to abortion decreased in some states. Primary care doctors in particular were encouraged to “add contraception to your health maintenance template, optimize contraception prescriptions to minimize contraceptive failure… [and] sign up for long-acting reversible contraceptive training.”

By the data, this push has been relatively successful. A December 2023 National Health Statistics Report from the CDC reported that “The percentage of women who had ever used the IUD in 2015–2019 (21.4%) was almost three times the percentage in 2006–2010 (7.7%).” Simultaneously, a 2022 study, “Trends in Oral Contraceptive and Intrauterine Device Use among Reproductive-aged Women in the US from 1999 to 2017,” found that from 2006-2017, oral contraceptive use decreased 4.4% annually.

Some women believe the copper IUD is more natural, safer than hormonal contraception

Live Action News has reported extensively on the significant health concerns associated with hormonal birth control use, and these concerns generally extend to the Levonorgestrel IUD (LNG-IUD), also known as the hormonal IUD. Women who are ready to ditch any and all forms of hormonal contraception may turn instead to the copper IUD, known by the brand name Paragard, believing that hormone-free means side effect-free.

But is it true that hormone-free means the copper IUD is more natural, and therefore safer? Here are the copper IUD-specific side effects women should know about.

How does the copper IUD prevent pregnancy?

The hormonal IUD is a small T-shaped plastic device wrapped in a copper coil that continuously releases copper into the uterus. According to the full prescribing information, “Paragard works by preventing sperm from reaching the egg, preventing sperm from fertilizing the egg, or possibly preventing attachment (implantation) in the uterus. Paragard does not stop your ovaries from making an egg (ovulating) each month.” They’re considered effective for up to 10 years.

General IUD side effects

Risks associated with either type of IUD include:

Perforation (puncture or penetration) of the uterus or a nearby organ by the IUD, which may cause severe bleeding
Accidental expulsion, where the IUD falls out
Infection

These side effects are rare, but an FDA-funded study published in the Lancet in 2022 found that perforation was much more likely to occur than previously assumed. Risks were highest for women who had IUDs placed in the first few months postpartum.

Expulsion risk is also highest for newly postpartum women. In a 2018 systematic review and meta-analysis, IUD placement within 10 minutes after birth had a 10% expulsion rate, within 10 minutes to 4 weeks postpartum had a 29.7% expulsion rate, and after 4 weeks had a 1.9% risk.

Additionally, because both LNG- IUDs and copper-IUDs function differently from other types of contraception and are not designed to prevent ovulation, they may function as abortifacients in very early pregnancies, as Live Action News previously described.

Side effects specific to copper IUDs

Copper IUD users are more likely to experience heavier periods, painful periods, spotting between periods, and even continuous bleeding, and these risks have long been known. Thousands of lawsuits alleging internal breakage of the Paragard IUD have been consolidated into multidistrict litigation (MDL) and are set to go to trial in 2025.

Paragard users may also be at higher risk of developing bacterial vaginosis, which increases risk of contracting sexually transmitted infections.

Can copper IUDs cause copper toxicity?

Women with certain health conditions should not have a copper IUD inserted, according to Healthline, because of the possibility of copper poisoning or copper toxicity (buildup of excess copper in the body). These conditions include Wilson’s disease, liver disease, hepatitis, anemia (low red blood cell count, which may occur as a result of heavy periods from the Paragard), thyroid issues, leukemia, lymphoma, and rheumatoid arthritis.

No large-scale research to date has definitively linked copper IUDs to copper toxicity in the general population. And yet some women do experience signs of copper toxicity while using the copper IUD, including headaches, fatigue, nausea, depression, irritability, cravings, mood swings, and brain fog. Natural Womanhood, where I serve as the Managing Editor, has shared multiple women’s stories of problems with the copper IUD, including devastating mental health effects.

In January 2025, NW profiled the tragic case of Army midwife Krista Labbe. In late 2023, Labbe tragically took her life after experiencing psychosis attributed by both her family and an expert to copper toxicity. Labbe had four copper IUDs inserted in just 8 years, and her psychosis may have been triggered by repeated “copper bursts” — known to occur shortly after copper IUD insertion.

The bottom line

As women increasingly abandon hormonal contraception, particularly the pill, they deserve to be informed of the risks that copper IUDs may pose to their health. After all, hormone-free doesn’t mean risk-free.

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