copper iud copper iud intrauterine device (iud) with copper(shortly called cu-t), also known as intrauterine coil or copper coil, is a type of intrauterine device which contains copper. it is used for birth control and emergency contraception within five days of unprotected sex. it is one of the most effective forms of birth control with a one-year failure rate around 0.7%. the device is placed in the uterus and lasts up to twelve years. it may be used by women of all ages regardless of whether or not they have had children. following removal, fertility quickly returns. this article is about non-hormone-based iuds. for hormone-based, see hormonal iuds. copper iudphoto of a common iud (paragard t 380a)backgroundtypeintrauterinefirst use1970strade namescopper-t, paragard, othersahfs/drugs.comfda professional drug informationfailure rates (first year)perfect use0.6%typical use0.8%usageduration effect5–12+ yearsreversibilityrapiduser reminderscheck thread position after each period. have removed shortly after menopause, if not before.clinic reviewannuallyadvantages and disadvantagessti protectionnoperiodsmay be heavier and more painfulbenefitsunnecessary to take any daily action.emergency contraception if inserted within 5 daysriskssmall risk of pid in first 20 days following insertion. rarely, uterine perforation. side effects may be heavy menstrual periods, and/or rarely the device may come out. it is less recommended for people at high risk of sexually transmitted infections as it may increase the risk of pelvic inflammatory disease in the first three weeks after insertion. it is recommended for people who don't tolerate or hardly tolerate hormonal contraceptives. if a woman becomes pregnant with an iud in place removal is recommended. very rarely, uterine perforation may occur during insertion if not done properly. the copper iud is a type of long-acting reversible birth control. it primarily works by killing the sperm. the copper iud came into medical use in the 1970s. it is on the world health organization's list of essential medicines. they are used by more than 170 million women globally. medical uses copper iuds are a form of long-acting reversible contraception and are one of the most effective forms of birth control available. the type of frame and amount of copper can affect the effectiveness of different copper iud models. the failure rates for different models vary between 0.1 and 2.2% after 1 year of use. the t-shaped models with a surface area of 380 mm² of copper have the lowest failure rates. the tcu 380a (paragard) has a one-year failure rate of 0.8% and a cumulative 12-year failure rate of 2.2%. over 12 years of use, the models with less surface area of copper have higher failure rates. the tcu 220a has a 12-year failure rate of 5.8%. the frameless gynefix has a failure rate of less than 1% per year. worldwide, older iud models with lower effectiveness rates are no longer produced. unlike other forms of reversible contraception, the typical use failure rate and the perfect use failure rate for the copper iuds are the same because the iud does not depend on user action. a 2008 review of the available t-shaped copper iuds recommended that the tcu 380a and the tcu 280s be used as the first choice for copper iuds because those two models have the lowest failure rates and the longest lifespans. the effectiveness of the copper iud (failure rate of 0.8%) is comparable to tubal sterilization (failure rate of 0.5%) for the first year. however, the effects of the copper iud are reversible, which can be viewed as either an advantage or a disadvantage, depending on a person's goals for contraception. emergency contraception it was first discovered in 1976 that the copper iud could be used as a form of emergency contraception (ec). the copper iud is the most effective form of emergency contraception. it is more effective than the hormonal ec pills currently available. the pregnancy rate among those using the copper iud for ec is 0.09%. it can be used for ec up to five days after the act of unprotected sex and does not decrease in effectiveness during the five days. an additional advantage of using the copper iud for emergency contraception is that it can be used as a form of birth control for 10–12 years after insertion. removal and return to fertility removal of the copper iud should also be performed by a qualified medical practitioner. fertility has been shown to return to previous levels quickly after removal of the device. one study found that the median amount of time from removal to planned pregnancy was three months for those women using the tcu 380ag. side effects expulsion: sometimes, the copper iud can be spontaneously expelled from the uterus. expulsion rates can range from 2.2% to 11.4% of users from the first year to the 10th year. the tcu380a may have lower rates of expulsion than other models. unusual vaginal discharge, cramping or pain, spotting between periods, postcoital (after sex) spotting, dyspareunia, or the absence or lengthening of the strings can be signs of a possible expulsion. if expulsion occurs, the woman is not protected against pregnancy. if an iud with copper is inserted after an expulsion has occurred, the risk of re-expulsion has been estimated in one study to be approximately one third of cases after one year. magnetic resonance imaging (mri) may cause dislocation of a copper iud, and it is therefore recommended to check the location of the iud both before and after mri. transvaginal ultrasonography showing a perforated copper iud as a hyperechoic (rendered as bright) line at right, 3 centimeters away from the uterus at left. the iud is surrounded by a hypoechoic (dark) foreign-body granuloma. perforation: very rarely, the iud can move through the wall of the uterus. risk of perforation is mostly determined by the skill of the practitioner performing the insertion. for experienced medical practitioners, the risk of perforation is 1 per 1,000 insertions or less. it is recommended to consult an obstetrician/gynecologist, who has the equipment to properly insert the iud and check that it does not move during the months following insertion. infection: the insertion of a copper iud poses a transient risk of pelvic inflammatory disease (pid) in the first 21 days after insertion. however, it is a small risk and is attributable to preexisting gonorrhea or chlamydia infection at the time of insertion, and not to the iud itself. proper infection prevention procedures have little or no effect on the course of gonorrhea or chlamydia infections but are important in helping protect both clients and providers from infection in general. such infection prevention practices include washing hands and then putting on gloves, cleaning the cervix and vagina, making minimal contact with non-sterile surfaces (using a no-touch insertion technique), and, after the procedure, washing hands again and then processing instruments. the device itself carries no increased risk of pid beyond the time of insertion. cramping: some women can feel cramping during the iud insertion process and immediately after as a result of cervix dilation during insertion. taking nsaids before the procedure often reduces discomfort, as the use of a local anaesthetic. misoprostol 6 to 12 hrs before insertion can help with cervical dilation. some women may have cramps for 1 to 2 weeks following insertion. heavier periods: the copper iud may increase the amount of blood flow during a woman's menstrual periods. on average, menstrual blood loss may increase by 20–50% after insertion of a copper-t iud; this symptom may clear up for some women after 3 to 6 months. irregular bleeding and spotting: for some women, the copper iud may cause spotting between periods during the first 3 to 6 months after insertion. transvaginal ultrasonography visualizing an iud with copper in the optimal location within the uterus. pregnancy: although rare, if pregnancy does occur with the copper iud in place there can be side effects. the risk of ectopic pregnancy to a woman using an iud is lower than the risk of ectopic pregnancy to a woman using no form of birth control. however, of pregnancies that do occur during iud use, a higher than expected percentage (3–4%) are ectopic. if pregnancy occurs with the iud in place there is a higher risk of miscarriage or early delivery. if this occurs and the iud strings are visible, the iud should be removed immediately by a clinician. although the dalkon shield iud was associated with septic abortions (infections associated with miscarriage), other brands of iud are not. iuds are also not associated with birth defects. some barrier contraceptives protect against stis. hormonal contraceptives reduce the risk of developing pelvic inflammatory disease (pid), a serious complication of certain stis. iuds, by contrast, do not protect against stis or pid. copper toxicity: there exists anecdotal evidence linking copper iuds to cases of copper toxicity. contraindications a category 3 condition indicates conditions where the theoretical or proven risks usually outweigh the advantages of inserting a copper iud. a category 4 condition indicates conditions that represent an unacceptable health risk if a copper iud is inserted. women should not use a copper iud if they: (category 4) are pregnant or think they may be pregnant have certain uterine abnormalities have malignant gestational trophoblastic disease have or may have an sti have or may have had a pelvic infection within the past three months have pelvic tuberculosis have unexplained abnormal vaginal bleeding have untreated cervical cancer have uterine cancer having a septic pregnancy or abortion (category 3) are postpartum between 48 hours and 4 weeks (increased iud expulsion rate with delayed postpartum insertion). the cdc and who criteria differ in their recommendation for women postpartum between 48 hours and 4 weeks. the cdc does not list this as a contraindication. have aids (unless clinically well on anti-retroviral therapy) have benign gestational trophoblastic disease have ovarian cancer have very high individual likelihood of exposure to gonorrhea or chlamydial stis a full list of contraindications can be found in the world health organization (who) medical eligibility criteria for contraceptive use and the centers for disease control and prevention (cdc) united states medical eligibility criteria for contraceptive use. being a nulliparous women (women who have never given birth) is not a contraindication for iud use. iuds are safe and acceptable even in young nulliparous women. the same is likely the case for virgin women, unless there is a microperforate hymen that obstructs any insertion of the iud. device description there are a number of models of copper iuds available around the world. most copper devices consist of a plastic core that is wrapped in a copper wire. many of the devices have a t-shape similar to the hormonal iud. however, there are "frameless" copper iuds available as well. paragard is the only model currently available in the united states. at least three copper iud models are available in canada, two of which are slimmer t-shape versions used for women who have not had children. early copper iuds had copper around only the vertical stem, but more recent models have copper sleeves wrapped around the horizontal arms as well, increasing effectiveness. some newer models also contain a silver core instead of a plastic core to delay copper fragmentation as well as increase the lifespan of the device. the lifespan of the devices range from 3 years to 10 years; however, some studies have demonstrated that the tcu 380a may be effective through 12 years. its atc code is g02ba (who). insertion the copper iud must be inserted by a qualified medical practitioner. it is recommended to consult an obstetrician/gynecologist, who has the equipment to properly insert the iud and check that it does not move during the months following insertion. a copper iud can be inserted at any phase of the menstrual cycle, but the optimal time is right after the menstrual period when the cervix is softest and the woman is least likely to be pregnant. the insertion process generally takes five minutes or less. the procedure can cause cramping or be painful for some women. before placement of an iud, a medical history and physical examination by a medical professional is useful to check for any contraindications or concerns. it is also recommended by some clinicians that patients be tested for gonorrhea and chlamydia, as these two infections increase the risk of contracting pelvic inflammatory disease shortly after insertion. immediately prior to insertion, the clinician will perform a pelvic exam to determine the position of