Expected Side Effects of Intrauterine Copper Contraceptive
The main side effects of copper intrauterine devices (Cu-IUDs) include increased menstrual bleeding, longer menstrual periods, and cramping, particularly during the first few months after insertion. 1, 2
Common Side Effects
Menstrual Changes
- Heavier and longer periods: The copper T 380A IUD typically causes increased menstrual bleeding, which may continue even with long-term use 2
- Spotting between periods: Intermenstrual spotting can occur, especially in the first few months 3
- Cramping and pain: Users may experience more menstrual cramping, particularly during the first few cycles 3
Insertion-Related Effects
- Discomfort during insertion: Most women experience some pain or discomfort during the IUD placement procedure 4
- Post-insertion cramping: Cramping and spotting commonly occur during the first few weeks after insertion 4
Side Effect Patterns Over Time
Research shows that many side effects follow specific patterns:
- During menstrual periods, most bleeding and pain side effects tend to decrease over time 3
- During intermenstrual intervals, overall spotting and pain complaints may remain unchanged, but the number of days with these problems can increase 3
Less Common Side Effects
- Expulsion: Occasionally, the IUD may slip partially out of the uterus or be expelled entirely, most commonly in the first few months 4
- Thread issues: The thin plastic thread that extends through the cervix may occasionally cause discomfort to partners during intercourse
Important Considerations
Effectiveness
Despite these side effects, copper IUDs are highly effective with a typical failure rate of only 0.8%, making them one of the most reliable contraceptive methods available 1
Duration of Use
The copper IUD may remain in place for up to 10 years, providing long-term contraception without requiring daily, weekly, or monthly attention 4
Who Should Exercise Caution
Copper IUDs may not be ideal for women who:
- Already have heavy menstrual bleeding
- Have a history of anemia
- Have certain pelvic infections or conditions
- Are at increased risk of ectopic pregnancy 4
Management of Side Effects
For women experiencing troublesome bleeding or pain with copper IUDs:
- NSAIDs may help manage pain but show inconsistent results for reducing bleeding 5
- Vitamin B1 has shown some promise in reducing the number of pads used per day and fewer bleeding days compared to placebo (low-certainty evidence) 5
- Mefenamic acid may result in less blood loss compared to tranexamic acid (low-certainty evidence) 5
Important Clinical Insight
Interestingly, research suggests that women who report heavy menstrual bleeding before IUD insertion are not at significantly increased risk for early discontinuation of copper IUDs 6. This indicates that pre-existing heavy menstruation should not necessarily disqualify women from choosing this contraceptive method.