What Is the Paragard IUD? Side Effects, Safety, and Effectiveness

A long-acting, effective, and reversible birth control might sound like a great option to you — something low-maintenance that you can set and forget. If this is the type of birth control you’re looking for, an intrauterine device (IUD) has all of these qualities.

Currently, there are two types of IUDs available: one that slowly releases hormones and one that doesn’t release any hormones. The name of the hormone-free IUD is Paragard. 

In this article, we’ll discuss how the Paragard IUD works, its effectiveness, and what types of side effects are common with it.

What is the Paragard IUD? 

Paragard is a non-oral prescription birth control. It’s a type of IUD that contains copper instead of hormones. The small, T-shaped device has copper wire wrapped around it, and it’s placed in the uterus by a healthcare provider. You have to make an appointment to have the Paragard IUD placed.

How does Paragard work?

The copper on the Paragard IUD is toxic to sperm. When exposed to the copper in Paragard, sperm can’t swim as well and have a harder time reaching an egg to fertilize it. Paragard is also believed to help stop a fertilized egg from implanting in the uterus. These actions help prevent a pregnancy from happening.

Paragard works immediately after having it inserted. So unlike many hormonal birth controls, you don’t need to use any backup protection against pregnancy when it’s first inserted. It can also be used off-label as emergency contraception if it’s placed within 5 days of unprotected sex.

It’s important to note that Paragard doesn’t protect again sexually transmitted infections (STIs). Using condoms is still your best bet for protecting against STIs.

How effective is Paragard?

Paragard is one of the most effective forms of birth control. Less than 1 out of every 100 people who use Paragard get pregnant while using it. This IUD is FDA-approved to prevent pregnancy for up to 10 years. But you can have it removed earlier than that — if you want to — in order to get pregnant.

How is Paragard inserted?

Paragard is inserted into the uterus by a healthcare provider using a thin tube at an office visit. Your healthcare provider will examine your cervix first to make sure it’s safe to place Paragard. You may also have a pregnancy test done at your visit.

Some healthcare providers may give you a numbing agent before inserting Paragard to help prevent pain. You may also be advised to take an over-the-counter pain reliever, like ibuprofen (Advil), about an hour before your appointment. This can help lower the amount of pain or discomfort you may feel afterwards.

After Paragard has been placed, two thin threads will hang out of your cervix a small amount. Your healthcare provider will instruct you how to check for these threads. It’s recommended to self-check for the threads once a month. If there’s ever a time where you can’t locate the threads, or if they feel longer or shorter, contact your healthcare provider. You’ll need to be checked to make sure your IUD is still correctly placed.

What are the side effects of using Paragard?

Because Paragard doesn’t contain hormones, it’s side effects are different from most other birth control methods. Paragard may make your period heavier or last longer and could cause more cramping. These side effects are worse right after having it placed, and usually start to subside after 3 to 6 months.

Some other side effects can include:

• Anemia (a low number of red blood cells)

• Backache

• Pain during sex

• Spotting or breakthrough bleeding

• Vaginitis (swelling of the vagina)

In some cases, Paragard could be pushed out of the uterus. This is called expulsion, and it’s fairly uncommon (happens to about 2% of all people). But if expulsion happens, then you aren’t protected against pregnancy.

Is Paragard safe?

Paragard is considered safe and effective for most people. But it does have some serious warnings to be aware of. Here, we’ll dive deeper into a few of those. But keep in mind that these are rare.

IUD movement

Paragard has a small risk of moving out of place, such as becoming stuck in the wall of the uterus. This can make removing Paragard very difficult. In rare cases, people have needed surgery to have it removed. Paragard could also go through part of the uterus. If this happens, the IUD can move to another area of the body. Be sure to check for Paragard’s threads regularly at home to make sure nothing has changed.

Ectopic pregnancies

If you get pregnant after Paragard is inserted, it could cause an ectopic pregnancy (a pregnancy that starts outside of the uterus). This is a dangerous situation that can affect your future fertility and be life threatening. If you become pregnant while using Paragard, it’s more likely to be ectopic. Contact your healthcare provider immediately if you have Paragard placed and become pregnant.

Pelvic inflammatory disease (PID)

Some people have developed an infection called PID after having IUDs placed. This is because bacteria could enter your uterus during the insertion. In rare cases, PID can become severe enough to require surgery. Because of scarring with infection, PID can also raise your risk of ectopic pregnancies and future infertility.

If you experience lower abdominal pain, unusual vaginal bleeding, or fever while using Paragard, contact your healthcare provider. You shouldn’t have Paragard placed if you currently have PID or an untreated STI. Doing so can put you at a higher risk of developing PID after insertion.

Copper toxicity

Copper toxicity (a harmful build-up of copper in the body) may be another possible risk. But this is likely only a concern if you have a condition called Wilson’s Disease. Wilson’s Disease is a rare genetic condition that causes copper to build up in your body. If you have Wilson’s Disease, you shouldn’t use Paragard. Copper toxicity is very unlikely if you don’t have this condition.

Who shouldn’t use Paragard?

There are certain people who shouldn't use Paragard.

If you’re pregnant or think you may be pregnant, you shouldn't use Paragard. While this IUD can be an option for emergency contraception, it’s not a form of abortion.

Paragard should also be typically avoided if you have:

• An abnormally shaped uterus

• Cervical or uterine cancer

• Pelvic inflammatory disease (PID)

• A serious infection called sepsis that happened after giving birth or after an abortion

• A current STI, like chlamydia or gonorrhea

• Unexplained bleeding from the vagina

• Wilson’s Disease

If you experience severe pain, unusual vaginal bleeding, or you can’t feel Paragard’s threads, contact your healthcare provider right away.

Paragard vs. Mirena: how do they compare?

There are five types of IUDs. Four contain a hormone called levonorgestrel. As mentioned earlier, Paragard is the only IUD available that is hormone-free.

The four available levonorgestrel IUDs are:

• Mirena

• Kyleena

• Liletta

• Skyla

Hormonal IUDs, like Mirena, work differently than Paragard. Like Paragard, hormonal IUDs make it harder for sperm to swim and reach an egg. But unlike Paragard, they also thicken the cervical mucus. This makes it difficult for sperm to enter the uterus in the first place. Mirena also thins the lining of your uterus, making periods lighter and shorter for many women who use it.

All IUDs have to be placed by a healthcare provider in an office. They’re all similarly effective in protecting against pregnancy. But different IUDs protect against pregnancy for a different number of years. Compared to levonorgestrel IUDs, Paragard protects against pregnancy the longest. 

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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