10 Paragard (Copper IUD) Side Effects You Should Know About

The Paragard intrauterine device (IUD) is a long-acting, hormone-free, and reversible birth control device. This copper IUD can be a convenient option for people who want to skip the pill or hormones altogether. However, it still has the potential for side effects. Some can be bothersome but manageable, while others can be more serious.

Since Paragard is hormone-free, you may experience side effects that are different from those you might experience with hormonal birth control options. The IUD also contains copper, which can be a problem for certain women. Here we’ll discuss 10 Paragard side effects and what to do if you experience them.

1. Increased cramping and heavier periods

It’s normal to experience cramping during and after Paragard insertion. For some, cramping resolves quickly. But, for others, this side effect may last for a few weeks.

Paragard can also cause you to have more cramping with periods and make your periods heavier or last longer. These period changes were the most common reason women stopped using Paragard in clinical trials. The good news is that these side effects usually start to improve after 3 to 6 months.

Over-the-counter (OTC) pain relievers may help with cramping from Paragard. These include ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol). Placing a heating pad on your lower belly can also help.

2. Breakthrough bleeding or spotting

In addition to heavier or longer periods, you may notice breakthrough bleeding or spotting with Paragard. This should also improve within 3 to 6 months.

However, bleeding can also be a sign of more serious Paragard side effects. These side effects include IUD movement, infection, and pregnancy outside of the uterus (ectopic pregnancy). Contact your provider right away if your bleeding is accompanied by other symptoms, like pain or fever.

3. Pain during sex

Some women experience pain during sex, called dyspareunia, with Paragard. It’s important to let your healthcare provider know if this happens. Painful sex can be a sign of an infection or of your IUD moving out of place.

4. Back pain

It’s possible you’ll experience back pain with Paragard, especially in the days after the IUD is inserted. Similar to cramping, back pain can be managed with OTC pain relievers and/or a heating pad. And it should also improve over time. However, lower back pain can also be a symptom of an ectopic pregnancy, which is covered later.

5. Vaginitis

Some women develop vaginitis, or inflammation of the vagina, with Paragard. If this happens, you may notice symptoms such as itching or burning, abnormal discharge, or an unpleasant odor. 

In some cases, vaginitis from Paragard may be caused by bacterial vaginosis — a type of bacterial infection. And you may need to take an antibiotic pill, or apply a prescription cream or gel, to treat it. While rare, abnormal odor or discharge can also be symptoms of pelvic inflammatory disease (PID).

Contact your healthcare provider if you notice any changes in vaginal odor or discharge, or if you experience itching or irritation. Your provider can figure out the cause and how to treat it.

6. Anemia

As mentioned above, you may experience heavier periods with Paragard. This increased blood loss every month can heighten your risk of iron-deficiency anemia. This is when your iron levels are low, resulting in fewer red blood cells being made.

If you develop anemia, you may not notice any obvious symptoms. But a few possible signs and symptoms are tiredness or dizziness, headaches, and brittle nails or hair loss.

Let your healthcare provider know if you experience any of these symptoms. If needed, they may have you take iron supplements to get your levels back to normal.

7. IUD expulsion or movement

Although uncommon, IUD expulsion can happen when using Paragard. This is when the IUD is partially or completely pushed out of the uterus. 

There’s also a small risk of the IUD moving and becoming embedded (stuck) in the wall of the uterus. If this happens, it can be difficult to remove and surgery may be required. 

A Paragard IUD can also move to another area of the body if it goes through part of the uterus. IUD movement can cause pain, bleeding, or no symptoms at all.

Two thin threads from the IUD should hang out of your cervix after Paragard is placed. Check for the threads once a month to ensure it’s still in the right place. Your healthcare provider will give you tips about how to check for the threads.

Contact your healthcare provider if you notice the threads feel shorter or longer, or if you can’t feel them at all. You’ll need to be checked to make sure your IUD is still in place and that it hasn’t moved.

Keep in mind: If the IUD moves out of place, you aren’t protected against pregnancy.

8. Ectopic pregnancy

An ectopic pregnancy is a pregnancy that starts outside of the uterus. An ectopic pregnancy can be dangerous and even life-threatening. It can also affect your future fertility.

Paragard works well to prevent pregnancy. But getting pregnant while a Paragard IUD is in place raises the likelihood that the pregnancy will be ectopic. Contact your healthcare provider immediately if you become pregnant while using Paragard. 

Unexpected vaginal bleeding, abdominal pain or cramping, and low back pain may be symptoms of an ectopic pregnancy. Contact your healthcare provider immediately if you have these symptoms.

9. Pelvic inflammatory disease

As discussed earlier, there’s a small risk that a serious infection called pelvic inflammatory disease (PID) could happen after your IUD is placed. That’s because bacteria could enter your uterus during the process. PID is more likely to happen within the first 3 weeks after placement. 

If left untreated, PID can cause scarring of the fallopian tubes. These are the tubes that allow an egg to travel from the ovary to the uterus. This scarring can also raise your risk of ectopic pregnancies and infertility. Symptoms of PID include fever, lower abdominal pain, and unusual vaginal discharge and odor. Contact your healthcare provider if you experience any of these symptoms.

You shouldn’t have Paragard placed if you currently have PID or an untreated sexually transmitted infection (STI). An existing STI can put you at a higher risk of developing PID after insertion.

10. Copper toxicity

Another possible severe side effect of Paragard is copper toxicity. This is a buildup of copper in the body that can be harmful. Symptoms include headache, vomiting, and diarrhea. Dark stool, blood in your vomit, and abdominal pain are also possible. Contact your provider if you experience any of these symptoms while using Paragard.

Copper toxicity from Paragard is rare. But it’s typically more likely to happen if you have a rare genetic condition called Wilson disease. Wilson disease causes copper to build up in your body. Because of this, you shouldn’t use Paragard if you have this condition.

When should you contact your healthcare provider about Paragard side effects?

Some of the possible side effects of Paragard, like menstrual cycle changes, are more common and less serious than others. But they may end up being a reason that this IUD isn’t right for you. If your periods are unmanageable after 3 to 6 months, consider contacting your healthcare provider about other birth control options.

As mentioned, serious Paragard side effects are also possible. If you experience any symptoms associated with a serious side effect listed above or if you become pregnant while using Paragard, contact your healthcare provider right away. If any of your symptoms feel severe or life-threatening, go to your nearest emergency room.

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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:

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.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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