An Intra-Uterine Device (IUD) is a small, flexible, plastic device placed inside a woman’s uterus.
Paragard is the brand-name for a type of IUD that has a tiny piece of copper wire wrapped around the plastic body. Some women choose this IUD because they want a method without artificial hormones. Paragard IUD makes it harder for sperm and eggs to move in the uterus, or for a fertilized egg to lodge in the lining of the uterus. It is 99.2% to 99.4% effective in preventing pregnancy, making it slightly less effective than sterilization.
Many women with the ParaGard have heavier, longer, more painful menstrual periods than before it was inserted. Some also have irregular bleeding. A woman can have an IUD removed whenever she wants, although she can keep it in for up to 12 years.
Each IUD has a plastic string attached that extends into the vagina. Sometimes women and their partners are able to feel the IUD strings high inside the vagina, but usually this is not bothersome. If the string becomes uncomfortable for you or your partner, it can be adjusted by your provider.
Paraguard does not protect against sexually transmitted infections (STI), including HIV/AIDS.
Insertion and Removal
First, patients may need a pre-insertion clinic visit for discussion and pre-testing. Then, a physician or advanced practice clinician inserts the IUD. The insertion takes 5 to 15 minutes, and some women barely feel it. Others find the insertion excruciatingly painful. For most it is somewhere in between. Usually, any pain lasts only a few minutes.
Very rarely during insertion, the IUD can poke a hole in the uterus (“perforation”). If this happens, the IUD is removed, and typically the uterus heals with no problems. Sometimes in cases of perforation, the IUD moves into the abdominal cavity or becomes embedded in the wall of the uterus; it would then have to be removed surgically.
When it comes time for the IUD to be removed, it only takes a few seconds. With a speculum in the woman’s vagina, the medical professional simply pulls gently on her IUD string. It usually slips out easily, and sometimes the woman doesn’t even feel this.
It is your right to have the IUD removed anytime you want, such as if you want to get pregnant or if the bleeding or cramping becomes uncomfortable. Unfortunately, some women have had trouble getting their IUDs taken out because of the cost—either their coverage was gone when the time came for removal or their program did not pay for removal. Some providers are reluctant to remove IUDs for what they consider trivial reasons. It is a good idea to talk with your medical professional about these things before having the IUD put in.
Getting an IUD involves a clinic visit. To prevent infection, some clinics require women to have check-ups prior to insertion. This can include a full medical, pelvic, and breast exam, with a Pap smear, STI check, and pregnancy test. If anything unusual is found, it is addressed before the IUD is inserted. After insertion, the Paragard is effective immediately. Paragard can also be inserted up to 5 days after unprotected intercourse as a form of emergency contraception.
The ParaGard can stay in for ten or more years.
- Doesn’t require action from the user
- Causes no hormonal effects such as mood changes, or changes in sexual response
- Private, can’t be seen and usually can’t be felt
- Highly effective
- Lasts a long time
- Provides no protection from sexually transmitted infections
- Requires a medical visit to start or stop use
- Can cause irregular bleeding or cramping throughout the cycle
- Causes heavier, more painful menstrual periods
In most cases, you will not be able to have the Paragard inserted if:
- There is any possibility you are pregnant
- You have a serious pelvic infection (PID), chlamydia, or gonorrhea. These need to be completely treated before the IUD is put in
- You have a post-childbirth or post-abortion infection. These should be resolved before you get the IUD.
- You are being treated for cervical cancer – you should finish your treatment before the IUD is put in
- The shape of your uterus blocks the IUD from being inserted
- You have pelvic tuberculosis or malignant trophoblastic disease (both rare diseases)
- You are allergic to copper or have Wilson’s disease
Your provider will help decide if Paragard is safe for you if:
- You gave birth or had an abortion in the past four weeks
- You have a high chance of getting sexually transmitted infections – if either you or your partner have other partners besides each other
- You are severely anemic (low iron levels)
- You have AIDS or HIV
- You have benign trophoblastic disease (rare)
Life with an IUD
Many women have cramping and irregular bleeding for the first few months. If the cramping is severe and is not only during menstruation, you should ask your provider if it is simply an unpleasant effect of the IUD or if it is a sign of infection. If the amount of the bleeding is more than you usually have in your cycle, your provider can help determine if it’s serious. Both non-medical home remedies and medical treatments can help. Bleeding and cramping usually last only a few months. If they are too bothersome, you can have the IUD taken out.
The IUD and Pregnancy
Women with IUDs almost never get pregnant. But if they do, there is danger of a serious, fast spreading pelvic infection. So, the IUD should be removed for the woman’s safety.
An ectopic pregnancy (growing outside the uterus) can be life threatening for a woman if it’s not caught early enough. The IUD doesn’t cause these but if you become pregnant during use, there is a higher chance that the pregnancy is ectopic. If you have any signs of pregnancy, it is important to get a pregnancy test as soon as possible.
The IUD could come out, sometimes without the woman noticing. You can check for the string once a month by feeling with your finger. Because the string is soft, and can be tucked pretty far back in the folds of your vagina, your provider can show you how to find it. If you stop feeling the string, or if you or your partner feel the hard plastic part of your IUD in your vagina, it could be coming out, and you should have it checked.
IUD and infection
If a woman gets chlamydia, gonorrhea or a pelvic infection with the IUD in the uterus, it is important that the infection us treated as soon as possible. If the treatment is successful, the IUD can usually stay in place.
- ParaGard IUD (manufacturer’s website)
- Not Your Mother’s IUD – published by National Women’s Health Network in Jan 2011
- IUD Toolkit from K4 Health