ParaGard is an intrauterine device (IUD) that's inserted into the uterus for long-term birth control (contraception). The T-shaped plastic frame has copper wire coiled around the stem and two copper sleeves along the arms that continuously release copper to bathe the lining of the uterus. ParaGard produces an inflammatory reaction in the uterus that is toxic to sperm, which helps prevent fertilization.
ParaGard is the only copper IUD available in the U.S. ParaGard prevents pregnancy for up to 10 years after insertion.
Why it's done
How you prepare
What you can expect
ParaGard offers effective, long-term contraception. It can be used in premenopausal women of all ages, including teenagers. Among various benefits, ParaGard:
Eliminates the need to interrupt sex for contraception or seek partner compliance
Can remain in place for up to 10 years
Can be removed at any time, followed by a quick return to fertility
Decreases the risk of endometrial cancer and possibly cervical cancer
Can be used while breast-feeding — though there may be an increased risk of perforation or expulsion when inserted soon after delivery
Doesn't carry the risk of side effects related to hormonal birth control methods
Can be used for emergency contraception if inserted within five days after unprotected sex
ParaGard isn't appropriate for everyone, however. Your health care provider may discourage use of ParaGard if you:
Have uterine abnormalities that interfere with the placement or retention of ParaGard
Have a pelvic infection, such as pelvic inflammatory disease
Have uterine or cervical cancer
Have unexplained vaginal bleeding
Are allergic to any component of ParaGard
Have a disorder that causes too much copper to accumulate in your liver, brain and other vital organs (Wilson's disease)
Have or are at high risk of a sexually transmitted infection, and won't use condoms
Had previous problems with an IUD
Less than 1 percent of women who use ParaGard will get pregnant in the first year of typical use. If you do conceive while using ParaGard, you're at higher risk of an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. However, because ParaGard prevents most pregnancies, the overall risk of having an ectopic pregnancy is lower than it is for other sexually active women who don't use contraception.
ParaGard doesn't offer protection from sexually transmitted infections (STIs).
Side effects associated with ParaGard include:
Bleeding between periods
Inflammation of the vagina (vaginitis)
Pain during sex
Severe menstrual pain and heavy bleeding
It's also possible to expel ParaGard from your uterus. You might not even feel it if this happens. You may be more likely to expel ParaGard if you:
Have never been pregnant
Have heavy or prolonged periods
Have severe menstrual pain
Previously expelled an IUD
Are younger than age 20
Had the IUD inserted immediately after childbirth or a second trimester abortion
Your health care provider will evaluate your overall health and do a pelvic exam before inserting ParaGard. He or she may also recommend screening for STIs. You can have ParaGard inserted anytime during a normal menstrual cycle if you've been consistently using another birth control method or you haven't had sex since your last period.
If you are breast-feeding, have irregular periods or haven't been consistently using birth control, you may need to take a pregnancy test before ParaGard is inserted or have it inserted during a period.
Taking a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin IB, others), one to two hours before the procedure can help reduce cramping.
ParaGard is typically inserted in a health care provider's office.
During the procedure
Your health care provider will insert a speculum into your vagina and cleanse your vagina and cervix with an antiseptic solution. Then he or she may use a special instrument to gently align your cervical canal and uterine cavity, and another tool to measure the depth of your uterine cavity. Next, your health care provider will fold down ParaGard's horizontal arms and place the device inside an applicator tube.
He or she will insert the tube into your cervical canal and carefully place ParaGard in your uterus. When the applicator tube is removed, ParaGard will remain in place. Your health care provider will trim ParaGard's strings so that they don't protrude too far into the vagina and may record the length of the strings.
During ParaGard insertion, as with some other procedures, you may experience dizziness, fainting, nausea, low blood pressure or a slower than normal heart rate (bradycardia). Your health care provider will likely suggest that you stay lying down for a few minutes after the procedure to allow these side effects to pass. Rarely, it's also possible for the IUD to perforate the uterine wall or cervix.
After the procedure
After every period, check to feel that ParaGard's strings are protruding from your cervix. Don't pull on the strings. It's OK to use tampons with ParaGard.
About a month after ParaGard is inserted, your health care provider may re-examine you to make sure the device hasn't moved and check for signs and symptoms of infection.
While you're using ParaGard, contact your health care provider immediately if you have:
Signs or symptoms of pregnancy
Unusually heavy vaginal bleeding
Foul vaginal discharge
Worsening pelvic pain
Severe abdominal pain or tenderness
Possible exposure to a sexually transmitted infection
It's also important to contact your health care provider immediately if you think ParaGard is no longer in place. Call your doctor if:
You have breakthrough bleeding or bleeding after sex
Sex is painful for you or your partner
The strings are missing or suddenly seem longer
You feel part of the device at your cervix or in your vagina
Your health care provider will check the location of ParaGard and remove it if necessary.
ParaGard is usually removed in a health care provider's office. Your provider will likely use forceps to grasp the device's strings and gently pull. The device's arms will fold upward as it's withdrawn from the uterus.
Light bleeding and cramping are common during removal. In some cases, removal may be more complicated.