Copper IUD

Zero hormones. Loads of staying power.

Gets an A+ in pregnancy prevention.

The cheat Sheet

Common brand names

Load 375, TT380 Short, TT380 Standard, NOVA T 380, Paragard (US only)

Preventing pregnancy

More than 99% effective

Starting on this method

Get an STI check beforehand. Once you’re clear, you’ll need to book an appointment with your doctor or a specialist nurse to have it inserted. This can be done under local or general anesthetic (this costs more).

Lasts for

Immediate protection once it’s in so you won’t need to use any other contraception. Lasts for 5-10 years.

Hormones

No synthetic hormones

STIs

No protection against STIs

Periods

May make periods heavier or last longer

Acne/skin

Doesn’t impact skin

Mood/emotions

No known effect on mood

Pregnancy after removal

It is possible to get pregnant immediately post-IUD removal.

Visibility

Not visible

Financial investment

One off - Insertion cost plus the cost of the device. Medicare rebate available

The copper IUD aka intrauterine device (IUD) is a tiny (we’re talking 50 cent piece size), T-shaped plastic device wrapped in copper wire that is inserted into the uterus. It has one mission and one mission only: prevent pregnancy.

Unlike the hormonal IUDs, the copper IUD doesn’t release any synthetic hormones. Copper and sperm aren’t friends, creating an environment that is inhospitable to sperm. It stops those swimmers from moving properly and makes fertilisation very unlikely. It also changes the uterine lining, making it harder for the fertilised egg to implant.

The copper IUD is also a suitable method of emergency contraception. This means that if you do have unprotected sex or your current method of contraception (ie. condom breaks, missed a pill etc) fails then getting the copper IUD inserted can be a backup option to stop any potential pregnancy in its tracks. However, the copper IUD is a long term contraceptive method (it can last for up to 5-10 years in the uterus), so if you are after a quick fix, maybe look into the emergency contraceptive pill.

Folks with naturally lighter, regular and/or manageable periods
The roamers, the forgetters, the live-in-the-moment-ers
Anyone on a long-term baby break (or skipping it altogether

Inserted by a doctor or nurse, and yes, it can be a VERY painful procedure.
No STI protection. If you need both, you’ll still want condoms.
May not be for you if you get frequent infections (like UTIs), have a copper allergy, or Wilson’s disease, low iron levels, endometriosis or heavy periods. Chat to your doctor as there may be a more suitable method for you.

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Two women in conversation overlaid with labels 'Copper IUD' and 'Sperm,' and text saying, 'You made it really clear that you do not want to be my friend.'

The not-so-fun stuff

Common side effects

Let’s be real, no contraceptive method is perfect. With the copper IUD, side effects aren’t one-size-fits-all. Some people barely notice it’s there, while others might deal with heavier periods or more cramping. Everyone’s body responds differently and every response is valid.

We want you to have the full picture so you can decide if it’s right for your body, not just what looks good on paper.

So here it is: the good, the meh, and the stuff worth keeping an eye on.

Clinical trials reported side effects

Because the copper IUD is completely hormone-free, it won’t cause hormone-related side effects like mood changes or breast tenderness. Any side effects you might notice, like heavier bleeding or more cramping are related to the device itself, not hormones, and often improve within 3–6 months as your body adjusts.

Some of the most commonly reported ones include:

Changes in menstrual bleeding (heavier periods)
Painful periods
Spotting or irregular bleeding
Pain during insertion

Real world user-reported side effects

The Lowdown is a contraception review platform where real people share their lived experiences with different birth control methods, including the copper IUD. It’s a goldmine of lived experience.

Substantely heavier periods
Period-like cramps
Changes to vaginal discharge
Tender breasts
Thrush

Less Common But important to know

Pelvic inflammatory disease (PID)

There’s a small risk of PID in the first 20 days after your IUD is inserted, not because of the IUD itself, but because if there’s an untreated STI hanging around, bacteria can get pushed up into the uterus during insertion. The chance of this happening is around 0.5% or less. After this initial period, your risk is the same as anyone without an IUD.

To reduce the risk of this happening, make sure you get an STI check appointment AND get the results back too before your insertion appointment. If there’s anything to treat, you’ll want to sort it all out first!

IUD expulsion (aka your IUD evacuates its warm home)

Sometimes (happens in about 1 in 20 users), the IUD can partially or fully slip out, especially in the first 3 to 6 months after insertion. You might notice this, or you might not (string checks are handy for this very reason).

You might be more at risk if you:

Have heavy or irregular periods
Are getting it soon after giving birth, especially within 6 weeks
Are young or haven’t given birth (some research suggests a slightly higher risk)
Experience a less-than-ideal insertion (make sure the person who is inserting the IUD knows what they’re doing!)

Uterine perforation

This one sounds scary (and it kind of is), but it’s very rare. It happens in 1 in every 500 insertions. Perforation means the IUD accidentally pokes through the uterine wall, usually during the insertion procedure.

You might be more at risk if you are:

Breastfeeding (lower estrogen means softer uterine wall and therefore a slightly higher risk)
Undergoing a postpartum insertion (especially within 12 weeks of giving birth)
Get an Inexperienced providers (technique really matters here)

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What happens if it does perforate?

You may not notice right away. It’s often picked up via missing strings, pelvic pain, or during a scan. Sometimes it sorts itself out, sometimes it needs surgical removal. Most people recover without any long-term issues.

Ectopic pregnancy

Pregnancy with a copper IUD is very rare, but if it does happen, there’s a higher chance it could be ectopic, when a pregnancy grows in the fallopian tube instead of the uterus. It can be serious, so if you ever think you might be pregnant with an IUD in place, check in with your healthcare provider as soon as you can.

Three people wrapped together in a large blanket standing by a window in a cozy room.

Pre insertion Prep

Wear ultra comfy clothes, nothing too tight around your stomach (calling all granny panties).

Bring a pad with you to the appointment to use afterwards if there's a little bit of spotting.

If you're not going under general anaesthetic:

Take pain relief around 30-60 minutes before your appointment to help minimise cramping.
Have a light meal and drink plenty of water beforehand to avoid feeling lightheaded afterwards.

Relaxation techniques to use when you are mid IUD insertion

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To help make it a little more bearable, here’s some relaxation techniques that will help take your mind off the pain and discomfort and ease anxiety and stress. These breathing techniques help tell your brain that you are not in a dangerous situation where flight, fight, freeze or fawn response is more likely to kick in.

No bears in the cave here, just Trudy the gyno ha!

Box breathing

What to do mid-insertion:

Inhale for 4 seconds
Hold your breath for 4 seconds
Exhale for 4 seconds
Hold for 4 seconds, then repeat

I’m a floating cloud

What to do mid-insertion:

Picture yourself lying on a soft, fluffy cloud, floating effortlessly through the sky. With each inhale, imagine the cloud lifting you higher. With each exhale, feel your body releasing tension into the air.

Why it helps:

It creates a sense of weightlessness, helping you relax your pelvic muscles and reduce pain perception.

I’m living in the future to stop me from living in the present

Prep before the appointment:

Plan what you are going to do post IUD insertion. Think low-impact ‘happy place’. This could be indulging in your favourite food, curled up in bed binge watching your favourite tv series or snuggling with Meow-bert the long haired ragdoll. Organise this with your support person so they are onboard with the plan.

What to do mid-insertion:

Imagine yourself an hour from now in your pre-planned happy place.

Why it helps:

Your brain believes what you tell it - so by focusing on the post-procedure relief, you shift away from discomfort in the moment.

Mindfullness tips

Now I know this can be challenging, especially when it can feel impossible to take your mind off the physical pain you may be experiencing in that moment.

However, a couple of things that can make it easier:

Practice whatever technique you wish to use before the insertion procedure so you are well equipped once you are there.
Communicate this with your support person beforehand and if needed (and if they are in the room with you), ask them to coach you through the prompts/techniques.

What to actually expect during the IUD insertion

Although it feels like a lifetime when you are in it, the IUD insertion typically takes 5-10 minutes.

1. Prep (hello anticipatory anxiety)

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First of all, 3 deep breaths. You got this.

Positioning: You'll lie on your back on an examination table, with your feet up in stirrups, similar to a standard pelvic exam.

Duration: A few minutes.

Sensation: Typically minimal discomfort (phew!)

2. Speculum insertion (creating the runway)

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What happens: A speculum (think duck beak-shaped device) is gently inserted into your vagina to hold it open and provide access to your cervix.

Duration: Approximately 1-2 minutes.

Sensation: You may feel pressure or a stretching sensation in the vagina.

3. Cervical stabilisation (opening act)

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What happens: Your healthcare provider uses an instrument called a tenaculum (kind of looks like large tweezers) to grasp and stabilise the cervix.

Duration: A few seconds for getting it in the right position.

Sensation: This can cause a sharp cramp or a brief pinch, and sometimes mild spotting. Totally normal.

Pain management: Sometimes you can get a topical anesthetic to help reduce the pain at this step.

4. Uterine measurement (aka sounding the place out)

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What happens: A thin rod, called a uterine sound, is inserted through the cervix to measure the depth and orientation of your uterus. This is done so that the healthcare provider places the IUD in the right spot (some would say this is quite important ha!).

Duration: Less than a minute.

‍Sensation: This may cause a brief, sharp cramp as the instrument touches the top of the uterus.

5. IUD insertion (the main event)

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What happens: The IUD, contained within an applicator tube, is inserted through the cervix into the uterus. Once in place, the IUD is released, and the applicator is removed.

Duration: A few minutes.

Sensation: You may experience cramping or a sense of pressure during this step. This is normally the most painful part, but it means its almost done! You are on the home stretch now.

6. Home stretch

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What happens: Your healthcare provider trims the IUD strings so they extend slightly into the vagina.

Duration: Less than a minute.

Sensation: Normally minimal to no discomfort. You’re done! Phew!

Insertion - what’s right and what’s wrong

Green flags

You can feel the strings (or your healthcare provider confirms they’re in place).
Mild to moderate cramping or spotting in the days or weeks following insertion.
Slightly heavier periods at first
Cramps may linger, but they should feel dull and achy, not sharp or stabbing.

Red flags - go to your doctor or the hospital

You can’t feel the strings, or they suddenly feel longer or shorter. This could mean the IUD has shifted or expelled (aka: it’s evacuated its cozy home and is now squatting in your cervix or vaginal canal). Sometimes strings naturally curl around the cervix. If you can’t feel them but feel fine, your provider can check placement with an ultrasound.
You experience pain during sex or your partner feels the hard part of the IUD. This may suggest the IUD is sitting too low or has moved.
Funky-smelling discharge, chills, or a fever could be early signs of infection. Normal discharge is okay, but if it’s new, persistent, or comes with pain, check in.
You expel the IUD. If you see it in your underwear, in the toilet, or on the floor (it happens), it’s no longer protecting you from pregnancy. You’ll need a new one or a backup form of contraception.
You have severe, sharp, or worsening pain. This could mean the IUD is in the wrong position or, in rare cases, has perforated the uterus. You know your body, trust yourself!
Heavy, continuous bleeding. If you are soaking through a pad or tampon every hour or experiencing prolonged bleeding beyond your normal cycle.

Pain-free, baby!

I can feel it, but it’s no biggie.

It’s annoying, but I can tune it out.

It’s constant and starting to wear me down.

It’s hard to focus. I’m uncomfortable and kind of done.

I need support — I can’t manage this on my own. Might be time to call the doctor.

This is serious. I’m struggling to cope and thinking about urgent care.

I can’t move or think straight. This feels emergency-level.

The worst pain I’ve ever felt. This is an emergency. Hospital, now.

A cute drop

Light flow

Moderate

Heavy

Very heavy

Flood zone

The pain-o-metre

A lot of us downplay our pain.
Especially when it comes to periods, cramping, or anything uterus-adjacent. We’re taught to tough it out, to call it “normal,” even when it’s not. Why? Because for a very long time, the world told us to.

That’s exactly why we created this Pain-O-Metre, to help you check in with your body, validate what you’re feeling, and remind you that asking for help isn’t dramatic. It’s smart.

‍This scale is here to help you check in with your body - it’s not a substitute for medical advice. If you’re ever unsure, always check in with a healthcare provider.

The Blood-o-metre

This scale is a guide, not a diagnosis. Everyone’s body and baseline are different, and pain or bleeding that’s affecting your daily life, mental health, or ability to function is reason enough to check in with a medical professional.

When in doubt - Trust your gut, and seek support.

Pain-free, baby!

Post insertion procedure

You did it! Your uterus has a new roomie! How are you feeling? If the answer is “not amazing,” that’s okay. You’ve just had something placed inside your body...sooo it's understandable if you feel crappy!

Let’s walk through what the next few days and weeks might look like with your new copper IUD.

24 hours after

Cramping & discomfort

Mild to moderate cramping and low back pain are very normal after insertion. Think: annoying period vibes with a side of “I’d like to stay horizontal.” Pain usually starts to ease within a few hours to a day.

Spotting or light bleeding

Your uterus just had a visitor. Light spotting or brown discharge is super common and totally normal.

48 hours after

Lingering cramps

Cramps may continue for another day or two, usually less intense than right after insertion.

Heat pack, comfy clothes, and your favourite snack is highly recommended.

Spotting continues

Spotting may still be happening, but it should start to taper off. For some, it may linger on and off for a few weeks - annoying, but not uncommon.

1 week after

Body in adjustment mode

By now, most cramping and bleeding will be easing up. Some people feel completely back to normal, while others still notice mild symptoms. Both are okay.

Time to check the strings

If you feel comfortable, gently insert a clean finger into your vagina and feel for the strings, they’ll feel like thin fishing line.

Feel the strings? All good.

Can’t find them, or they feel much longer or shorter? Contact your healthcare provider.

1 month after

Changes to your period

‍You may notice changes in your menstrual cycle, such as heavier bleeding and increased cramping during periods. This is common with copper IUDs. Some people find it improves with time, others disagree. Gauge it for yourself!

Time for a follow up appointment

At the 4-6 week mark, a quick check-up helps make sure:

Your IUD is still in place
You’re healing well
Any symptoms you’re unsure about can be addressed

Where this info comes from

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This page was created using guidance from trusted Australian and international health organisations, clinical guidelines, and peer-reviewed research. These sources support the medical accuracy, accessibility, and lived experience approach behind this content.

Australian health organisations

International clinical guidelines & organisations

Research

Achilles, S. L., Austin, M. N., Meyn, L. A., et al. (2018). Impact of contraceptive initiation on vaginal microbiota. American Journal of Obstetrics and Gynecology, 218(6), 622.e1–622.e10. https://doi.org/10.1016/j.ajog.2018.02.017
Brown, B. P., Feng, C., Tanko, R. F., Jaumdally, S. Z., Bunjun, R., Dabee, S., Happel, A.-U., Gasper, M., Nyangahu, D. D., Onono, M., Nair, G., Palanee-Phillips, T., Scoville, C. W., Heller, K., Baeten, J. M., Bosinger, S. E., Burgener, A., Passmore, J.-A. S., Heffron, R., & Jaspan, H. B. (2023). Copper intrauterine device increases vaginal concentrations of inflammatory anaerobes and depletes lactobacilli compared to hormonal options in a randomized trial. Nature Communications, 14(1), 499. https://doi.org/10.1038/s41467-023-36002-4
Ellington, K., & Saccomano, S. J. (2020). Recurrent bacterial vaginosis. The Nurse practitioner, 45(10), 27–32. https://doi.org/10.1097/01.NPR.0000696904.36628.0a
Hubacher, D., Chen, P. L., & Park, S. (2009). Side effects from the copper IUD: do they decrease over time?. Contraception, 79(5), 356–362. https://doi.org/10.1016/j.contraception.2008.11.012
Mohllajee, A. P., Curtis, K. M., & Peterson, H. B. (2006). Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review. Contraception, 73(2), 145–153. https://doi.org/10.1016/j.contraception.2005.08.007
Peebles, K., Kiweewa, F. M., Palanee-Phillips, T., Chappell, C., Singh, D., Bunge, K. E., Naidoo, L., Makanani, B., Jeenarain, N., Reynolds, D., Hillier, S. L., Brown, E. R., Baeten, J. M., Balkus, J. E., & MTN-020/ASPIRE study team (2021). Elevated Risk of Bacterial Vaginosis Among Users of the Copper Intrauterine Device: A Prospective Longitudinal Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 73(3), 513–520. https://doi.org/10.1093/cid/ciaa703

Review & community platforms

The Lowdown

Books

Otten, C. (2021). The sex ed you never had. Allen & Unwin.