What are the Side Effects of Copper IUD Removal?

Intrauterine devices (IUDs) are the most commonly used reversible birth control method worldwide. Copper IUDs can prevent pregnancy for 3-10 years, depending on the type. After the IUD expires, it will need to be removed. You can also have it removed early if you want to become pregnant or if you experience harmful side effects. Removing an IUD is usually very simple and needs to be done in a doctor’s office. Your doctor will hold the threads of the copper IUD with ring forceps and pull, causing the arms of the T-shaped IUD to fold upward. In most cases, the IUD simply slips out, and IUD removal pain tends to be less than the pain of inserting the IUD. However, removal of a copper IUD may cause side effects.

Reasons for removal of a copper IUD

Many women report no problems with their copper IUDs, and only have them removed because they have expired. However, copper IUDs may be removed for a variety of reasons. For example, up to 10% of women require removal of their IUDs because of the side effects1. Heavy bleeding during periods is the most common reason for removal of a copper IUD. Other negative side effects that may lead to early removal include changes in menstrual cycle, irregular bleeding, abdominal pain, and damage to the cells or DNA of the uterus and cervix. These side effects are largely caused by the burst of copper ions released when a copper IUD is inserted, and the continuous release of these ions throughout copper IUD use.

Other reasons for removal include expulsion of the IUD (when it naturally falls out of the uterus). It may fall out partially or completely, and the risk of expulsion is higher during your period. If an IUD is expelled (even partially), it must be fully removed by a doctor. If at all possible, copper IUDs should be removed if pregnancy occurs. For women who become pregnant with a copper IUD, the risk of pregnancy loss is high even after removal of the IUD. If a sexually transmitted infection occurs, the IUD may need to be removed (in some cases, antibiotics can be taken and the IUD can be left in). If sex is painful, the IUD strings seem abnormal, or you can feel parts of the IUD in your cervix or vagina, contact a healthcare professional to get their advice on your specific situation. 

Removal of copper IUDs that have become problematic

There have been reports of IUDs that have moved out of the correct position2. This can lead to pain, copper fragments found outside of the uterus, and even penetration of the uterine wall. In these cases, the IUD may need to be removed via a different method than normally used. For example, a hysteroscopy may be required to remove the dislodged IUD3. A hysteroscopy is a fairly simple procedure done under anesthesia. It allows your doctor to use additional tools to remove the IUD. 

Copper IUD Removal Side Effects

There have also been reports of copper coils or fragments being left in the uterus after removal of the copper IUD2. After removal of your copper IUD, please contact your doctor if you have extreme pain or cramps, a high fever, chills, excessive vaginal bleeding, or bad-smelling discharge from your vagina.

Please note, it is not recommended to remove a copper IUD yourself; this is a process that should be done by a healthcare professional. Many women do experience barriers to removal of copper IUDs, including cost, access to the proper facilities, and lack of medical insurance. One study found that counseling women about expected side effects and changes in period-related bleeding helped women decide to continue using IUDs, even when they did experience those negative side effects4.

Long-term side effects of copper IUDs after removal

Some women may be worried that use of a copper IUD will cause permanent infertility or copper IUD side effects after removal, especially because of the higher risk of pelvic inflammatory disease associated with copper IUD use. A study was done to determine whether there is a higher risk of infertility with IUD use, and if that risk went up with continued IUD use5. Women using the copper IUDs tested in this study (both multiload copper-250 and Copper-T200 were tested) had a faster return to fertility than women who had used other types of IUDs. Most women who used copper IUDs experienced a return to fertility about 3 months after removal. The length of time of copper IUD use did not influence the return of fertility in these women.

Another study also reported that there is no evidence that previous use of a copper IUD increases rates of infertility – even if the IUD was removed due to complications or side effects6. Additionally, a long-term study by another research group showed that there was no significant reduction in fertility or increased risk for ectopic pregnancy within the first two years after removal of a copper IUD7. However, they did report an increased risk in miscarriage rate for women within two years of removing their copper IUDs. This group also reported that removal of copper IUDs because of complications – such as excessive bleeding – was not associated with a higher risk of complications in subsequent pregnancy.

What to expect after IUD removal

Women may experience light bleeding after IUD removal for a time period ranging from hours to several days. It can take as long as three months for women to experience their first period after IUD removal. For most women, their period after IUD removal returns to their pre-implantation baseline. If you experience severe pain or heavy bleeding after IUD removal, contact your healthcare provider. 

Mirena is another type of IUD; it releases the hormone progestin, which is commonly used in oral birth control8. The side effects of Mirena removal are similar to those of copper IUD removal. Many women wonder how long after Mirena removal they should expect to get their period. Most women report their first period after Mirena removal within three months. For many women, their period after Mirena removal eventually returns to the pre-IUD baseline. Again, if you experience severe pain or heavy bleeding after Mirena removal, contact your healthcare provider.

FAQ

Can I just remove my IUD myself?

Never attempt to remove your IUD yourself. Though the procedure seems simple, it should always be performed by a medical professional.

How long after IUD removal can I expect my period to return?

Most women experience the return of their period within 3 months of IUD removal. 

How soon can I get pregnant after IUD removal?

As soon as your IUD is removed, you can get pregnant. Around 80% of women who tried to conceive were pregnant within a year of IUD removal.

References

1.  Fadiloglu, S., Dilbaz, B., Fadiloglu, E. et al. Relationship between copper IUD complications and ultrasonographic findings. Arch Gynecol Obstet 297, 989–996 (2018).
2. Dubovis M, Rizk N. Retained copper fragments following removal of a copper intrauterine device: Two case reports. Case Rep Womens Health. 2020;27:e00208. Published 2020 Apr 24. doi:10.1016/j.crwh.2020.e00208
3. Cullberg G, Larsson B. Some adverse effects of copper-IUD. Acta Obstet Gynecol Scand. 1979;58(1):87-90. doi:10.3109/00016347909154921
4. Raifman S, Barar R, Foster D. Effect of Knowledge of Self-removability of Intrauterine Contraceptives on Uptake, Continuation, and Satisfaction. Womens Health Issues. 2018;28(1):68-74. doi:10.1016/j.whi.2017.07.006
5. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility–follow-up after participation in a randomized clinical trial. Contraception. 2007;75(2):88-92. doi:10.1016/j.contraception.2006.09.010
6. Anwar M, Widayanto S, Maruo T, Mochizuki M. Return of fertility after the removal of intrauterine devices: a comparison of inert and copper bearing devices. Asia Oceania J Obstet Gynaecol. 1993;19(1):77-83. doi:10.1111/j.1447-0756.1993.tb00351.x
7. Jennifer C. Wilson. A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices for conception and because of complications: A four-year study. American Journal of Obstetrics and Gynecology. 1989; 160(2):391-396.
8. Llamas M, Miller E., Daller JA. Mirena iud removal: Side effects & what to expect. https://www.drugwatch.com/mirena/removal/#:~:text=After%20a%20routine%20Mirena%20removal,they%20should%20contact%20their%20doctor. Published March 30, 2021.