Intrauterine Copper Contraceptive

The Basics

What is Intrauterine Copper Contraceptive?

Copper IUD is used for contraception.

Brand names for Intrauterine Copper Contraceptive

Paragard

How Intrauterine Copper Contraceptive is classified

Intrauterine Devices, Copper, Contraceptive Devices, Contraceptives, Contraceptives – Postcoital

Intrauterine Copper Contraceptive During Pregnancy

Intrauterine Copper Contraceptive pregnancy category

Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Intrauterine Copper Contraceptive while pregnant

ParaGard® is contraindicated during pregnancy. (See CONTRAINDICATIONS and WARNINGS.)

Taking Intrauterine Copper Contraceptive While Breastfeeding

What are recommendations for lactation if you're taking Intrauterine Copper Contraceptive?

The copper IUD is acceptable to use during breastfeeding as a long-term contraceptive. It has been studied extensively during lactation in comparison with other forms of contraception and does not affect lactation performance or the milk copper concentration. In women who are breastfeeding, insertion of the device should be after 4 weeks postpartum. A meta-analysis found that uterine perforation with IUD insertion was 6 to 10 times more likely in breastfeeding mothers than in non-breastfeeding women, but that the risk of expulsion was no greater in breastfeeding mothers.[1] A more recent prospective study found a slight increase in the risk of expulsion of intrauterine devises with breastfeeding,[2] and the American College of Obstetrics and Gynecology recommends that women be counseled that immediate postpartum insertion may have a higher expulsion rate than later insertion.[3] The copper IUD is considered to be the most effective emergency contraceptive when inserted up to 5 days after unprotected intercourse.[4]

Maternal / infant drug levels

The copper IUD is acceptable to use during breastfeeding as a long-term contraceptive. It has been studied extensively during lactation in comparison with other forms of contraception and does not affect lactation performance or the milk copper concentration. In women who are breastfeeding, insertion of the device should be after 4 weeks postpartum. A meta-analysis found that uterine perforation with IUD insertion was 6 to 10 times more likely in breastfeeding mothers than in non-breastfeeding women, but that the risk of expulsion was no greater in breastfeeding mothers.[1] A more recent prospective study found a slight increase in the risk of expulsion of intrauterine devises with breastfeeding,[2] and the American College of Obstetrics and Gynecology recommends that women be counseled that immediate postpartum insertion may have a higher expulsion rate than later insertion.[3] The copper IUD is considered to be the most effective emergency contraceptive when inserted up to 5 days after unprotected intercourse.[4]

Possible effects of Intrauterine Copper Contraceptive on milk supply

A study compared prolactin serum concentrations in 40 women using a copper-containing intrauterine device (Copper T, Copper 7 or Soonawalla Y) to those of 20 women who were using condoms or practicing abstinence. Serum prolactin levels were higher in lactating women using a copper IUD (n = 7) than in lactating controls (n = 5) and in nonlactating women using a copper IUD (n = 33) than in lactating controls (n = 15). The authors also noted that they had seen 12 women with galactorrhea who were using a copper IUD, although they did not establish a cause-and-effect relationship. None of the study patients had galactorrhea.[10]

A 30-year-old woman had been using a copper IUD (Gravigard) for 19 months when she noted spontaneous galactorrhea, mostly from the left breast. Thyroid function and basal serum prolactin levels were normal and a brain tumor was ruled out. Three months later, the IUD was removed and milk production stopped 7 months after removal. The patient used no IUD for 3 months, then the copper IUD was replaced. Mild spontaneous lactation began 3 days after IUD placement, mainly from the right breast. The patient was taking no medications that would cause galactorrhea. The galactorrhea was probably caused by the IUD.[11]

Eighty-four women had 6 subdermal implants containing 100 mg each of progesterone inserted between days 30 to 35 postpartum as a contraceptive. Compared to women who received either a placebo or a Copper T intrauterine device, no difference was found in the breastfeeding rates during the first 9 months postpartum. At 1 year postpartum, more women in the Copper T group were breastfeeding than in the progesterone or placebo groups.[12]

An open-label, two-center, randomized study in breastfeeding women compared a copper-containing IUD (Multiload Cu250) with an oral progestin-only contraceptive (lynestrenol 500 mcg). There were no statistically significant differences between groups with regard to the amount of milk production or number of daily breastfeedings.[6]

A study compared the performance of a copper-containing IUD (Copper T 380A; n = 122), progesterone vaginal rings (n = 187), an oral progestin-only contraceptive (lynestrenol 500 mcg; n = 117), and levonorgestrel implants (Norplant; n = 120) in lactating women. After the first year of use, none of the methods affected breastfeeding performance. Users of the progestin-only methods experienced a period of lactational amenorrhea 4 to 5 months longer than did users of Copper T or untreated women.[8] In a multicenter study, women who received a (Copper T 380A; N = 734) intrauterine device were compared to women who received a vaginal ring that released about 10 mg daily of progesterone (N = 802) beginning at day 29 to 63 postpartum. No differences were found in the rate of breastfeeding between the 2 groups over the first year postpartum.[9]

A nonblinded, nonrandomized study compared a copper-containing IUD (Multiload Cu375; n = 40) to oral desogestrel 75 mcg daily (n = 42) begun 28 to 56 days postpartum for contraception. During the 7-month trial period, 1 woman dropped out of the trial because of diminished lactation compared with none in the IUD group. At the end of the first and fourth treatment cycle, there were no differences in the amount of milk produced between the desogestrel and IUD groups. No differences in triglyceride, protein or lactose content of milk were found at the end of 1, 4, and 7 cycles of therapy.[13]

Possible alternatives to Intrauterine Copper Contraceptive

Etonogestrel, Oral Levonorgestrel, Intrauterine Levonorgestrel, Levonorgestrel Implant, Medroxyprogesterone Acetate; Norethindrone; Progesterone.