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This article is for Medical Professionals

Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Intrauterine Contraceptive Device (The Coil) article more useful, or one of our other health articles.

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This article refers to copper-containing intrauterine contraceptive devices (Cu-IUCDs). For information on Mirena® and Jaydess®, the levonorgestrel-releasing intrauterine systems (LNG-IUS), see the separate Intrauterine System (IUS) article. For information regarding IUCD and IUS insertion, see the separate Intrauterine Contraceptives (IUCD and IUS) - Management article.

The Cu-IUCD is a long-acting reversible contraceptive (LARC). It is typically T-shaped or frameless and is anchored to the myometrium at the fundus. The amount of copper in the device and the type of frame (structure) can affect the effectiveness of different models. The T- shaped models with a surface area of 380 mm2 of copper have the lowest failure rates. Earlier models with lower effectiveness are no longer produced worldwide.

The addition of small quantities of silver to the core prevents fragmentation of the copper, extending the lifespan and efficacy. In some countries the addition of other noble metals such as gold is used for the same effect.

The National Institute for Health and Care Excellence (NICE) advises that all currently available LARC methods (IUCDs, the IUS, injectable contraceptives and implants) are more cost-effective than the combined oral contraceptive (COC) pill even at one year of use.[1] IUCDs, the IUS and implants are also more cost-effective than the injectable contraceptives. NICE also advises that increasing the uptake of LARC methods will reduce the numbers of unintended pregnancies. It is important that women should be advised of LARC methods when seeking contraception.

Although IUCDs are used by large numbers of women, global distribution of their use is uneven. In a few countries, including China and most of Central Asia, IUCDs constitute at least half of all contraceptive use.[2] In Northern Africa and the Middle East, they represent about a quarter of all use, and in parts of Europe, about a fifth. In the Americas, IUCD use is generally well below 10%. In the UK their use is between 11.3 and 12.1%.[3]

  • The primary mode of action is through setting up a cytotoxic inflammatory reaction in the endometrium, which is spermicidal.
  • The copper concentration in cervical mucus is also substantial and inhibits sperm motility.
  • The copper devices may also prevent implantation if fertilisation occurs. However, the studies suggesting this were of older devices with lower copper content, and there is no clear evidence that modern devices allow fertilisation to occur.
  • The postcoital use of copper devices utilises this post-fertilisation contraceptive effect.
  • Many factors determine efficacy in individual women, including sexual activity, age and parity.
  • Cumulative pregnancy rates for IUCDs with copper content >300 mm2are noted as being between 0.1% and 1% after the first year of use and around 2.2% for the TCu380A after 12 years.[4]
  • A Cochrane review has concluded that the TCu380A and TCu380S appear to be more effective than other Cu-IUCDs.[5]
  • The frameless GyneFix® has comparable failure rates to the TCu380A and has been shown to have an improved continuation rate compared to framed devices.[6]
  • Over 12 years of use the models with less surface area of copper have higher failure rates.
  • All Cu-IUCDs are licensed for at least five years of use and some are recommended for longer use.[4]
  • The TCu380A is effective for up to 12 years of use and licensed for 10 years.
  • The TCu380S (TT 380® Slimline and T-Safe® 380A QuickLoad) is licensed for 10 years of use.
  • In the UK it is widely accepted that if a Cu-IUCD is inserted when a woman is 40 years or over it can be retained and will remain effective until the menopause is confirmed.
  • Longer-acting devices are generally preferred, as this reduces the risks associated with removal and re-insertion (perforation, infection, expulsion).
  • Short-stemmed devices can be used if the uterine cavity is less than 6.5 cm at sounding.

Types of device currently available in the UK[7]

DeviceCopper (mm2)Duration
Copper-sleeved devices:
Recommended first choice for all women opting for Cu-IUCD.
TT 380® Slimline
Marketed as a replacement for the Ortho Gynae® T380 which is no longer available in the UK.
TCu380A QuickLoad®
Replacement for the TCu380A (T-Safe® 380A) which is no longer available in the UK.
Mini TT 380® Slimline
Can be used when the uterine cavity is less than 6.5 cm on sounding.
Flexi-T® 380
There are limited data on the Flexi-T®. Unlike other banded devices, it therefore cannot be recommended for 10 years of use.
Copper in stem only:
Ancora® 375 Cu3755
Cu-Safe® T3003005
Load® 3753755
Neo-Safe® T3803805
UT 380 Short®
Can be used when the uterine cavity is less than 6.5 cm on sounding.

5 (NICE CKS 10 years)

Nova-T® 3803805
Novaplus T 380® Cu (mini and normal sizes)3805
Novaplus T 380® Ag (mini and normal sizes)3805
Neo-Safe® T3803805
Multiload® Cu375
Can be used when the uterine cavity is less than 6.5 cm on sounding.
Multi-Safe® 3753755
Multi-Safe® 375 Short Stem
Can be used when the uterine cavity is less than 6.5 cm on sounding.
Flexi-T® 300
Can be used when the uterine cavity is less than 6.5 cm on sounding.
Flexi-T® 3803805
Frameless copper devices:
Can be used when the uterine cavity is less than 6.5 cm on sounding.


  • For most women seeking contraception, the Cu-IUCD is a safe option.
  • Any Cu-IUCD sited in a woman aged over 40 years, can be safely left in situ until the menopause; however, it is only licensed for 10 years use.
  • It can be appropriate for many other women, including those who traditionally offer contraceptive challenge, such as obese women, women with diabetes or epilepsy, women with migraine and women with contra-indications to oestrogen (see the separate Contraception and Special Groups article).
  • Advantages as a contraceptive method include:
    • Rapid return of fertility post-removal.
    • Convenience (long-lasting method that is independent of intercourse).
    • No hormonal content.
  • Disadvantages include heavier and more painful menstruation and the discomfort of fitting.
  • Fitting an IUCD is technically a little less difficult than an IUS, as the IUS has a larger diameter than other IUCDs.

Emergency contraception[8]

Insertion of a copper-banded IUCD prevents conception in 98% of women if:

  • Unprotected sexual intercourse (UPSI) occurred before insertion and there is a risk of pregnancy, a Cu-IUCD can safely be inserted up to five days after the first episode of UPSI or within five days of the earliest expected time of ovulation.
  • For a woman with a regular four-week cycle, this means that an IUCD can be inserted up to and including day 19 of her cycle, regardless of when the unprotected sex took place following her last period. However, LMP must be accurately known and cycles must be regular in order to make the estimation.

Although not suitable for all women, the Cu-IUCD should be offered as a postcoital contraceptive when:

  • Efficacy is the woman's main priority. The Cu-IUCD is more effective than emergency hormonal contraception, with a failure rate of considerably lower than 1%.[9]
  • Exposure occurred up to five days ago, including multiple exposures within this period.
  • It is to be retained as a long-term method of contraception.
  • There is contra-indication to hormonal methods.

See the separate Intrauterine Contraceptives (IUCD and IUS) - Management article for details on choice of device.

NB: the IUS is NOT suitable for emergency contraception.

Absolute contra-indications[10]

There are few absolute evidence-based contra-indications and they fall into five categories: infection, pregnancy, uterine factors, gynaecological cancers and adverse reactions to copper.


  • History of pelvic inflammatory disease (PID) or purulent cervicitis, although it may be inserted three months after infection, if there are no signs of persisting infection.
  • Recent exposure to sexually transmitted infection (STI).
  • Septic abortion or postpartum endometritis in the previous three months.


  • Current pregnancy.
  • Between 48 hours and four weeks postpartum. UK medical eligibility criteria (UKMEC) state that risks generally outweigh benefits if postpartum insertion occurs between 48 hours and four weeks. Beyond four weeks postpartum, benefits outweigh risks, even if the woman is breastfeeding (there is no increased copper level in breast milk).[10]

Uterine factors

  • Uterine abnormality distorting the uterine cavity - eg, fibroids, bicornuate uterus.
  • Uterus less than 5.5 cm in length on sounding.
  • The device may be expelled, but may also be less effective (eg, if placed in one horn of bicornuate uterus).

Gynaecological cancers

  • Ovarian, cervical or endometrial cancer.
  • Malignant trophoblastic disease.
  • Undiagnosed irregular vaginal bleeding/suspicion of genital malignancy.

Adverse reactions to copper
Copper allergy or Wilson's disease.

Other factors

  • Previous history of bacterial endocarditis after prosthetic valve replacement.
  • Significant immunosuppression.

Relative contra-indications - usable with caution[10]

  • Nulliparous, young age (see under 'Special groups', below).
  • Definite history of pelvic infection.
  • High risk of STI.
  • Known HIV infection.
  • Structural heart disease, with risk of endocarditis. The American Heart Association and NICE recommend discussion with the patient's own cardiologist but do not routinely recommend the use of antibiotic prophylaxis for genitourinary procedures.
  • History of ectopic pregnancy.
  • Patient has a prosthesis which could be compromised by blood-borne infection.
  • Two days to four weeks postpartum.
  • Benign trophoblastic disease.
  • Severe cervical stenosis.
  • Fibroids or congenital abnormality of uterus, but no marked distortion of the cavity.
  • After endometrial ablation or resection.
  • Between 48 hours and four weeks post-termination: the chances of expulsion following insertion are slightly increased in this period. It is recommended that the IUCD/IUS should only be inserted at this time if the patient is at risk of pregnancy and finds no other method acceptable and the operator is experienced.

Post-termination insertion

  • Insertion after termination of pregnancy is safe and practical. It can often be a convenient time to perform the procedure and may avoid some discomfort. Expulsion rates are marginally increased.
  • Insertion following terminations of pregnancy of more than 14 weeks of gestation are usually postponed for two weeks.

Use in adolescents

  • There are little data regarding safety, efficacy and acceptability in adolescents.
  • Women aged under 20 years are more likely to request removal due to pain and bleeding, or to experience expulsion, although discontinuation rates of all methods of contraception are higher in this age group.
  • There is no evidence to suggest that infection rates at insertion are any higher in adolescents.
  • A systematic review which looked at case reports of use in teenagers suggested that continuation rates are high and pregnancy rates low, although none addressed the TCu380A.[6]

Use in nulliparous women

  • The Cu-IUCD is a recommended form of contraception for nulliparous women.
  • The length, width and depth of the uterus tend to be smaller in nulliparous women.
  • Continuation rates of the TCu380A can be particularly low in this group; discontinuation being mainly for pain and bleeding.

For complications associated directly with the insertion process, including perforation, expulsion and lost threads, see the separate Intrauterine Contraceptives (IUCD and IUS) - Management article.

Altered or abnormal bleeding

  • Prolonged, heavier and more painful periods are common after insertion of a Cu-IUCD, and are the most common reason for discontinuation of the device.
  • For women using an IUCD, non-steroidal anti-inflammatory drugs can be used to treat spotting, light bleeding or prolonged menses. Thrombolytics such as tranexamic acid may be used for menorrhagia.
  • Heavy bleeding should make the clinician consider the possibility of early pregnancy at the time of insertion.
  • Menstrual bleeding and pain are the most common reasons for early discontinuation of intrauterine contraception.
  • Abnormal bleeding beyond the first six months after insertion requires investigation for gynaecological pathology.

Pelvic infection

  • This is most strongly related to the insertion procedure and to the background risk of STIs.
  • There is a sixfold increase in risk of PID in the first 20 days following insertion.
  • If pelvic infection is suspected in a woman using an IUCD/IUS then antibiotics should be started.
  • The device does not need to be removed unless symptoms fail to resolve within 72 hours.
  • Women should be followed up and their partners treated where appropriate. Sexual health risk assessment and counselling should be offered.

Actinomyces-like organisms

  • Actinomyces-like organisms (ALOs) are commensals of the female genital tract and have been identified in women with and without intrauterine contraception.
  • Their role in infection in women using intrauterine contraception is not clear.
  • If ALOs are seen on a swab or smear, removal of the device is not indicated if the woman is asymptomatic.[7]
  • If symptoms of pelvic pain occur in conjunction with the presence of ALOs, other causes of infection should be considered and removal of the device may be advisable.


  • Ectopic pregnancy must be excluded although most pregnancies will be intrauterine.
  • Ectopic pregnancy is increased relative to normal pregnancies where copper devices are used. However, there is no absolute increase in risk.
  • Women who become pregnant must be counselled regarding the increased risk of second-trimester miscarriage, infection and preterm delivery if the device remains in situ, and that removal reduces these outcomes but is associated with a small risk of miscarriage.
  • If threads are visible or retrievable in the endocervical canal, the device should be removed up to 12 weeks of gestation.
  • In other cases the device should be sought at delivery or termination and, if not detected at this time, an abdominal X-ray performed to ensure it is not extrauterine.

Evidence suggests that the IUCD does not delay return to fertility after removal.

Where pregnancy is desired

The IUCD can be removed at any time.

Where pregnancy is not desired

  • The IUCD should be removed with menstruation or, if there has been no unprotected sexual intercourse in the previous seven days, at other times.
  • Where the IUCD is to be exchanged, intercourse should be avoided for the previous seven days in case re-insertion fails.
  • Where removal is at the end of the licensed duration use: remove at any time in the menstrual cycle. If pregnancy is to be avoided, remove in the first few days after the onset of menstruation or advise condoms or abstinence from sexual intercourse for at least seven days before the procedure in case re-insertion is not possible.
  • When switching to the COC pill, remove after seven consecutive pills.
  • When switching to the depot or implant progestogen methods, remove the IUCD after seven days of use of the new method.

Postmenopausal removal

If inserted after the age of 40 years, the IUCD can continue to be used and will remain effective for contraception until the menopause is confirmed.

IUCD - gold standard is the banded T-Safe copper 380A®

IUS - Mirena® or Jaydess®

Method of action

Prevents fertilisation and inhibits implantation.

Prevent implantation mainly.
Duration of action

5-10 years if contains 380 mm copper.

Until no longer requires contraception.

Mirena® is effective for five years or until contraception is no longer required.

Jaydess® is effective for three years.

Failure rate

1-2% over five years for most devices.[1]

Evidence suggests that the latest copper-banded IUCDs are better than the COC pill and as effective as sterilisation.[11]

Expulsion in less than 1 woman in 20 per five years.


PID incidence is less than 1% if there is low risk for STI.

Perforation incidence is less than 1 per 1,000.[1]

Ectopic pregnancy risk is 1 in 20, if pregnant with IUCD in situ.

60% request removal within five years due to bleeding, pain or hormonal problems.

PID risk is less than 1%, if there is low risk for STI.

Perforation risk is less than 1 per 1,000.

Ectopic pregnancy risk is 1 in 20, if pregnant with IUS in situ.

Query increased risk of acne.

Effect on mensesIncreased menstrual loss and dysmenorrhoea.

Irregular bleeding and spotting for first six months.

Oligomenorrhoea or amenorrhoea likely if these persist for one year.

Lesser chance of amenorrhoea with Jaydess®.

Return to fertilityNo delay.No delay.
Advice given at fitting

Pain and discomfort last a few hours, followed by light bleeding for a few days.

Watch for signs of perforation.

Follow-up should be in 3-6 weeks.

Return if concerned.

Check threads.

Pain and discomfort last a few hours, followed by light bleeding for a few days.

Watch for signs of perforation.

Follow-up should be in 3-6 weeks.

Return if concerned.

Check threads.

Editor's note

Dr Krishna Vakharia, 24th March 2023[12]

An observational study looking at progesterone and breast cancer risk has been published. It was shown that there was an elevated risk of breast cancer- 20-30% - in women who are under 50 who currently use or have recently used progesterone-only contraception. This is in all forms of progesterone-only contraception: pill, implant, injection and coil.

It was shown that in those people who had progesterone-only contraception for five years, the 15-year absolute excess risk of breast cancer associated with use of oral contraceptives ranges from 8 per 100,000 users for use from age 16 to 20 to about 265 per 100,000 users for use from age 35 to 39.

However, taking into account that in 20-year-olds the risk of breast cancer is extremely low, this added risk with progesterone-only contraception remains very low. Factors such as excessive alcohol use (increases breast cancer risk by 20%) and obesity will have a similar degree of risk for breast cancer. Pregnancy and all the potential risks that entails, such as blood clots, gestational diabetes as well as the emotional trauma of an unwanted pregnancy or termination, need to be taken into account when counselling.

The risk of breast cancer increases with age - however, it still remains low. The added risk in the 35-39 year group is still low. All women should be told about the risks when taking hormonal contraception.

For those who have a high risk of cancer - those who have the BRCA 1 or BRCA 2 genes or a strong family history - there is no evidence yet to know what the increased risks would be, and should be discussed during contraception counselling.

Currently, the guidance for having progesterone-only contraception has not changed, as benefits outweigh the risks.

Dr Mary Lowth is an author or the original author of this leaflet.

Further reading and references

  1. Long-acting reversible contraception; NICE Clinical Guideline (October 2005 - updated July 2019)

  2. Daniele MAS, Cleland J, Benova L, et al; Provider and lay perspectives on intra-uterine contraception: a global review. Reprod Health. 2017 Sep 2614(1):119. doi: 10.1186/s12978-017-0380-8.

  3. Firman N, Palmer MJ, Timaeus IM, et al; Contraceptive method use among women and its association with age, relationship status and duration: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Sex Reprod Health. 2018 May 25. pii: bmjsrh-2017-200037. doi: 10.1136/bmjsrh-2017-200037.

  4. Intrauterine Contraception; Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit (2015 - last updated September 2019)

  5. O'Brien PA, Kulier R, Helmerhorst FM, et al; Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception. 2008 May77(5):318-27. doi: 10.1016/j.contraception.2007.12.011. Epub 2008 Mar 18.

  6. Wildemeersch D, Jandi S, Pett A, et al; Use of frameless intrauterine devices and systems in young nulliparous and adolescent women: results of a multicenter study. Int J Womens Health. 2014 Aug 66:727-34. doi: 10.2147/IJWH.S65462. eCollection 2014.

  7. Contraception - IUS/IUD; NICE CKS, March 2019 (UK access only)

  8. CEU Clinical Guidance: Emergency Contraception; Faculty of Sexual and Reproductive Healthcare (March 2017 - updated December 2020)

  9. Contraception - emergency; NICE CKS, February 2017 (UK access only)

  10. UK Medical Eligibility Criteria Summary Table for intrauterine and hormonal contraception; Faculty of Sexual and Reproductive Healthcare, 2016 - amended September 2019

  11. Contraception - assessment; NICE CKS, Dec 2017 (UK access only)

  12. Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case–control study and meta-analysis; Public Library of Science (PLOS, March 2023