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Who Should Not Use Paragard?

Do not use Paragard if you:

  • Might be pregnant
  • Have a uterus that is abnormally shaped inside
  • Have a pelvic infection called pelvic inflammatory disease (PID) or have current behavior that puts you at high risk of PID
  • Have had an infection in your uterus after a pregnancy or abortion in the past 3 months
  • Have cancer of the uterus or cervix
  • Have unexplained bleeding from your vagina
  • Have an infection in your cervix
  • Have Wilson’s disease
  • Are allergic to anything in Paragard
  • Already have an IUD in your uterus
  • Get infections easily

Before having Paragard placed, tell your healthcare provider if you have any of the conditions listed above, a slow heart beat, dizziness, seizures, recently had a baby or if you are breastfeeding, have AIDS, HIV, or any other sexually transmitted infection.

What are the Possible Side Effects of Paragard?

Paragard can cause serious side effects, including:

  • Ectopic Pregnancy and Intrauterine Pregnancy Risks: There are risks if you become pregnant while using Paragard (see “What if I become pregnant while using Paragard?”).
  • Life-Threatening Infection: Life-threatening infection can occur within the first few days after Paragard is placed. Call your healthcare provider immediately if you develop severe pain or fever shortly after Paragard is placed.
  • Pelvic Inflammatory Disease (PID) or Endometritis: Some IUS users get a serious pelvic infection called pelvic inflammatory disease (PID) or endometritis. PID and endometritis are usually sexually transmitted; you are at a higher risk if you or your partner has sex with others. PID and endometritis are usually treated with antibiotics. PID and endometritis can cause serious problems such as infertility, ectopic pregnancy, and chronic pelvic pain. More serious cases may require surgery and rarely, PID can even cause death. Tell your healthcare provider right away if you have any of these signs of PID or endometritis: low abdominal (stomach area) or pelvic pain, pelvic tenderness, painful sex, unusual or bad smelling vaginal discharge, chills, long-lasting or heavy bleeding, fever, genital lesions or sores.
  • Embedment: Paragard may become attached to (embedded) the wall of the uterus. This may make it hard to remove Paragard. Surgery may be needed.
  • Perforation: Paragard may go through the wall of the uterus. This is called perforation. You are not protected from pregnancy if perforation occurs. It may move outside the uterus and cause scarring, infection, damage to other organs, pain, or infertility. Surgery may be needed. Excessive pain or vaginal bleeding during placement of Paragard, pain or bleeding that gets worse after placement, or not being able to feel the threads may happen with perforation. The risk of perforation is increased in breastfeeding women.
  • Expulsion: Paragard may partially or completely fall out of the uterus. This is called expulsion. Expulsion occurs in about 2 out of 100 women. Excessive pain, vaginal bleeding during placement of Paragard, pain that gets worse, bleeding after placement, or not being able to feel the threads may happen with expulsion. You are not protected from pregnancy if Paragard is expelled.
  • Changes in Bleeding: You may have heavier and longer periods with spotting in between. Sometimes the bleeding is heavier than usual at first. Call your healthcare provider if the bleeding remains heavier or longer and spotting continues.
  • Reactions After Placement or Removal: Some women have had reactions such as dizziness (syncope), slowed heart rate (bradycardia), or seizures, immediately after Paragard was placed or removed. This happened especially in women who have had these conditions before.

Common Side Effects

You may have other side effects with Paragard. For example, you may experience anemia (low blood count), expulsion, pain during sex, spotting, prolonged or painful periods, vaginal irritation, vaginal discharge, backache, cramping or pain.

This is not a complete list of possible side effects. Tell your healthcare provider about any side effect that bothers you or does not go away.

When Should I Call My Healthcare Provider?

Call your healthcare provider if you have any concerns about Paragard. Be sure to call if you:

  • Think you are pregnant
  • Have pelvic pain or pain during sex
  • Have unusual vaginal discharge or genital sores
  • Have unexplained fever, flu-like symptoms or chills
  • Might be exposed to sexually transmitted diseases (STDs)
  • Are concerned that Paragard may have been expelled (came out)
  • Can feel any other part of the Paragard besides the threads
  • Become HIV positive or your partner becomes HIV positive
  • Have severe or prolonged vaginal bleeding
  • Miss a menstrual period
  • Cannot feel Paragard threads or can feel the threads are much longer

What if I Become Pregnant While Using Paragard?

If you think you are pregnant, contact your healthcare provider right away.  If you are pregnant while using Paragard, you may have an ectopic pregnancy which means the pregnancy is not in your uterus.  Unusual vaginal bleeding or abdominal pain may be signs of an ectopic pregnancy.  Ectopic pregnancy is a medical emergency that often requires surgery; it can cause internal bleeding, infertility and even death.

There are also risks if you get pregnant and Paragard is in your uterus. Severe infection, miscarriage, premature delivery, and even death can occur. Because of this, your healthcare provider may try to remove Paragard, even though removing it may cause a miscarriage.

If you continue your pregnancy with Paragard in place, see your healthcare provider regularly. Call your healthcare provider right away if you get flu-like symptoms, fever, chills, cramping, pain, bleeding, vaginal discharge, or fluid leaking from
your vagina.

It is not known if Paragard can cause long-term effects on the fetus if it stays in place during a pregnancy.

Is it Safe to Breastfeed While Using Paragard?

You may use Paragard when you are breastfeeding. The risk of Paragard becoming attached to (embedded) or going through the wall of the uterus is increased if Paragard is placed while you are breastfeeding.

Safe for Use In a Wide Range of Women, Including Women with Certain Medical Conditions

Before starting Paragard, you should share your full medical history with your healthcare provider to find out if Paragard is right for you.

According to CDC (Centers for Disease Control and Prevention) recommendations, Paragard may be used with no restriction in over 20 preexisting characteristics and medical conditions including but not limited to:

  • Breast cancer (family history, current, past and no evidence of current disease for 5 years)
  • Cystic fibrosis
  • Depression
  • Diabetes
  • Epilepsy
  • Gallbladder disease
  • Headaches including migraines with and without auras and menstrual migraines
  • History of bariatric surgery
  • History of stroke
  • History of high blood pressure during pregnancy
  • Hypertension
  • Inflammatory bowel disease including ulcerative colitis and Crohn’s disease
  • Ischemic heart disease
  • Liver tumors
  • Lupus
  • Malaria
  • Risk factors for cardiovascular disease including smoking
  • Multiple sclerosis (MS)
  • Ovarian cancer
  • Ovarian cysts
  • Past ectopic pregnancy
  • Thyroid disease
  • Viral hepatitis
  • Valvular heart disease
  • Women with a body mass index (BMI) greater than or equal to 30

For full list of conditions visit the CDC Website.

  • IUDs, including Paragard, have been associated with an increased risk of pelvic inflammatory disease (PID). Don’t use Paragard if you have a pelvic infection, certain cancers, a copper allergy, Wilson’s disease, or PID. Continue reading
  • If you miss a period, have persistent abdominal pain, or if Paragard comes out, tell your healthcare provider (HCP). If it comes out, use back-up birth control. Continue reading