Question explored with the scientific record
What are the options for long acting reversible non-hormonal contraception
The copper IUD is the only long-acting reversible option with zero hormones, and it works well, but the evidence shows real trade-offs in bleeding, cramping, and expulsion.
The copper IUD (Cu-IUD) is the only long-acting reversible contraceptive without hormones. It works for 5 to 10 years and is highly effective: in one large study, LARC methods like IUDs had a failure rate of about 0.27 per 100 women, versus 4.55 for pills, patches, and rings [7]. The Cu-IUD also works as emergency contraception, though most women do not know this and cost and access are major barriers [1].
The trade-offs are real. In a 5-year study, copper IUD users had expulsion rates of about 10 in 100, versus about 5 in 100 for the hormonal IUD, and pregnancy rates of 1.6 versus 0.1 [3]. Copper users also report more painful periods [4], and one study found copper IUD users gained about 5 kg over 10 years, similar to hormonal IUD users [2]. The copper IUD does not affect testosterone or SHBG levels, unlike hormonal methods [5].
The evidence has gaps. Most studies compare copper to hormonal IUDs, not to no contraception. The long-term safety data is thin, and one lab study showed copper ions can be toxic to cells at high concentrations, though this is far from proof of harm in the body [6]. No study here tracked users beyond 10 years.
| Outcome (5 years) | Copper IUD | Hormonal IUD |
|---|---|---|
| Expulsion rate | ~10 in 100 | ~5 in 100 |
| Pregnancy rate | 1.6 in 100 | 0.1 in 100 |
| Weight gain (10 yrs) | ~5 kg | ~4 kg |
My call: the copper IUD is a solid non-hormonal choice, but expect heavier bleeding and cramping, and know the expulsion risk is about double the hormonal option. Confidence: moderate, because the comparison studies are solid but the long-term safety data beyond 10 years is missing.
Sources used 7
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Acceptability of the copper intrauterine device as a form of emergency contraception in New South Wales, Australia
This cross-sectional study surveyed clients and clinicians at a New South Wales family planning service to assess knowledge, acceptability, and barriers to using the copper intrauterine device (Cu-IUD) as emergency contraception (EC), finding low client awareness, limited clinic…
DOI: 10.1080/13625187.2020.1726888 -
Weight variation in users of depot-medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine system and a copper intrauterine device for up to ten years of use
This study evaluates weight variation in women using depot-medroxyprogesterone acetate (DMPA), levonorgestrel-releasing intrauterine system (LNG-IUS), and copper intrauterine device (Cu-IUD) over a period of up to ten years, finding that DMPA users gained significantly more weig…
DOI: 10.3109/13625187.2014.951433 -
Continuation of copper and levonorgestrel intrauterine devices: a retrospective cohort study
This retrospective cohort study compares the continuation rates and performance of copper and levonorgestrel intrauterine devices (IUDs) over five years, finding no significant difference in continuation rates at five years but higher expulsion and pregnancy rates associated wit…
DOI: 10.1016/j.ajog.2017.03.005 -
Clinical performance of the TCu 380A and Lippes Loop IUDs in three developing countries
This study evaluates the clinical performance of the Copper T 380A and Lippes Loop intrauterine devices (IUDs) over 12 months in 710 women across three developing countries, finding a lower pregnancy rate for the TCu 380A IUD compared to the Lippes Loop, although not statistical…
DOI: 10.1016/0010-7824(95)00119-u -
Effects of depot medroxyprogesterone acetate, the copper IUD and the levonorgestrel implant on testosterone, sex hormone binding globulin and free testosterone levels: ancillary study of the ECHO randomized clinical trial
This study investigates the effects of depot medroxyprogesterone acetate, the copper IUD, and the levonorgestrel implant on testosterone and sex hormone binding globulin levels in young women, revealing that the levonorgestrel implant is associated with higher free testosterone …
DOI: 10.1186/s12905-024-02990-8 -
Concentration-dependent cytotoxicity of copper ions on mouse fibroblasts in vitro: effects of copper ion release from TCu380A vs TCu220C intra-uterine devices
This study investigates the concentration-dependent cytotoxicity of copper ions released from two types of intrauterine devices (TCu380A and TCu220C) on L929 mouse fibroblasts, revealing significant toxicity associated with higher copper concentrations.
DOI: 10.1007/s10544-012-9651-x -
Effectiveness of Long-Acting Reversible Contraception
This study demonstrates that long-acting reversible contraception (LARC) methods, such as IUDs and implants, significantly reduce the rate of unintended pregnancies compared to other contraceptive methods like pills, patches, and rings, particularly among younger women.
DOI: 10.1056/NEJMoa1110855