Copper IUD Side Effects: A Real Story (Episode 341)

Full Transcript: Episode 341

This is the Fertility Friday Podcast, episode number 341.

Lisa: Welcome to the Fertility Friday Podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys — I know, I’m a busy girl, but I manage to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health, and I’m so excited that you’re here with us today.

Today I’m sharing a brand new episode of my Pill Reality series. I’m sharing my interview with Frances, who shared her experience using the copper IUD. It was a really interesting conversation because in many of the other Pill Reality series episodes I’ve done, there were certain specific themes that would come out — really particular side effects — but in Frances’ case there were several side effects that kind of came together, and her final assessment was that she felt it may have been due to inflammation caused by the copper IUD. So this is a really interesting and compelling episode to listen to. If you have questions about the copper IUD, or if you’ve been experiencing certain side effects and weren’t sure if they could be related, this is a conversation that highlights some of the challenges that can occur. Of course, one of the things we touch on throughout the episode is that we’re certainly not anti-copper-IUD or anti-birth-control here — it’s more about providing space to share the actual experiences of women who use these devices, because not everybody does well on every type of birth control. So with that said, let’s jump into my conversation with Frances all about her experience using the copper IUD.

Lisa: I’m really excited to be here today with Frances. Frances is a member of the Fertility Friday community, and every now and then I put out posts or start conversations about hormonal contraceptives. I reached out to Frances and asked if she wanted to come on the show and share her experience. Welcome to the show.

Frances: Hello, thank you for having me on. I’m really excited.

Lisa: I’m glad to have you here. One of the things I’ve found over all the years of doing this podcast is that I always go back to this desire to provide a platform for women to share their stories and experiences, in their own words. So many of us have had experiences — whether with the pill or other health issues — where we’ve been dismissed or not taken seriously, so it’s about just saying what happened and letting everyone decide for themselves what that means for them.

Frances: Yeah, definitely, and that’s what I love about your show — I got to hear all these really interesting, unique stories that women had to tell about their experiences with contraception, which made me think about my own story, which I always thought was really weird. I rarely met any women who’d had a similar experience, and whenever I explained my story to people they just looked confused. It was actually through finding online communities and finding your podcast that I realized there was a place to tell my story, and I think it’s important to put it out there because there are probably a lot of women who can really relate to what I went through with the copper IUD.

Lisa: Absolutely — in my line of work I hear a lot of stories, and the podcast has given me an opportunity to share that so everyone who listens gets a window into what’s really going on. It’s irritating and heartbreaking that so many women go through similar experiences but feel alone, because in their own circle not that many women have experienced it. That’s what this has been about — so that you’re not alone, and anytime someone comes on the show and shares their experience, whether it’s a guest like yourself or a professional, it helps to normalize it. I think with the copper IUD especially it’s just a bit more of an unknown — the side effects of hormonal contraception are talked about more, but even in fairly progressive health circles, the copper IUD is still presented as a form of contraception that won’t affect your hormones or your mental health, and there’s still not much understanding of how it can affect you.

Lisa: Well, let’s get into it. Could you share when you got your first period, and take us through your journey with your cycles and how you were managing your fertility?

Frances: Sure — I started my period around 13 or 14, and from what I remember, my periods were pretty uneventful. They weren’t heavy or painful, and they didn’t cause much upheaval in my life; I’d get mild cramps sometimes, but generally they weren’t an issue. When I was 17 I got into my first relationship and went on the pill without putting much thought into it — I was terrified of getting pregnant, so I used condoms as well because I was terrible at remembering to take the pill. My experience with the pill was that it wiped out my libido. That was my first sexual partner and my first time using contraception, so I had no frame of reference, but at the beginning of the relationship I had a decent sex drive, and it just evaporated over time. I had no idea it was the pill causing that. I was on the pill for about a year and a half, then came off it, and I noticed my sex drive came back, along with some subtle changes in my emotional wellbeing — I felt more present and alive. I was living abroad in Ghana when I came off it, and I remember appreciating the culture more, and that sense of awe and wonder came back. I decided to go back on the pill while I was out there, and that same numbness returned, so I decided the pill wasn’t for me and came off it for good.

Lisa: There’s a couple of things you’ve said that stand out, because I’ve heard so many women describe this. I had friends in university who joked about never wanting to have sex on the pill, and others whose personalities changed completely and became very anxious. I think you did a really nice job of describing that loss of connectedness and sense of awe. Can you talk a bit more about the libido piece? It’s sad that this isn’t talked about more, because it takes away from your natural right to experience your sexuality at that age.

Frances: Definitely — not having a libido in a relationship is a big deal. Luckily the person I was with was really respectful, so it wasn’t a huge issue in that sense, but it’s hard when you’re young and feel like you should be experiencing that. Once I realized it was the pill doing this, I felt strongly that I wanted my own mind back and to feel like my authentic self, and that’s really what led me to the copper IUD — it stood out as the ideal option. When I started university I went to the sexual health clinic for contraception, looked over the leaflet, and saw it was mostly hormonal options; natural family planning was listed too, but I’d never heard of it and assumed you could get pregnant any day of the cycle, so I ignored it. Then I saw the copper IUD — long-acting and no hormones — and thought it was perfect, especially since I was so bad at remembering the pill. I did read a lot online, including some horror stories on forums, but told myself everyone’s different and people only post online about bad experiences, so that’s how I decided to get the IUD.

Lisa: Before we get into the IUD itself — one thing I find interesting is that you’d been cycling for about four years before going on the pill at 17, and you mentioned your cycles were pretty typical. Then you had the chance to go off and back on the pill, which let you notice the difference. That’s a useful comment for listeners who’ve been on hormonal contraceptives for five or ten years — once you’ve been on something for a long time, you lose your frame of reference for what your normal even is.

Frances: Totally, and that’s why I was glad I was on the pill rather than the implant or the shot, because I could just stop taking it. With the shot especially you’re committed for a while. For me, it was coming off it and then going back on a few months later that really let me notice the shift, which was really useful.

Lisa: Let’s talk about the IUD. What was the process like having it inserted, and what happened once you were taking it?

Frances: I’d done a lot of reading beforehand, so I knew the insertion was probably going to be painful, and I took some paracetamol before I went. The staff were lovely — really kind and patient — but the insertion itself was painful. I have a high cervix, so they needed an extra-long speculum instrument. I’m a pretty black-and-white person, so I told myself I’d just get through the painful part and then be sorted for five years.

Lisa: On a scale of zero to ten, where would you put the pain?

Frances: Maybe a six or seven — like a cervical smear that just keeps going, and then you get cramps afterward. Especially in my case, because they had trouble finding my cervix, which made it more uncomfortable. The nurse held my hand, which was sweet. I was in my first year of university at the time, so I spent two days in bed with a hot water bottle because the cramps were pretty bad.

Lisa: Could you say more about how long that pain lasted — at its worst, and then over those two days?

Frances: It’s been about eight years now, so I’m trying to remember, but the insertion itself probably took less than ten minutes, and that was the most painful part. After that it was abdominal cramps that felt like someone twisting a corkscrew, so I went home, ate a lot of cookies, and sat with my hot water bottle. The next day was less painful, but I still wasn’t up for doing much. After that the cramps went away, though they came back worse during my periods.

Lisa: One of the things that’s come out as I’ve interviewed more women about IUDs is that insertion pain is a much bigger deal than I initially realized. It’s interesting that a small percentage of women are offered numbing agents, and in those cases it’s much more manageable.

Frances: I think they did put a numbing gel on, though I’m not entirely sure — I wasn’t too fazed by the pain, even though I have a fairly low pain threshold. I think I should start talking about what it was like once it was in. Straight away there was a big change in my periods — I’d assumed I was an ideal candidate for the coil because my periods had always been fine, but they became really heavy and a lot longer. It was really helpful later when I read The Fifth Vital Sign, because it spelled out what a healthy amount of blood loss actually looks like, which I’d never heard before. I was using a moon cup at the time, so I could measure how much I was losing, and it was way over the healthy parameters you wrote about — a maximum of around 80 milliliters, or 60 if you’re screening for iron deficiency.

Lisa: Right — some researchers argue 60 milliliters is more appropriate for screening for iron deficiency specifically. In your case, because the copper IUD is known to increase inflammation to some degree, that’s part of why it works, but it also means you really need to stay on top of regular checks to make sure you’re not becoming iron deficient.

Frances: No one had that conversation with me, and I didn’t read anything about checking iron levels anywhere. I did become iron deficient, and I think the coil played a big part in that. Comparing my cycle to the 60-milliliter maximum — one moon cup holds about 28.8 milliliters, so roughly two moon cups plus a little is the upper limit for an optimal flow. On my heaviest day with the coil I was losing four to five full moon cups, and my periods lasted eight or nine days. So on my heaviest day I was losing well over double what I should have been, with more blood on top of that across the other days. I’m not surprised I became iron deficient.

Lisa: I appreciate you sharing the specific amounts, because most of us are just living our lives without any sense of how much blood loss is actually normal in a period.

Frances: Thinking back to my typical pre-coil cycles, I wasn’t using a moon cup then, just pads and tampons, and I don’t think I even needed tampons most of the time — pads were enough. After the coil I started using a moon cup because I couldn’t manage the flow otherwise. What I find bizarre now is that through lack of education, I didn’t realize this was unhealthy — I just knew my periods had become a real hassle every month, requiring a lot more planning around supplies, but I didn’t know it wasn’t healthy.

Lisa: It’s interesting that even though you were doing so much research and making informed decisions, there were still gaps in what you were told.

Frances: I’m not anti-IUD — I think it’s great that it exists — I’m just pro informed consent, and I think we set the bar pretty low for what women should expect from their periods, like heavy periods are just part of being a woman. Another change I noticed was that the color of my blood became really dark, almost black on the heaviest days, and dark brown and thick on lighter days. Now that I’ve had it removed, my periods are back to a brighter red, and the difference is stark.

Lisa: Did you experience any pain or cramping changes as well?

Frances: Yes — my periods became more painful, though never debilitating. On my heaviest days I’d have mild but consistent pain through most of the day, which was definitely worse than before, though it never really stopped me from doing things.

Lisa: It sounds similar to the pill experience, where at the time you didn’t necessarily think it was out of the ordinary, even though it was annoying. At what point did you decide to have it removed?

Frances: I was honestly the biggest cheerleader of the coil for a long time — I’d tell people it just gave me heavy periods and that was the only side effect, not realizing it was contributing to other things I’ll get into. About three years after getting it, I tried cutting down on meat, and almost immediately started having intense red meat cravings that persisted. A year after I had the IUD removed — which was in 2017 — I got my iron levels tested and they were low, and my GP confirmed that the heavy periods on the coil would have depleted my iron stores. I had the coil removed after about five years, and the first four years my periods were consistently very heavy; the last year they got a bit lighter for some reason. Since removal, three years now, my periods are shorter — six or seven days instead of eight or nine — and much brighter red, though not quite back to how they were before the coil.

Lisa: You mentioned other effects that led you to have it removed — could you share more?

Frances: Yes — the other big one was hormone imbalance, which is ironic given it has no hormones in it. I instinctively knew it was the IUD, even without having read about it anywhere. It started small and got worse over the years — I began getting PMS before my periods, feeling really low, sometimes even a day of feeling genuinely depressed and crying over small things, then being fine the next day. I also started getting real anxiety, including anxiety attacks before my period, which got worse over the years, to the point where I joked that periods meant a week of mental illness followed by a week of physical illness. When I had the IUD removed, my anxiety attacks cleared up almost immediately. I also started getting hot flashes and night sweats about six months after insertion, which I now understand is related to estrogen fluctuating, and worse hormonal acne around my chin. My periods really did start derailing two weeks out of every month, and I’d just gotten used to managing my emotions one week and the bleeding the next.

Lisa: The copper IUD does have real benefits — it’s non-hormonal, and you continue menstruating and ovulating, so you keep your natural cycle — but there are challenges, and every woman experiences it differently. Some women I’ve interviewed have had increased cramping at random times throughout the cycle, not just during their period, which is an interesting and less predictable side effect.

Frances: I know someone who had shooting pains down her leg with it, so it really can have powerful effects on different people. I thought my experience was really unusual, since it has no hormones — I assumed I must be the only person having this kind of reaction.

Lisa: For all the birth control methods available, the copper IUD potentially has the least direct impact on your hormones, but some studies do show slightly lower progesterone levels in the luteal phase for copper IUD users. That makes sense given the copper IUD works partly through a spermicidal effect and partly through a degree of inflammation that makes the uterine lining inhospitable, which could plausibly have a subtle impact on hormone levels and contribute to increased PMS symptoms, since PMS symptoms typically coincide with the drop in progesterone the week before your period. That said, a stressful life would also be a contributing factor.

Frances: That makes sense — I’ve been working with a naturopath for the last three years, and we identified that I have low progesterone and probably some estrogen dominance, so it makes sense that any contraceptive device influencing my periods could be influencing my hormones through an indirect mechanism, even without containing hormones itself. Even three years after having it removed, I still get occasional hot flashes, which I never had before the coil.

Lisa: If you were charting, it would be interesting to see where in your cycle that’s happening and whether it’s consistent.

Frances: It seems to happen just before my period starts.

Lisa: That’s when estrogen is highest, so there’s an opportunity to look at whether your body is processing that estrogen the way it’s supposed to.

Lisa: Knowing what you know now, if you could talk to yourself before you got the copper IUD, what would you say, and would you have chosen differently?

Frances: There’s one more thing I wanted to mention first, which is probably the worst part of how it affected me — my mental health got really bad on the copper IUD. It was a slow burn; I’ve always had some anxiety, but looking back, once I had it inserted my anxiety got noticeably worse, and I started obsessing over things much more, with dark, obsessive thoughts I couldn’t shake for years. I never connected this to the IUD at the time — I just thought it was part of being an anxious person. Eventually I had it removed to see if it would help with some other health issues, and the best way I can describe how I felt afterward is like a veil had been lifted — my anxieties started to melt away and I could think about them much more clearly. The difference was really stark, and it makes me sad because I had the copper IUD from about 19 to 24, which were important years, and I know now I would have been happier without it.

Lisa: When you say you’d have tried to convince yourself not to take it, is that mostly because of the anxiety?

Frances: Yes, definitely — the heavy periods and iron deficiency I could sort of manage, and the hormone imbalance contributed to that too, but the anxiety and dark, obsessive thoughts really brought me down during years when I wanted to feel carefree. It’s hard to know what I would have done differently, since pregnancy wasn’t an option for me at the time, but I think I would have been happier without it.

Lisa: You mentioned panic attacks — did those completely resolve after removal?

Frances: I’d call them anxiety attacks rather than panic attacks — a physical feeling of being overwhelmed, heart racing, unpleasant but never debilitating. After I had it removed, in the two years that followed I had barely any anxiety attacks at all; it was night and day.

Lisa: That’s a surprising side effect, since it’s not hormonal. I’ve talked a lot about hormonal contraceptives and how they relate to anxiety, depression, and intrusive thoughts, often connected to B-vitamin depletion affecting tryptophan and serotonin production, alongside hormonal disruption. In your case there are no synthetic hormones, but the shifts you experienced in your periods and PMS symptoms suggest there were still hormonal changes happening as a byproduct.

Frances: I couldn’t believe it — personally I think it’s the inflammation. I’ve since learned through working with my naturopath that I had a lot of other chronic inflammation going on, so I think the IUD may have added fuel to that, which might be why it wasn’t a great match for me.

Lisa: It makes sense if you think of it like a foreign object in the body — if you have a splinter, your body develops inflammation around it and tries to expel it. I’ve spoken to women whose bodies actually expelled the IUD.

Frances: I’ve heard stories like that in Facebook groups too. It’s a foreign object in your body, and this isn’t about judgment — it’s about having the conversation and exploring the ideas.

Lisa: Exactly — if you have a foreign body inserted into an internal organ and it causes inflammation, that’s actually part of why it’s an effective method, since without that inflammatory response it likely wouldn’t work as well. But that also means the body may see it as something to be resisted.

Frances: That’s what I understand now, yes.

Lisa: Well, I just want to thank you so much for sharing your experience and taking us through it — it really puts together an interesting picture of the copper IUD, because in your case it wasn’t just one thing, it was all these different pieces coming together.

Frances: If I had to sum up my experience with the copper IUD, I’d say it was really inflammatory — it inflamed my body from the get-go and unbalanced me so much. I’m not saying that’s the case for everyone, but in my case I don’t think it was the right method for me. By the end I felt so depleted — of iron, energy, and emotional resilience — that I’m just glad I took the chance to have it removed instead of getting a new one put in.

Lisa: Thinking about everything you’ve shared — at the time you got it, it felt like the answer to everything, even though you’d read about some of the negative side effects. This is one of the challenges for a lot of women, especially now, when the choice can feel very binary between being on the pill or being pregnant. What would have been useful for you to know going in is what a normal period actually looks like, because that information alone could have let you watch for warning signs, address the iron deficiency earlier, and understand the potential link to hormonal and emotional symptoms — giving you more informed choices along the way, regardless of what you ultimately decided.

Frances: No, I think just having more information about what a healthy period looks like would have helped, especially since long-acting contraception is pushed so heavily in the UK. When I came off the IUD I had to work through feelings of being irresponsible, the same way I’d felt going on it in the first place — like I was doing the responsible adult thing. Luckily, now that I’m learning fertility awareness through your podcast, I know there’s another effective option, and I’ve developed a lot of confidence and knowledge about my body, even though I’m still learning and taking it slowly since I’m single right now. It’s been amazing to realize how much you can learn just by observing your own bodily signs.

Lisa: It sounds like fertility awareness is a great fit for your personality, since you were already an avid researcher.

Frances: Definitely — I love seeing my cervical fluid, it’s honestly fascinating to me.

Lisa: For the woman listening who feels the way you did in your late teens and early twenties, and feels like the non-hormonal options aren’t really presented as valid alternatives — what would you want her to know?

Frances: I’d say every woman knows what’s best for her at that point in her life, but the best thing to do is educate yourself about fertility awareness. If I’d known about it earlier, I might still have chosen the copper IUD, but I’d have known there were other options in the back of my mind. I’m reading Taking Charge of Your Fertility now and I’m amazed at how little I knew about this method — it really is a serious option. I’m still single at the moment, so I haven’t used it as contraception yet, but I think the best thing anyone can do is educate themselves and then make the most informed decision they can.

Lisa: Absolutely. Frances, thank you so much for being here.

Frances: Thank you so much for having me on — it’s been really fun, I really appreciate it.

Lisa: I hope you enjoyed today’s episode — another really insightful conversation about contraceptives, in this case a non-hormonal one. One question I get a lot when sharing information about hormonal contraceptives is what my opinion is of the copper IUD, and the honest answer is that for me personally, given my own history of heavier and more painful periods, it wasn’t the right option — though that doesn’t carry over to everyone. If you have periods that are already on the heavier or more painful side, it’s worth knowing that many women who use the copper IUD experience an increase in bleeding and cramping intensity, at least in part due to the inflammation that is one of the device’s main modes of action. For women who had lighter periods to begin with, the increase may be much less noticeable. Other side effects some women have described on the show include cramping that occurs outside of the period itself, at random points in the cycle, which is harder to plan for than period-related cramping. And of course, one of the most common threads across IUDs generally is insertion pain — something I’ve talked about more as I’ve done more of these interviews, and something that’s especially worth being aware of if you’ve never had a baby or a procedure involving the cervix before, since that can increase the likelihood of a more painful insertion. Many doctors don’t routinely mention that you can ask for pain relief or numbing during insertion, and that’s worth knowing going in. At the end of the day, this comes back to informed consent, and to giving women the platform to share their own experiences, because historically, women’s collective experiences with these devices and methods are often minimized or dismissed. Thank you so much for tuning in to today’s show — if you feel like this episode could benefit someone you know, please share it. I wish you all a wonderful week, and as always, until next time, be well and happy charting.