Editing Copper IUD (section)

=== Complications ===
The most common complications related to the copper IUD are expulsion, perforation, and infection. [[Infertility]] after discontinuation and [[Breastfeeding difficulties|difficulty breastfeeding]] during use are not associated with the copper IUD.<ref name=":2" /><ref name="Dean 2011" />

Expulsion rates can range from 2.2% to 11.4% of users from the first year to the 10th year. The TCu{{Nbsp}}380A may have lower rates of expulsion than other models,  and the frameless copper IUD has a similar rate of expulsion to models with frames.<ref>{{cite journal | vauthors = O'Brien PA, Marfleet C | title = Frameless versus classical intrauterine device for contraception | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003282 | date = January 2005 | pmid = 15674904 | doi = 10.1002/14651858.CD003282.pub2 | collaboration = Cochrane Fertility Regulation Group }}</ref><ref name="Kane2010">{{cite journal | vauthors = Kaneshiro B, Aeby T | title = Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device | journal = International Journal of Women's Health | volume = 2 | pages = 211–220 | date = August 2010 | pmid = 21072313 | pmc = 2971735 | doi = 10.2147/ijwh.s6914 | doi-access = free }}</ref> Expulsion is more likely with immediate or early postpartum or post-abortal placement.<ref name=":10" /><ref name="Averbach et al 2020">{{cite journal | vauthors = Averbach SH, Ermias Y, Jeng G, Curtis KM, Whiteman MK, Berry-Bibee E, Jamieson DJ, Marchbanks PA, Tepper NK, Jatlaoui TC | title = Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis | journal = American Journal of Obstetrics and Gynecology | volume = 223 | issue = 2 | pages = 177–188 | date = August 2020 | pmid = 32142826 | pmc = 7395881 | doi = 10.1016/j.ajog.2020.02.045 }}</ref> In the postpartum period, expulsion is less likely when the device is placed less than ten{{Nbsp}}minutes after the placenta is delivered, or when inserted after a [[Caesarean section|cesarean delivery]].<ref name=":3" /> Unusual vaginal discharge, cramping or pain, [[Intermenstrual bleeding|spotting between periods]], postcoital (after sex) spotting, [[Dyspareunia|pain during intercourse]] (dyspareunia), or the absence or lengthening of the strings can be signs of a possible expulsion.<ref name="Dean 2011" /> As with intentional removal, the device is immediately ineffective after expulsion. If an IUD with copper is inserted after an expulsion has occurred, the risk of re-expulsion has been estimated in one study to be approximately one third of cases after one year.<ref>{{cite journal | vauthors = Bahamondes L, Díaz J, Marchi NM, Petta CA, Cristofoletti ML, Gomez G | title = Performance of copper intrauterine devices when inserted after an expulsion | journal = Human Reproduction | volume = 10 | issue = 11 | pages = 2917–2918 | date = November 1995 | pmid = 8747044 | doi = 10.1093/oxfordjournals.humrep.a135819 }}</ref> [[Magnetic resonance imaging]] (MRI) may cause dislocation of a copper IUD, and it is therefore recommended to check the location of the IUD both before and after MRI.<ref name="Berger-KulemannEinspieler2013">{{cite journal | vauthors = Berger-Kulemann V, Einspieler H, Hachemian N, Prayer D, Trattnig S, Weber M, Ba-Ssalamah A | title = Magnetic field interactions of copper-containing intrauterine devices in 3.0-Tesla magnetic resonance imaging: in vivo study | journal = Korean Journal of Radiology | volume = 14 | issue = 3 | pages = 416–422 | year = 2013 | pmid = 23690707 | pmc = 3655294 | doi = 10.3348/kjr.2013.14.3.416 }}</ref>

[[File:Perforated IUD.jpg|thumb|[[Transvaginal ultrasonography]] showing a perforated copper IUD as a [[hyperechoic]] (rendered as bright) line at right, 3 centimeters away from the [[uterus]] at left. The IUD is surrounded by a hypoechoic (dark) [[foreign-body granuloma]].]]

Perforation of the device through the uterine wall typically occurs at the time of placement, though it may occur spontaneously during the period of use. Estimates of the rate of perforation vary from 1.1 per 1000 to 1 per 3000 copper IUD insertions.<ref name="Good2010" /><ref name=":2" /> Perforation may be slightly more common in people using the copper IUD while breastfeeding.<ref>{{cite journal | vauthors = Berry-Bibee EN, Tepper NK, Jatlaoui TC, Whiteman MK, Jamieson DJ, Curtis KM | title = The safety of intrauterine devices in breastfeeding women: a systematic review | journal = Contraception | volume = 94 | issue = 6 | pages = 725–738 | date = December 2016 | pmid = 27421765 | pmc = 11283814 | doi = 10.1016/j.contraception.2016.07.006 }}</ref>

Due to its inflammatory mechanism of action, a copper IUD that has completely perforated typically requires surgical removal due to the formation of dense [[Adhesion (medicine)|adhesions]] around the device. A device embedded in the uterine wall may be removed [[Hysteroscopy|hysteroscopically]] or surgically.<ref name="Good2010" /><ref name=":3" />

The insertion of a copper IUD poses a transient risk of [[pelvic inflammatory disease]] (PID) for 21{{Nbsp}}days, though this is almost always in the setting of undiagnosed [[gonorrhea]] or [[chlamydia]] infection at the time of insertion. This occurs in less than 1 in 100 insertions. Beyond this time frame there is no increased risk of PID associated with copper IUD use.<ref name=":3" /><ref name="Moh2006" /><ref name=":2" /><ref name="USAID">{{Cite web |title=Infection Prevention Practices for IUD Insertion and Removal |url=http://www.maqweb.org/iudtoolkit/service_delivery/infectionprevention.shtml |archive-url=https://web.archive.org/web/20100101152205/http://www.maqweb.org/iudtoolkit/service_delivery/infectionprevention.shtml |archive-date=January 1, 2010}} By the United States Agency for International Development (USAID). Retrieved on February 14, 2010</ref><ref name="Dean 2011" /> Postpartum insertion of a copper IUD is not associated with increased risk of infection, provided that the delivery was not complicated by an infection such as [[chorioamnionitis]].<ref name=":3" />