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Less than 1 percent of women who use ParaGard will get pregnant in the first year of typical use. If you do conceive while using ParaGard, you're at higher risk of an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. However, because ParaGard prevents most pregnancies, the overall risk of having an ectopic pregnancy is lower than it is for other sexually active women who don't use contraception.

ParaGard doesn't offer protection from sexually transmitted infections (STIs).

Side effects associated with ParaGard include:

• Anemia
• Backache
• Bleeding between periods
• Cramps
• Inflammation of the vagina (vaginitis)
• Pain during sex
• Severe menstrual pain and heavy bleeding
• Vaginal discharge

It's also possible to expel ParaGard from your uterus. You might not even feel it if this happens. You may be more likely to expel ParaGard if you:

• Have never been pregnant
• Have heavy or prolonged periods
• Have severe menstrual pain
• Previously expelled an IUD
• Are younger than age 20
• Had the IUD inserted immediately after childbirth or a second trimester abortion

Your health care provider will evaluate your overall health and do a pelvic exam before inserting ParaGard. He or she may also recommend screening for STIs. You can have ParaGard inserted anytime during a normal menstrual cycle if you've been consistently using another birth control method or you haven't had sex since your last period.

If you are breast-feeding, have irregular periods or haven't been consistently using birth control, you may need to take a pregnancy test before ParaGard is inserted or have it inserted during a period.

Taking a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin IB, others), one to two hours before the procedure can help reduce cramping.

ParaGard is typically inserted in a health care provider's office.

During the procedure

Your health care provider will insert a speculum into your vagina and cleanse your vagina and cervix with an antiseptic solution. Then he or she may use a special instrument to gently align your cervical canal and uterine cavity, and another tool to measure the depth of your uterine cavity. Next, your health care provider will fold down ParaGard's horizontal arms and place the device inside an applicator tube.

He or she will insert the tube into your cervical canal and carefully place ParaGard in your uterus. When the applicator tube is removed, ParaGard will remain in place. Your health care provider will trim ParaGard's strings so that they don't protrude too far into the vagina and may record the length of the strings.

During ParaGard insertion, as with some other procedures, you may experience dizziness, fainting, nausea, low blood pressure or a slower than normal heart rate (bradycardia). Your health care provider will likely suggest that you stay lying down for a few minutes after the procedure to allow these side effects to pass. Rarely, it's also possible for the IUD to perforate the uterine wall or cervix.

After the procedure

After every period, check to feel that ParaGard's strings are protruding from your cervix. Don't pull on the strings. It's OK to use tampons with ParaGard.

About a month after ParaGard is inserted, your health care provider may re-examine you to make sure the device hasn't moved and check for signs and symptoms of infection.

While you're using ParaGard, contact your health care provider immediately if you have:

• Signs or symptoms of pregnancy
• Unusually heavy vaginal bleeding
• Foul vaginal discharge
• Worsening pelvic pain
• Severe abdominal pain or tenderness
• Unexplained fever
• Possible exposure to a sexually transmitted infection

It's also important to contact your health care provider immediately if you think ParaGard is no longer in place. Call your doctor if:

• You have breakthrough bleeding or bleeding after sex
• Sex is painful for you or your partner
• The strings are missing or suddenly seem longer
• You feel part of the device at your cervix or in your vagina

Your health care provider will check the location of ParaGard and remove it if necessary.

Removal

ParaGard is usually removed in a health care provider's office. Your provider will likely use forceps to grasp the device's strings and gently pull. The device's arms will fold upward as it's withdrawn from the uterus.

Light bleeding and cramping are common during removal. In some cases, removal may be more complicated.