How Copper T Works: Function, Insertion, Side Effects and Removal

A Copper T is a small, T-shaped intrauterine device (IUD) that is placed in the uterus to prevent pregnancy. It works by releasing copper, which is toxic to sperm and stops them from fertilising an egg. It contains no hormones and, depending on the type, can work for 5 to 10 years.

This guide explains how Copper T works, its parts, how it is inserted and removed by a healthcare provider, common side effects and when to see a doctor.

What Is a Copper T?

Copper T, also called a copper IUD or copper IUCD (intrauterine contraceptive device), is a long-acting, reversible method of contraception. It is one of the methods offered under India's national family planning programme and is widely available at government and private health facilities.

Two types are commonly used in India: Cu 380A, approved for up to 10 years, and Cu 375, approved for up to 5 years..

How Copper T Works to Prevent Pregnancy

The main function of Copper T is to stop sperm from fertilising an egg. The copper on the device slowly releases copper ions into the uterus. These ions cause a mild local reaction in the lining of the uterus that is toxic to sperm, reduces their movement and makes it very hard for them to reach and fertilise an egg.

Because it works mainly by preventing fertilisation, Copper T starts working as soon as it is inserted. A healthcare provider may also insert it as emergency contraception within 5 days of unprotected sex.

Parts of a Copper T

How Effective Is Copper T?

Copper T is more than 99% effective at preventing pregnancy. Because it does not depend on remembering to take or use anything, there is very little room for user error. The table compares typical first-year effectiveness with other methods.

Copper T does not protect against sexually transmitted infections (STIs) or HIV. Condoms are still needed for that.

Benefits of Copper T

1. Long-lasting: 5 to 10 years depending on the type.
2. Hormone-free, so it avoids hormonal side effects.
3. Can be used while breastfeeding.
4. Fertility returns quickly after removal.
5. Can be removed at any time by a provider if you want to become pregnant or change method.
6. Low cost over its lifetime.

Who Should Not Use Copper T

A healthcare provider will check your medical history before insertion. Copper T is usually not advised if you:

1. Are pregnant or might be pregnant.
2. Have a current pelvic infection, untreated gonorrhoea or chlamydia, or an infection after childbirth or abortion.
3. Have unexplained vaginal bleeding that has not been checked.
4. Have a uterus shape distorted by fibroids or other conditions.
5. Have cervical or uterine cancer awaiting treatment.
6. Are allergic to copper or have Wilson's disease.

How Is Copper T Inserted?

Copper T is inserted by a trained doctor or nurse in a clinic. It takes a few minutes. After checking that you are not pregnant, the provider examines the pelvis, measures the uterus, places the device through the cervix using a thin applicator, and trims the threads so they sit at the top of the vagina.

Most people feel cramping or pressure during insertion, which usually settles soon after. Mild cramps and spotting for a few days are common.

When Can Copper T Be Inserted?

1. At any time in the menstrual cycle if pregnancy has been ruled out.
2. Soon after childbirth (within 48 hours, known as PPIUCD) or from about 6 weeks after delivery.
3. Immediately after an abortion, if there is no infection.
4. Within 5 days of unprotected sex, as emergency contraception.

Instruments Used for Copper T Insertion

For clinic teams, a standard Copper T insertion set usually includes a sterile vaginal speculum, a tenaculum or vulsellum forceps, a uterine sound, sponge-holding forceps, long scissors to trim the threads, antiseptic solution, swabs and sterile gloves.

Living With a Copper T

Checking the Threads

Your provider will show you how to feel for the threads with clean fingers at the top of the vagina, usually after each period. Feeling the threads confirms the device is still in place. Do not pull on them.

If You Cannot Feel the Thread

If you cannot feel the threads, or they feel shorter or longer than before, the device may have moved, or the threads may simply have curled up into the cervix. Use condoms or avoid sex until a doctor or nurse has checked you. They can usually locate the threads during an examination, or with an ultrasound if needed.

Side Effects and Risks of Copper T

Most people use Copper T without serious problems. Common side effects are:

1. Heavier, longer or more painful periods, especially in the first 3 to 6 months.
2. Spotting between periods.
3. Cramping or back pain for a few days after insertion.

Less common risks include:

1. Expulsion: the device partly or fully slips out, most often in the first year.
2. Infection: a small increase in the risk of pelvic infection in the first few weeks after insertion.
3. Perforation: rarely, the device pushes into or through the wall of the uterus during insertion.
4. Pregnancy with the device in place: very rare, but it needs urgent assessment because of a higher chance of ectopic pregnancy.

When to See a Doctor

1. You cannot feel the threads, or you can feel the hard plastic of the device.
2. Severe pain in the lower abdomen, fever, or unusual vaginal discharge.
3. Very heavy bleeding or bleeding after sex.
4. A missed period or signs of pregnancy.
5. Pain during sex. A partner may occasionally feel the threads; a provider can trim them if needed.

How Is Copper T Removed?

Copper T must be removed by a trained healthcare provider. Do not try to remove it yourself or pull on the threads, as this can cause pain, injury or leave part of the device behind.

Removal is usually quick. The provider uses a speculum to see the cervix, holds the threads with forceps and gently pulls. The arms of the T fold up as it comes out. If the threads cannot be seen, the provider may use a special instrument, ultrasound or, rarely, a hysteroscope (a thin camera) to remove it safely.

When Should a Copper T Be Removed?

1. When it reaches the end of its approved duration (5 or 10 years, depending on the type). A new one can be inserted at the same visit.
2. When you want to become pregnant.
3. If you have problems such as severe pain, infection or heavy bleeding.
4. After menopause, usually one year after your last period.