Paragard Side Effects: What to Expect and When to Call Your Doctor

Paragard is over 99% effective and hormone-free — but like any medical device, it comes with potential side effects. Knowing what to expect (and when to worry) helps you make an informed decision and respond quickly if something does go wrong.

Common Side Effects of Paragard (What's Normal)

The following side effects are common with Paragard, especially in the first 3–6 months after insertion. They are not necessarily a sign that something is wrong:

Heavier or longer menstrual periods: The most commonly reported side effect. Many people with Paragard notice periods that are heavier, longer, or more crampy than before — particularly in the first few months. For most, this improves over time.

Spotting between periods: Irregular bleeding or spotting is common in the first 3 months as your body adjusts to the device.

Cramping and pelvic pain: Cramping is normal immediately after insertion and during the first few periods. Taking ibuprofen or naproxen (NSAIDs) can help manage discomfort.

Back pain: Some people experience mild lower back pain, especially around their period, while using Paragard.

Anemia: If heavy periods are significant and ongoing, iron-deficiency anemia can develop. Ask your provider to check your hemoglobin if you feel unusually fatigued.

Serious Side Effects of Paragard — Seek Medical Attention

The following side effects are rare but serious. Contact your healthcare provider immediately or go to an emergency room if you experience:

Severe pain or intense cramping after insertion: Some discomfort is expected, but severe, worsening pain could signal perforation, infection, or expulsion.

Uterine perforation: Paragard can penetrate the uterine wall during insertion in fewer than 1 in 1,000 cases. The risk is higher in breastfeeding patients. Symptoms include severe pain, inability to feel the IUD strings, and unexpected bleeding. Surgery may be required.

Expulsion: The IUD can slip out of place or fall out completely, usually during the first few months and most often during a period. If you can no longer feel the IUD strings, use backup contraception and call your provider.

Pelvic inflammatory disease (PID): IUD insertion can introduce bacteria into the uterus, increasing PID risk slightly. Symptoms include pelvic pain, unusual discharge, fever, and painful intercourse. Seek treatment promptly.

Group A streptococcal sepsis: A rare but life-threatening infection can occur after IUD insertion. If you develop severe pain within hours of insertion followed by fever, flu-like symptoms, or signs of sepsis within days, seek emergency care immediately.

Ectopic pregnancy: If pregnancy occurs while using Paragard (rare — less than 1%), there is a higher chance it will be ectopic (outside the uterus). Signs include severe abdominal or shoulder pain, vaginal bleeding, and dizziness. This is a medical emergency.

Device fragmentation during removal: A risk that has gained attention due to ongoing litigation. In some cases, the plastic arms of Paragard may break during removal, requiring surgical retrieval. Report any unusual resistance or pain during a removal procedure to your provider immediately.

When to Call Your Doctor

Call your healthcare provider if you experience any of the following:

You can no longer feel the IUD strings

You feel the hard plastic of the IUD at your cervix

Severe or worsening pelvic pain

Fever, chills, or flu-like symptoms after insertion

Unusual vaginal discharge with odor

Signs of pregnancy (missed period, positive pregnancy test)

Extremely heavy periods that don't improve after 3–6 months

Tips for Managing Common Paragard Side Effects

For heavy periods: Take ibuprofen 400–600 mg every 6–8 hours starting the day before your period and for the first 2–3 days. NSAIDs reduce prostaglandin levels, which can decrease menstrual bleeding and cramping.

For cramping: A heating pad and NSAIDs are effective. Most cramping improves significantly after the first 3 months.

For anemia: Eat iron-rich foods (leafy greens, red meat, fortified cereals) and consider an iron supplement if your provider recommends it.

For more information on drug interactions with Paragard, see: Paragard Drug Interactions: What to Avoid. If you're looking for a provider or need to find Paragard near you, visit medfinder.com.