Endometriosis Iud Copper and Fibroids: What to Know

September 13, 2025

Endometriosis, Copper IUDs, and Fibroids: What to Know

If you live with endometriosis or uterine fibroids, choosing birth control can feel complicated—especially when you are considering an intrauterine device (IUD). Below is a clear, evidence-based guide to how the copper IUD compares with hormonal IUDs for people with endometriosis and/or fibroids, including who may benefit, who should avoid a copper IUD, and questions to raise with your clinician.

Key takeaways

Copper IUDs are highly effective and hormone-free, but they often make periods heavier and cramping worse—an issue for many people with endometriosis or fibroids.
Hormonal (levonorgestrel) IUDs can significantly reduce menstrual bleeding and cramping and may help endometriosis-related pain for many users.
With fibroids that distort the shape of the uterine cavity, any IUD (copper or hormonal) is generally not recommended; expulsion risk is higher and insertion can be difficult.
With fibroids that do not distort the cavity, IUDs may be used, but copper IUDs may worsen heavy bleeding.

Endometriosis and fibroids in brief

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often causing pelvic pain, painful periods, and sometimes infertility. Hormonal therapies, including certain contraceptives, are commonly used to reduce pain by suppressing menstrual bleeding and inflammatory activity (NIH/NICHD).

Uterine fibroids are benign muscle tumors of the uterus. They can cause heavy menstrual bleeding, pelvic pressure, pain, and reproductive challenges. Treatment ranges from watchful waiting and medications to procedures like uterine artery embolization or surgery (NIH/NICHD).

How the copper IUD works

The copper IUD (brand example: ParaGard) releases copper ions that create a sperm-hostile environment in the uterus, preventing fertilization. It contains no hormones and is labeled for up to 10 years of use. The U.S. Food and Drug Administration (FDA) notes that copper IUDs can increase menstrual bleeding and cramping, especially in the first months after insertion (FDA labeling).

Endometriosis and the copper IUD: Pros and cons

Pros

Highly effective contraception without hormones (useful if you cannot or prefer not to use hormonal methods).
Long-acting, reversible, and fertility returns quickly after removal.

Considerations and limitations

Does not treat endometriosis. Because it lacks hormones, a copper IUD will not suppress endometrial-like tissue activity. Many people with endometriosis benefit from therapies that reduce or stop periods; the copper IUD does the opposite for many users.
May increase period pain and flow. Dysmenorrhea (cramping) and heavier bleeding are common side effects—potentially problematic if you already have significant period pain from endometriosis (CDC; FDA labeling).

Bottom line for endometriosis: The copper IUD is an excellent contraceptive but is not a pain-management tool for endometriosis and may worsen cramps and bleeding for some. If pain control and lighter periods are priorities, a hormonal IUD or other hormonal therapy is often preferred (ACOG; NIH/NICHD).

Fibroids and the copper IUD: Who is a candidate?

Whether an IUD is appropriate with fibroids depends on the shape of the uterine cavity and your symptoms:

Fibroids that distort the uterine cavity (often submucosal): The U.S. Medical Eligibility Criteria (US MEC) categorizes both copper and hormonal IUDs as Category 4 (unacceptable risk). Insertion may be difficult, expulsion more likely, and the device may not sit properly (CDC US MEC; FDA).
Fibroids that do not distort the cavity: IUDs are generally Category 2 (advantages outweigh risks). Still, copper IUDs can make periods heavier; since fibroids commonly cause heavy bleeding, many patients prefer a hormonal IUD, which typically reduces bleeding substantially (CDC US MEC; ACOG).

Expulsion and bleeding

Overall IUD expulsion rates are about 2–10% in the first year; rates are higher with heavy bleeding and with fibroids, especially if the cavity is irregular (CDC).
The copper IUD can worsen menorrhagia and dysmenorrhea—two of the most common fibroid symptoms (FDA labeling).

When a hormonal IUD may be a better fit

Levonorgestrel-releasing IUDs (LNG-IUDs) release a small, local dose of progestin. They are FDA-approved for contraception and for treatment of heavy menstrual bleeding. For many users, they:

Reduce menstrual blood loss dramatically over 3–6 months (often by 70–90%).
Decrease menstrual cramps and can lead to lighter or absent periods.
May help reduce endometriosis-related pain for some individuals, although this is an off-label use for endometriosis specifically (ACOG; NIH/NICHD).

For people with fibroids without cavity distortion, LNG-IUDs are often used to control heavy bleeding, sometimes improving iron-deficiency anemia and quality of life (ACOG). If fibroids do distort the cavity, an IUD may not be feasible until the cavity is corrected (for example, by removing submucosal fibroids).

Safety, contraindications, and red flags

Who should avoid a copper IUD?

Pregnancy, current pelvic infection, unexplained vaginal bleeding, and known or suspected uterine cavity distortion (including certain fibroids) are key contraindications in FDA labeling.
Allergy to copper or Wilson disease also contraindicates copper IUD use (FDA).

Risks to discuss

Expulsion: Most common in the first months; higher with heavy bleeding and fibroids.
Perforation: Rare (~1/1,000).
Infection: Slightly increased risk of pelvic infection in the first 20 days after insertion, then returns to baseline (CDC).

When to call your clinician

Severe or worsening pelvic pain, fever, heavy or prolonged bleeding, foul discharge, a positive pregnancy test, or if you cannot feel strings and think the IUD may have moved.

Fertility and future planning

IUDs are fully reversible, and most people return to their usual fertility quickly after removal. Endometriosis and fibroids themselves—not IUDs—are more likely to impact fertility. If pregnancy is a short-term goal, discuss how each option fits your timeline and whether additional treatment for endometriosis or fibroids should come first (NIH/NICHD).

How to choose: Questions to ask

Do my fibroids distort the uterine cavity on ultrasound or hysteroscopy?
Is heavy bleeding a major symptom for me (and would a copper IUD likely worsen it)?
Is controlling pelvic pain a priority—and would a hormonal option help me more?
What is my expulsion risk, and how will we monitor placement?
If an IUD isn’t ideal, what are my best alternatives (pills, injections, implants, or non-contraceptive treatments)?

This article is for educational purposes and is not a substitute for personalized medical advice. Talk with a qualified clinician about your individual risks, benefits, and preferences.