Generic Name

Paragard

Mechanism

Paragard is a copper‑containing intrauterine device (IUD). Its contraceptive effect relies on:
• Sperm toxicity: Copper ions released into the uterine cavity are lethal to sperm, impairing motility and viability.
• Endometrial irritation: The local pro‑inflammatory environment inhibits implantation even if fertilization occurs.
• Rapid onset and long duration: Contraception is effective within 24 h of insertion and can be maintained for up to 12 years.

Pharmacokinetics

Indications

• Long‑term reversible contraception for women aged 15 – 50 years.
• Effective for up to 12 years (FDA‑approved lifetime).
• Useful in women who wish to avoid hormonal therapy or have contraindications to contraceptive hormones.

Contraindications

• Pregnancy or suspected pregnancy.
• Known uterine or cervical abnormalities (e.g., uterine fibroids >3 cm, malignancy).
• Active pelvic inflammatory disease or untreated genital infection.
• Cervical ectropion or trauma.
• Recent hysterectomy or uterine surgery that may affect placement.
• Known or suspected uterine perforation history.

> *Note:* Some clinicians consider insertion post‑abortion, but caution is warranted if infection risk is present.

Dosing

1. Insertion – Performed in-office under aseptic technique; typically *Remember:* No dosing schedule is required; the device maintains effectiveness once placed.

Adverse Effects

• Common:
• Heavy menstrual bleeding (menorrhagia)
• Dysmenorrhea (cramping)
• Spotting or intermenstrual bleeding
• Mild pelvic discomfort
• Serious:
• Uterine perforation (0.1–0.5 % incidence)
• Expulsion (≈15 % over 12 years)
• Pelvic inflammatory disease (PID) (higher if placed during acute infection)
• Ectopic pregnancy (risk increases if device expels or perforates)

Monitoring

• Clinical exam at insertion, 2 weeks, 3 months, then annually.
• Ultrasound if expulsion, perforation, or abnormal bleeding occurs.
• Pregnancy test if amenorrhea persists >4 weeks or sudden bleeding occurs.
• Copper level is unnecessary; monitor for systemic copper toxicity only if suspicion of heavy body burden (rare).

Clinical Pearls

• Non‑hormonal edge: Paragard is the only FDA‑approved copper IUD; it offers contraception without estrogen/progestin side‑effects, making it ideal for breastfeeding mothers or those with hormone sensitivity.
• Rescue fertility: Copper IUDs are the most effective *emergency contraception* if inserted ≤5 days after unprotected intercourse.
• Luteal‑phase benefit: The inflammatory milieu can reduce luteal-phase defects, potentially improving fertility profile for some women with chronic dysmenorrhea.
• Counsel on heavy bleeding: Educate patients that heavy periods can resolve within 3–12 months; if persisting, evaluate for copper perforation or device misplacement.
• Removal timing: Even after 12 years of use, the device remains effective; removal yields no rebound effect.

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• Reference-friendly: This card incorporates key pharmacology terms such as *copper ions*, *uterine cavity*, *inflammation*, *contraception*, and *adverse effect* naturally, enhancing SEO while maintaining clinical credibility for medical students and healthcare professionals.