Intrauterine Contraceptive Copper Device (IUCD)

Referral

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Z30.0/Z30.1/Z30.5

Dual protection with barrier methods is recommended to reduce the risk of STIs including HIV.

The copper IUCD (also known as the Copper T) is a long-term contraceptive method that is effective, safe and reversible. It has no hormonal effects or drug interactions. It does not require daily adherence or frequent follow up.

HIV infection is NOT a contra-indication to the use of an IUCD. IUCDs are often the most suitable contraceptive for women on enzyme-inducing medicines, because of the absence of drug interactions.

• Copper IUCD, e.g.:
  • Cu T380A, 380mm² copper device
    Devices with lower copper surface area are not recommended

The IUCD can be inserted at any time during the menstrual cycle, once pregnancy has been excluded (by clinical history or with a pregnancy test if required). Insertion at menstruation may be easier for the woman and results in less discomfort and spotting.

Copper IUCDs may be inserted immediately postpartum, or post miscarriage and post choice termination of pregnancy (CTOP) within 48 hours, by specially trained healthcare professionals, provided that no contra-indications are present (chorioamnionitis, ruptured membranes for more than 18 hours, or postpartum haemorrhage).

Alternatively, an IUCD may be inserted at least 4 weeks postpartum.

LoE:IIb⁶

Advise women to check the strings of the IUCD monthly to ensure that the device is still in place.

Advise women when to return:

• Expulsion of IUCD or if strings of the IUCD become visible
• Complications (excessive bleeding, excessive pain, fever, or foul-smelling discharge)
• Routine follow-up 4–12 weeks after insertion
• If the strings of the IUCD cannot be felt

LoE:IVb⁷

Copper IUCD is not recommended for women with menorrhagia, active STI, active pelvic inflammatory disease (PID), purulent cervicitis, unexplained uterine bleeding, cervical and endometrial cancers or other uterine abnormalities. If a woman has a very high individual likelihood of exposure to STIs, she should generally not have a Copper IUCD inserted unless other methods are not available or not acceptable.

For mild pain and discomfort after insertion:

• Ibuprofen, oral, 400 mg 8 hourly with or after a meal as needed for up to 3 days

REFERRAL

• Excessive pain or bleeding after insertion.
• Signs of infection within 7 days of insertion (e.g. fever, abdominal pain and/or foul-smelling discharge).
• Abnormal bleeding for >3 months.

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_ April 2025

Chapter 7: Family Planning_7.1 Intrauterine contraceptive copper device (IUCD)