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Contraception - Management
When should a copper intrauterine device (IUD) be removed?

  • The decision when to remove the copper intrauterine device (IUD) depends on the intentions and circumstances of the woman — for example, her:
    • Desire to become pregnant.
    • Need to replace the device.
    • Desire to change method of contraception.
    • Need to remove the device after menopause.
  • If unprotected sexual intercourse has taken place during the 7 days before planned removal of a copper IUD, the woman should consider delaying removal or emergency contraception if she is not planning a pregnancy (see the CKS topic on Contraception - emergency).
  • Women who wish to become pregnant:
    • A copper IUD can be removed at any time in the menstrual cycle.
  • Women who have had unprotected sexual intercourse in the 7 days before IUD removal:
    • The primary mode of action of the copper IUD is prevention of fertilization. Ovulation still occurs and, with the untimely removal of an IUD, an ovum may be fertilized before device removal, and subsequently implant after removal.
    • If sexual intercourse with no additional contraception has occurred in the preceding 7 days, removal of the device may therefore leave the woman at risk of pregnancy.
      • The need to remove the copper IUD at this time should be reconsidered.
    • If the copper IUD is to be removed, the woman should consider using emergency contraception (see the CKS topic on Contraception - emergency).
    • Women should be advised to use condoms or abstain from sexual intercourse for 7 days before copper IUD removal. This also applies when reinsertion is planned, because reinsertion may fail.
  • Women who are having their copper IUD replaced:
    • A copper IUD can be removed at any time in the cycle if it is to be replaced immediately with another IUD. However, women should be advised to use condoms or abstain from sexual intercourse for 7 days before the exchange, in case the new IUD cannot be inserted immediately or if re-insertion problems are anticipated.
  • Women who are changing their method of contraception to:
    • Sterilization:
      • Remove the copper IUD during or after the first menstrual bleed following sterilization.
    • A hormonal contraceptive:
      • Initiate the hormonal contraceptive before copper IUD removal to maintain contraceptive protection — at least 2 days for the progesterone only pill (POP) and 7 days for the other hormonal methods.
    • The levonorgestrel-releasing intrauterine system (IUS):
      • A copper IUD can be replaced by the levonorgestrel-releasing IUS at any time in the menstrual cycle. However, women should be advised to use condoms or abstain from sexual intercourse for 7 days before removal of the IUD and for a further 7 days after insertion of the IUS.
  • Postmenopausal women:
    • Age less than 50 years:
      • Remove the copper IUD 2 years after the last menstrual period.
    • Age 50 years or older:
      • Remove the copper IUD 1 year after the last menstrual period.
  • Copper IUD users with pelvic inflammatory disease:
    • There is probably no need to remove the device, unless symptoms fail to resolve with the use of appropriate antibiotics.
    • For further information, see Managing pelvic inflammatory disease.
Basis for recommendation
  • These recommendations are based on those issued by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2004a].

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