Side-effects and managing side-effects

IUCDs cause very few side-effects. The most common are pelvic cramping and menstrual problems, including heavy and prolonged menstrual bleeding, and intermenstrual spotting. Although abnormal bleeding and spotting are the leading reasons for women to discontinue the method, these side-effects do not usually affect their health, and generally decrease in the first few months after insertion.

One potential, though uncommon, complication of IUCD use is device expulsion, which occurs in 2–8% of women. Expulsion occurs most often in the first few months after insertion, and it is most common in young women, and women who have never given birth. The IUCD can only be expelled outward into the vagina or cervix. It cannot travel to any other part of the body. Expulsion is not dangerous for the user; however, if the IUCD is expelled, the woman is no longer protected against pregnancy because the IUCD's contraceptive effect is immediately reversible.

Although it is a rare event, uterine perforation during IUCD insertion is one of the complications which occurs in 0.5 to 1.5 per 1,000 insertions, and is associated with the level of the provider's skill and experience.

Several additional IUCD-related complications include PID and ectopic pregnancy, but a woman's risk of these is minimal, especially if she is free of STIs.

Counselling women about side-effects and their possible complications, either at the time of insertion or at subsequent follow-up visits, is essential to ensure women's satisfaction with this method.