Women come to my clinic regularly with a printout from a government hospital discharge summary. Under “contraception advised,” the note reads “IUCD inserted.” No one explained what that meant, what to expect with periods, or how long it would stay in. Three months of heavier bleeding later, quiet worry about whether something has gone wrong.
This conversation happens more often than it should. The copper T (Cu-T) is one of India’s most widely used and genuinely effective contraceptive methods, offered free at government hospitals as part of the national family planning programme. Yet women frequently receive it with little explanation. The Mirena, a hormone-releasing alternative, is less well-known but transforms the experience for women who struggle with heavy bleeding.
This post covers both devices: how they work, what to expect from your periods, what insertion feels like, how long they last, and what happens to your fertility when you have them removed.
The Two Main Intrauterine Devices Available in India
Both are small, T-shaped devices placed inside the uterus by a doctor. They look similar from the outside but work very differently inside your body.
Copper T (Copper IUD): The wire wrapped around the plastic frame releases copper ions continuously. These ions are toxic to sperm, preventing fertilisation. The copper T does not affect your hormones in any meaningful way. Your ovaries continue to ovulate every cycle. What changes is your bleeding.
Mirena (LNG-IUS, or levonorgestrel intrauterine system): This releases a very small, localised dose of levonorgestrel (a progestin) directly into the uterine cavity. Most of the effect is local: it thickens cervical mucus so sperm cannot pass through, and it thins the endometrial lining so that even when ovulation does occasionally occur, the chances of implantation are extremely low. Unlike the pill, the hormone dose is so small and localised that most women do not experience the systemic side effects associated with oral contraceptives.
Both devices are highly effective. With typical use, both achieve pregnancy rates below 1% per year, comparable to sterilisation for the duration of use.
What the Copper T Does to Your Periods
This is the most important conversation that does not happen at the point of insertion.
The copper T reliably makes periods heavier and often longer. Multiple published studies and WHO family planning guidance consistently document a 50 to 75 percent increase in menstrual blood loss in the first year after insertion (WHO. Family Planning: A Global Handbook for Providers, 3rd ed., 2018). For many women, this settles down after three to six months. For some, it does not.
If you already have borderline iron stores, which is common given that NFHS-5 data shows 57 percent of Indian women are anaemic, heavier periods with a copper T can push you into frank iron-deficiency anaemia. This is not a reason to avoid the copper T, but it is a reason to check your ferritin level before insertion, and to monitor it at your six-month review.
Cramping, especially in the first few days after insertion and during the first few periods, is also common. This is the uterus adjusting to a foreign body, and it usually improves.
What the copper T does not do: It does not affect your mood, your weight, your libido, or your ovulation. It does not increase your risk of infertility. It does not cause cancer. And it does not terminate an established pregnancy.
What Mirena Does to Your Periods
The story with Mirena is almost the reverse. Most women find their periods become lighter, shorter, and often less painful. By the end of the first year, around 20 percent of users will have stopped having periods altogether, based on data from Mirena’s clinical trials and post-marketing evidence summarised in the WHO MEC 5th edition (2015). By year three, roughly 30 to 40 percent experience amenorrhea.
This amenorrhea is not harmful. The endometrium is present but suppressed rather than actively building and shedding. When the Mirena is removed, the lining rebuilds and periods return promptly in most women. The absence of periods while the Mirena is in place is a side effect many women come to appreciate, but it can initially cause anxiety, particularly if you are not expecting it. If your doctor has not warned you, a missing period on Mirena can prompt unnecessary pregnancy tests and worry.
Irregular spotting is common in the first three to six months as your body adjusts. It usually resolves.
What Mirena does not reliably do: It does not reliably prevent ovarian cysts (some functional cysts are more common with Mirena, though most resolve spontaneously). It does not cause long-term hormonal changes after removal. It does not affect bone density.
Insertion: What to Expect
Insertion takes approximately five to ten minutes. It is performed in a clinic or hospital without general anaesthesia. Most women describe the sensation as moderate cramping, similar to a bad menstrual cramp, peaking during the moment the device is placed and then easing within a few minutes.
A 2017 Cochrane review by Heller and colleagues evaluated interventions for reducing insertion pain (Heller R et al. Cochrane Database Syst Rev 2017;3:CD007373). Oral ibuprofen (400 mg taken one hour before) modestly reduces pain for some women. Misoprostol (a cervical softener) has not shown consistent benefit and is no longer routinely recommended for pre-insertion cervical preparation in non-parous women.
Taking 400 mg ibuprofen an hour before your appointment is reasonable. Eating something beforehand reduces the risk of feeling faint.
The first period after insertion is typically heavier and more crampy than usual for both device types, as the uterus finalises its adjustment. This is normal and expected.
WhatsApp Dr. Suganya on +91 99402 70499 if you have questions about whether an IUD is the right choice for you, or if you are experiencing symptoms after insertion that concern you.
How Long Do They Last?
Copper T 380A: 10 years (WHO and FDA approved duration). Many government hospitals in India supply the Cu-T 375, which is approved for five years. The device in your discharge summary should state which type was inserted. If you are unsure, ask your doctor or have a brief ultrasound to identify the device.
Mirena (52 mg levonorgestrel): Five years is the licensed duration in India. International evidence supports seven to eight years of effective contraception (Bayer, extended clinical study data), but as of 2026, the Indian prescribing information states five years. Replace at five years.
You can have either device removed at any time, at your own request, before the expiry date.
Indian Costs: Government vs Private
Copper T: At government hospitals and health centres under the National Family Planning Programme, the copper T is provided entirely free of charge, including insertion and follow-up. This is a genuine public health asset. At private clinics, the device costs approximately Rs 200 to 600 and the insertion procedure fee adds Rs 1,000 to 3,000.
Mirena: The device has an NPPA-regulated ceiling price of Rs 3,659 (May 2026 verified, exclusive of GST). Online pharmacy prices range from Rs 3,365 to 4,100 depending on the retailer. The insertion procedure at a private clinic adds Rs 2,000 to 5,000 in consultation and procedure fees, making the total roughly Rs 6,000 to 9,000 at most private clinics. Government hospitals do not stock Mirena under the current family planning supply chain, so this device is available only through private or corporate hospitals.
The cost asymmetry is significant. For women who can tolerate the copper T, the free-of-charge access is a substantial advantage. For women with heavy periods, anaemia, or dysmenorrhoea, the Mirena’s ability to dramatically reduce bleeding may make it the medically better option even at its higher cost.
Fertility Return After Removal
This is one of the most reassuring aspects of both devices.
For the copper T, fertility returns essentially immediately. Published data show that women who remove a copper IUD have cumulative pregnancy rates of 87 to 93 percent within 12 months, comparable to women who never used an IUD (ACOG Practice Bulletin No. 186, 2017; WHO Selected Practice Recommendations for Contraceptive Use, 3rd ed., 2016). The copper does not linger in your body and does not affect ovarian reserve.
For Mirena, most women resume normal ovulatory cycles within 30 to 45 days of removal. Conception rates after Mirena removal are similar to age-matched populations not using contraception (Andersson K et al. Contraception. 1994;50(5):411-421). The progestin does not accumulate in your system in the way that injectable contraception (such as Depo-Provera) does.
In practice: if you have an IUD and are planning to conceive, you can have it removed at any time and start trying in the same cycle if you choose.
Read our complete guide to trying to conceive naturally: a couple’s complete guide for what to do next.
Red Flags to Know After Insertion
Most IUD insertions are uneventful. The following symptoms, however, warrant a call or visit to your doctor:
In the first three to four weeks:
- Fever (temperature above 38 degrees Celsius), chills, or unusual pelvic pain: this could indicate pelvic inflammatory disease (PID), which is most common in the first 20 days after insertion (WHO. Selected Practice Recommendations for Contraceptive Use, 3rd ed., 2016). PID risk is tied to any pre-existing infection, not to the device itself. Screening for STIs before insertion significantly reduces this risk.
- Heavy bleeding soaking more than one pad per hour for more than two consecutive hours.
At any point while the device is in place:
- You cannot feel the strings on self-check (though most women are not taught to check, it is worth asking your doctor how). Missing strings may indicate expulsion, which occurs in about 2 to 10 percent of insertions, more commonly in the first year.
- Sudden change in your period pattern after months of stability.
- Positive pregnancy test: though rare, if pregnancy occurs with an IUD in situ, it must be assessed urgently to rule out ectopic pregnancy.
Perforation is rare. The EURAS-IUD cohort study (Heinemann K et al. Eur J Contracept Reprod Health Care 2015) found a perforation rate of approximately 1.3 per 1,000 insertions, with higher rates in breastfeeding women. Most perforations are recognised at the time of insertion or shortly after.
If a foreign doctor, health worker, or family member is telling you that you need to have your IUD removed for reasons not listed above, a brief check with your gynaecologist is worthwhile before acting.
Copper T vs Mirena: Which Is Right for You?
Neither device is universally better. The right choice depends on your individual situation.
Copper T is likely the better fit if:
- You prefer a non-hormonal method.
- Your periods are already light or moderate and you are not anaemic.
- Cost is a primary consideration (government supply is free).
- You want the longest single device duration (10 years for Cu-T 380A).
- You are breastfeeding and prefer no hormones at all (both devices are safe during breastfeeding, but some women feel reassured by the copper T’s non-hormonal nature).
Mirena is likely the better fit if:
- Your periods are heavy or painful and you want lighter or absent periods as an added benefit.
- You have endometriosis or adenomyosis and are using contraception partly to manage symptoms (Mirena is a recognised treatment for endometriosis-related pain).
- You have already tried the copper T and found the heavier bleeding unacceptable.
- You have PCOS with irregular or very heavy cycles (though your gynaecologist will discuss the full picture with you, including whether you are also trying to conceive).
Both are reversible. Both preserve fertility. Both are medically safe for the vast majority of women. Your gynaecologist is the right person to help you weigh your specific picture.
For a broader look at your contraceptive options, see i-Pill & Unwanted-72: what to expect and birth control pill side effects: OB-GYN guide.
If heavy periods are a concern regardless of contraception, the iron-rich Indian foods guide for women is worth reading alongside this post. And if your periods are irregular, see period delay: 12 reasons your period is late for a broader picture of what might be driving the pattern.
WhatsApp Dr. Suganya on +91 99402 70499 if you are weighing your options and would like a personalised conversation about which device, or which contraceptive approach, fits your situation.
Frequently Asked Questions
Does the copper T cause infertility? No. This is one of the most persistent myths about IUDs in India, and it is not supported by evidence. A 2017 systematic review found that pregnancy rates within 12 months of copper IUD removal are 87 to 93 percent, which is comparable to women who never used an IUD. The device does not affect your ovarian reserve, egg quality, or the health of your uterine lining after removal.
How painful is the insertion of a copper T or Mirena? Most women describe a moderate cramping sensation at the moment of insertion, lasting under a minute. Taking 400 mg ibuprofen about an hour before the appointment is reasonable. Women who have not previously delivered vaginally (nulliparous women) sometimes find insertion more uncomfortable, but it is a brief procedure. If you experience severe pain during insertion, tell your doctor immediately.
Can I get the copper T or Mirena if I have never had a baby? Yes. Both devices are safe and effective for women who have not delivered. Older guidelines used to caution against IUDs in nulliparous women, but current ACOG and WHO guidance does not restrict use based on parity. The insertion may be slightly more uncomfortable, but there is no increased risk of pelvic infection or infertility in the absence of pre-existing STIs.
What happens if I get pregnant with an IUD in place? Pregnancy with an IUD in place is uncommon (less than 1 percent per year) but can occur. If it does, see your doctor promptly. The priority is to confirm the location of the pregnancy, since the risk of ectopic pregnancy is higher when conception occurs with an IUD in situ. If the IUD strings are accessible and the pregnancy is intrauterine, the device is typically removed carefully. Your doctor will discuss the next steps with you.
Will I know if my copper T has moved or come out? Partial or complete expulsion happens in about 2 to 10 percent of cases, most commonly in the first year. Some women feel the device shift, others notice a change in their cramping pattern. Your doctor will teach you to check for the strings after each period. A routine ultrasound at your six-month follow-up is also a good way to confirm the device is in position. If you are in any doubt, an ultrasound is the clearest confirmation.
Will Mirena affect my mood or weight? The hormone dose in Mirena is very small and acts primarily locally in the uterus. Most women do not experience the mood changes or weight fluctuations associated with combined oral contraceptives. However, a small number of women do report mood-related changes, and this is something to discuss with your doctor if it occurs. If mood is a concern, the copper T is a hormone-free alternative.
Can I use a copper T or Mirena as emergency contraception? The copper T can be used as emergency contraception if inserted within five days of unprotected intercourse. It is highly effective in this context and can then remain in place for ongoing contraception. The Mirena is not recommended for use as emergency contraception.
