What is Paragard?

Paragard is a copper IUD (intrauterine device) used to prevent pregnancy for up to 10 years. Paragard IUD prevents pregnancy by continuously releasing copper, which interferes with sperm transport, fertilization of an egg, and possibly prevention of implantation. When Paragard IUD is inserted it can provide up to 10 years of contraception, and can be removed by a healthcare provider at any time if you decide you want to get pregnant.

Paragard IUD is a small, flexible plastic “T” shaped device with copper wrapped around the stem and placed on arms of the “T”. Two thin white threads are attached to the stem (lower end) of the device. The device is inserted into the space inside the uterus, with the threads protruding from the cervix into the vagina. The threads are the only part of Paragard you can feel when it is in your uterus.

Paragard does not protect against HIV infection (AIDS) or other sexually transmitted infections (STIs).

Paragard is an IUD contraceptive used by women who want birth control that is:

• long term as it works continuously for up to 10 years
• immediately reversible when removed
• 99% effective at preventing pregnancy
• low maintenance
• hormone free.

Paragard side effects

Common Paragard side effects

Common Paragard side effects may include anemia (low red blood cell count), backache, painful periods, pain during sex, expulsion (complete or partial), vaginal discharge, prolonged periods, spotting, pain and cramping, and vaginal irritation.

Serious Paragard side effects

Paragard can cause serious side effects including:

• ectopic pregnancy and intrauterine pregnancy risks: There are risks if you become pregnant while using Paragard (see “What if I become pregnant while using Paragard?”).
• life-threatening infection: Life-threatening infection can occur within the first few days after the IUD is placed. Call your healthcare provider immediately if you develop severe pain or fever shortly after it is placed.
• pelvic inflammatory disease (PID) or endometritis: Some IUD users get a serious pelvic infection called pelvic inflammatory disease (PID) or endometritis. PID and endometritis are usually sexually transmitted. You have a higher chance of getting PID and endometritis if you or your partner has sex with other partners. PID and endometritis can cause serious problems such as infertility, ectopic pregnancy, and pelvic pain that does not go away. PID and endometritis are usually treated with antibiotics. More serious cases of PID or endometritis may require surgery. A hysterectomy (removal of the uterus) is sometimes needed. In rare cases, infections that start as PID can even cause death.
  
  Tell your healthcare provider right away if you have any of these signs of PID or endometritis: low abdominal (stomach area) or pelvic pain, pelvic tenderness, painful sex, unusual or bad smelling vaginal discharge, chills, long-lasting or heavy bleeding, fever, genital lesions or sores.
• embedment: Paragard may become attached to (embedded) the wall of the uterus. This may make it hard to remove the device. Surgery may sometimes be needed to remove Paragard.
• perforation: Paragard may go through the wall of the uterus. This is called perforation. If this occurs, the IUD may no longer prevent pregnancy. If perforation occurs, the IUD may move outside the uterus and cause internal scarring, infection, damage to other organs, pain, or infertility and you may need surgery to have Paragard removed. Excessive pain or vaginal bleeding during placement of Paragard, pain or bleeding that gets worse after placement, or not being able to feel the threads may happen with perforation. You are not protected from pregnancy if Paragard moves outside the wall of the uterus. The risk of perforation is increased in breastfeeding women.
• expulsion: Paragard may partially or completely fall out of the uterus by itself. This is called expulsion. Expulsion occurs in about 2 out of 100 women. Excessive pain, vaginal bleeding during placement of the IUD, pain that gets worse, bleeding after placement, or not being able to feel the threads may happen with expulsion. You are not protected from pregnancy if Paragard is expelled.
• changes in menstrual bleeding: You may have heavier and longer periods with spotting in between. Sometimes the bleeding is heavier than usual at first. Call your healthcare provider if the bleeding remains heavier or longer and spotting continues.
• reactions after placement or removal: Some women have had reactions such as dizziness (syncope), slowed heart rate (bradycardia), or seizures, immediately after Paragard was placed or removed. This happened especially in women who have had these conditions before.

This is not a complete list of possible side effects you may have with Paragard. For more information, ask your healthcare provider. Tell your healthcare provider about any side effect that bothers you or does not go away.
Call your doctor for medical advice about side effects.

Who should not use Paragard?

Do not use this IUD if you:

• are or think you might be pregnant
• your uterus cavity (the space inside your uterus) is an abnormal shape for example due to large fibroid tumors
• have an untreated pelvic infection called pelvic inflammatory disease (PID) or you can get infections easily due problems with your immune system or current behaviors that may put you at risk eg multiple sexual partners or you use or abuse intravenous drugs
• have had an infection in your uterus after a pregnancy or abortion in the past 3 months
• have or suspect you might have cancer of the uterus or cervix
• have unexplained bleeding from your vagina
• have an untreated lower genital infection now in your cervix
• have Wilson’s disease (a disorder in how the body handles copper)
• have an allergy to copper, polyethylene, or barium sulfate
• have an intrauterine system (IUD) in your uterus already

Before having Paragard placed

To make sure this IUDis safe for you, tell your doctor if you have ever had:

• any of the conditions listed above
• slow heart beat (bradycardia)
• dizziness (syncope)
• seizures
• recently had a baby or if you are breastfeeding
• have AIDS, HIV, or any other sexually transmitted infection

How should I receive Paragard?

How is Paragard inserted? Paragard is placed in your uterus during an in-office visit. It can be inserted anytime during a normal menstrual cycle.

First, your healthcare provider will examine your pelvis to find the exact position of your uterus. Your healthcare provider will then cleanse your vagina and cervix with an antiseptic solution and measure your uterus. Your healthcare provider will then slide a plastic tube containing Paragard into your uterus. The tube is removed, leaving IUD inside your uterus. Two white threads will extend into your vagina. The threads will be trimmed so they are just long enough for you to feel with your fingers when you are doing a self-check.

When Paragard is inserted, you may feel cramping or pinching, and you may have some bleeding. Some women feel faint, nauseated, or dizzy for a few minutes afterward. Your healthcare provider may ask you to lie down until you are feeling better and to get up slowly.

You should return to your healthcare provider for a follow-up appointment after your first period after you have had IUD is placed to make sure that it is in the right position.

Should I check my Paragard is still in place?

You should check that Paragard is in the proper position by feeling the threads. It is a good habit to do once a month. Your healthcare provider should teach you how to check that it is in place.

First, wash your hands with soap and water. You can check by reaching up to the top of your vagina with clean fingers to feel the 2 threads. Do not pull on the threads.
If you feel changes in the length of the 2 threads, you cannot feel the threads, or you can feel any other part of the device other than the threads, it may not be in the right position and may not prevent pregnancy. If you feel that your IUD is not in the correct position you should use back-up birth control (such as condoms or spermicide) and ask your healthcare provider to check that Paragard is still in the right place.

If your Paragard is accidentally removed you may be at risk of becoming pregnant and should talk to a healthcare provider.

How long does Paragard last?

Once Paragard is inserted it can provide up to 10 years of contraception, and can be removed by a healthcare provider at any time if you decide you want to get pregnant. Paragard must be removed on or before 10 years from the date it was inserted.

After 10 years when you are having your Paragard removed if you want to continue using this form of contraception your healthcare provider can place your new Paragard at the same appointment.

What if I become pregnant while using Paragard?

You should call your healthcare provider right away if you think you may be pregnant. If you get pregnant while using this IUD you may have an ectopic pregnancy, which is a pregnancy that is not in your uterus. Signs of ectopic pregnancy are unusual vaginal bleeding or abdominal pain, especially with missed periods.

An ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility and even death.

If you get pregnant while using Paragard and the pregnancy is in the uterus, there are risks of severe infection, miscarriage, premature delivery, and even death if the pregnancy continues with the intrauterine device (IUD) still in place. Because of these risks, your healthcare provider may try to remove the device, even though removing it may cause a miscarriage. If Paragard cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy.

If you continue your pregnancy you will need see your healthcare provider regularly. Call your healthcare provider right away if you get flu-like symptoms, fever, chills, cramping, pain, bleeding, vaginal discharge, or fluid leaking from your vagina. These may be signs of infection.

It is not known if Paragard can cause long-term effects on the fetus if it stays in place during a pregnancy.

General Paragard Information

Will Paragard interfere with sexual intercourse?

You and your partner should not feel Paragard during intercourse as it is placed in the uterus, not in the vagina. Sometimes your partner may feel the threads. If this occurs, or if you or your partner experience pain during sex, talk with your healthcare provider.

How will Paragard change my periods?

Your period may become heavier and longer. You may also have frequent spotting between periods.

Is it safe to breastfeed while using Paragard?

You may use Paragard when you are breastfeeding. The risk of the device becoming attached to (embedded) or going through the wall of the uterus is increased if it is placed while you are breastfeeding.

Can I have an MRI with Paragard in place?

Paragard can be safely scanned with MRI only under specific conditions. Before you have an MRI, tell your healthcare provider that you have Paragard, an intrauterine device (IUD), in place.

Before you have a medical procedure using heat therapy tell your healthcare provider that you have Paragard in place.

What is Phexxi?

Phexxi contains a combination of lactic acid, citric acid, and potassium bitartrate and is used to prevent pregnancy when used just before vaginal sex in women who can become pregnant.

Phexxi is an on-demand method of birth control that does not contain hormones. It does not prevent pregnancy when used after vaginal sex.

Phexxi belongs to a class of medications called non-hormonal contraceptives. It works by lowering the pH of the vagina and reducing sperm motility.

Phexxi may be used in combination with other methods of birth control (including a condom, diaphragm, birth control pills, patches, inserts, implants, or injections).

Phexxi may prevent pregnancy, but this medication will not prevent the spread of human immunodeficiency virus (HIV, the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.

Avoid using this medicine in combination with a vaginal ring.

Warnings

Follow all directions on the Phexxi label and packaging. Tell your doctor and pharmacist if you or your sexual partner are allergic to lactic acid, citric acid, and potassium bitartrate, any other medications, or any of the ingredients in Phexxi gel..

Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take or use. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

Tell your doctor if you have or had urinary tract infections or problems with urination.

Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. while using Phexxi. If you become pregnant while using lactic acid, citric acid, and potassium bitartrate vaginal, call your doctor.

Before taking this medicine

Do not use Phexxi if you are already pregnant.

You should not use Phexxi if you have a history of frequent bladder infections or other problems with your urinary tract.

Tell your doctor if you’ve ever had an allergic reaction to any product that contains citric acid, lactic acid, potassium bitartrate, glycerin, xanthan gum, alginic acid, sodium hydroxide, or benzoic acid.

Tell your doctor if you recently had an abortion or miscarriage, or if you recently gave birth to a baby. Your doctor will tell you when it is safe to use Phexxi after any of these events.

Phexxi will not protect you from HIV or other sexually transmitted disease.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

How should I use Phexxi?

Use Phexxi before having vaginal sex. This medicine will not work if you use it after having sex.

Follow all directions on your prescription label and read all medication guides or instruction sheets. You may get pregnant if you do not carefully follow all instructions for use.

Phexxi may be used at any time during your menstrual cycle.

Phexxi is a vaginal gel provided in a prefilled vaginal applicator. Each applicator is for one use only. Insert the gel into your vagina within 1 hour before you have sex.

If you have sex more than once in a 1-hour period, you must insert another dose.

Phexxi may be used in combination with other methods of birth control (including a condom, diaphragm, or birth control pills, patches, inserts, implants, or injections).

Do not use Phexxi in combination with a vaginal ring.

Store in the foil pouch at room temperature, away from moisture and heat. Use right away after opening the pouch.

Dosing information

Usual Adult Dose for Contraception:

One prefilled applicatorful vaginally immediately before (or up to 1 hour before) each episode of vaginal intercourse.

Comments:
-This product is not effective if administered after intercourse.
-May use at any point in the menstrual cycle.
-An additional dose must be given if more than one act of vaginal intercourse occurs within one hour.
-May use as soon as it is safe to have vaginal intercourse after childbirth, abortion, or miscarriage.
-May use concomitantly with hormonal contraceptives, condoms (latex, polyurethane, and polyisoprene), and vaginal diaphragms; avoid use with vaginal rings.
-May use concomitantly with vaginal infection treatments including miconazole, metronidazole, and tioconazole.

Use: On-demand contraception in females of reproductive potential

What happens if I miss a dose?

Since Phexxi is used when needed, it does not have a regular dosing schedule.

If you do not have sex within 1 hour after inserting the gel, you must insert another dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while using Phexxi?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Phexxi side effects

Get emergency medical help if you have signs of an allergic reaction to Phexxi: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Phexxi may cause a bladder or kidney infection. Call your doctor at once if you have:

• pain or burning when you urinate;
• urine that looks cloudy; or
• pain in your flank, side, or lower back.

Stop using Phexxi if it causes severe irritation in or around your vagina.

Common Phexxi side effects may include:

• a bladder infection;
• vaginal burning, itching, or discomfort;
• vaginal itching or discharge; or
• bacterial or fungal infection in the vagina.

If you need to use any vaginal medication to treat a vaginal infection, you may keep using Phexxi.