Ectopic pregnancies with an IUD are rare. Because IUDs are so effective at preventing pregnancy in the first place, fewer than 1 in 500 IUD users will experience an ectopic pregnancy in a given year. But there’s an important nuance: if an IUD does fail and a pregnancy occurs, that pregnancy is more likely to be ectopic than it would be without an IUD. Understanding both of these facts helps put the actual risk in perspective.
The Numbers by IUD Type
A large study published in 2025 tracked ectopic pregnancy rates across four types of IUDs. The differences are meaningful. The highest-dose hormonal IUD (52 mg of levonorgestrel, sold as Mirena and Liletta) had the lowest ectopic rate: 0.04 per 100 women per year, or roughly 4 in 10,000. The copper IUD came in at 0.07 per 100 women per year. The mid-dose hormonal IUD (19.5 mg, sold as Kyleena) showed a rate of 0.10, and the lowest-dose hormonal IUD (13.5 mg, sold as Skyla) had the highest rate at 0.18 per 100 women per year.
To put those numbers in everyday terms: if 10,000 women used the highest-dose hormonal IUD for a year, about 4 would have an ectopic pregnancy. With the copper IUD, that number rises to about 7. With the lowest-dose hormonal IUD, roughly 18. All of these are still very low in absolute terms.
Why IUDs Don’t Cause Ectopic Pregnancies
There’s a persistent misconception that IUDs raise your risk of ectopic pregnancy. They don’t. A meta-analysis of case-control studies found that current IUD use carries no increased risk of ectopic pregnancy compared to women not using any contraception. The odds ratio was 1.06, which is statistically indistinguishable from no effect at all.
What’s actually happening is simpler than it sounds. IUDs work primarily inside the uterus: the copper version creates an environment toxic to sperm, and hormonal versions thicken cervical mucus and thin the uterine lining. Both types are extremely effective at preventing a fertilized egg from implanting in the uterus. They’re slightly less effective at preventing implantation outside the uterus, in a fallopian tube. So while the overall number of pregnancies drops dramatically with an IUD, the rare pregnancies that do slip through are disproportionately ectopic.
In one study of 81 pregnancies that occurred with a copper IUD in place, 4 were ectopic, roughly 5%. In the general population without contraception, about 1 to 2% of pregnancies are ectopic. That higher proportion among IUD failures is not because the device caused the ectopic. It’s because the device successfully prevented most of the normal uterine pregnancies that would have otherwise occurred, leaving ectopic pregnancies as a larger share of the remaining few.
Which IUD Carries the Lowest Risk
The pattern is straightforward: higher hormone doses correlate with lower ectopic rates. The 52-mg levonorgestrel IUD has the lowest ectopic rate of any option at 0.04 per 100 person-years, likely because its higher hormone level provides the strongest suppression of ovulation and fallopian tube activity. The copper IUD, which contains no hormones, sits in the middle of the range. The lower-dose hormonal IUDs fall on the higher end, though still well below the ectopic pregnancy rate seen in women using no contraception at all.
If your primary concern is minimizing ectopic risk specifically, the highest-dose hormonal IUD offers a clear advantage. But all IUD types reduce your absolute risk of ectopic pregnancy compared to using nothing, simply because they’re so effective at preventing pregnancy overall.
Symptoms to Watch For
Because IUD users generally don’t expect to become pregnant, an ectopic pregnancy can catch them off guard. The warning signs are the same regardless of whether you have an IUD: sharp pain on one side of the lower abdomen, vaginal bleeding that’s different from your normal period, nausea, and lightheadedness or feeling faint. These symptoms can develop gradually or come on suddenly.
A ruptured ectopic pregnancy is a medical emergency. In documented cases involving IUD users, patients have presented with sudden severe lower abdominal pain, tenderness when the abdomen is pressed, and near-fainting episodes. Ultrasound in these cases typically shows an IUD sitting correctly in the uterus with no pregnancy visible there, while fluid or an abnormal mass appears near the fallopian tubes.
The key signal to pay attention to is a positive pregnancy test combined with pelvic pain, especially one-sided pain. If you have an IUD and get a positive test, getting an ultrasound early matters. Confirming where the pregnancy is located (inside or outside the uterus) is the critical first step, and earlier detection gives you more treatment options and avoids the dangers of a rupture.
Putting the Risk in Context
Among women of reproductive age who aren’t using contraception, the ectopic pregnancy rate runs around 1 to 2 per 100 pregnancies. Women using IUDs get pregnant far less often, so their absolute ectopic risk is lower than that baseline. The highest rate seen in the IUD data, 0.18 per 100 person-years for the lowest-dose hormonal IUD, still means over 99.8% of users in any given year won’t experience one.
The confusion around IUDs and ectopic pregnancy traces back to older studies and older IUD designs, particularly the Dalkon Shield from the 1970s, which was associated with serious pelvic infections. Modern IUDs don’t carry those risks. Current evidence is clear that IUDs are among the safest and most effective contraceptive options available, and they reduce rather than increase your overall chance of an ectopic pregnancy.