An IUD (intrauterine device) is a small T-shaped device that is placed into the uterus by a doctor or nurse (1). When placed correctly, an IUD can be up to 99% effective in preventing pregnancy, can last for 3-12 years (depending on the IUD type), and can be removed at any time (2). If you’re interested in getting an IUD, there are a couple of factors to consider, such as the difference between hormonal and copper IUDs, and the five types of IUDs. To choose the IUD type that’s best for you, here’s what you need to know.
Copper IUD vs. hormonal IUD
Both types of IUDs, copper and hormonal, prevent pregnancy by changing the way sperm cells move so that they can’t reach an egg. The main difference is how they do that. A copper IUD uses no hormones and instead produces an inflammatory reaction that is toxic to sperm and eggs, preventing pregnancy. Hormonal IUDs, on the other hand, may release a hormone, such as progestin or levonorgestrel, that thickens cervical mucus to inhibit sperm movement.
Benefits and drawbacks
There are advantages and disadvantages to choosing the copper IUD vs. hormonal IUD, and the right fit for you will depend on your medical history, your preference as to how hormones play a role in your birth control plan, and your lifestyle. These are a few common benefits and drawbacks associated with both categories of IUDs (2).
How to choose an IUD
While your IUD can be removed at any point if the plan changes, choosing an IUD that’s right for your body, needs, lifestyle, goals, and preferences is important. In order to narrow your options, first consider asking yourself three basic questions about how you’d like your birth control to function (2).
1. How comfortable am I with hormones being a part of my contraceptive plan?
2. What does my five or ten year family plan look like? (I.e., if you’d like to have a baby in the next three years, you may want to look closely at an IUD that aligns with that time period.)
3. Are there certain side effects I feel I couldn’t cope with regularly? (I.e., if you have inherently heavy periods, you might not be comfortable intensifying your menstrual symptoms with a copper IUD.)
The next step to choosing an IUD is to learn about the five types of IUDs out there. Keep your answers in mind when weighing the benefits, side effects, and other basic features of each IUD, bearing in mind that each person’s experience — from how the IUD insertion feels to side effects to overall experience — can be unique to them.
5 types of IUDs
The key differences between the five IUD types — Mirena, Kyleena, Paragard, Skyla, and Liletta — are what they’re made of, how they work, how long they last, and potential side effects. Learning about each IUD can help inform your decision, but it’s always best to also rely on your HCP or OB/GYN to help you determine which type might be best for you.
Mirena is a hormonal IUD that’s FDA-approved for treatment of heavy menstrual bleeding, in addition to being an effective contraceptive. It can stop menstrual flow or make periods lighter.
- How it works. Mirena contains 52 mg of a single hormone called levonorgestrel, which works to prevent pregnancy by thickening cervical mucus so sperm cannot enter the uterus, or by inhibiting sperm movement so it’s more difficult to reach or fertilize an egg (2).
- Effectiveness. 99%
- How long it lasts. Five to seven years
- Side effects. The most common side effects of Mirena are acne, nausea, abdominal discomfort, breast tenderness and mood swings. Since Mirena releases hormones into the body, mood swings and weight gain are possible (7).
Who it’s best for: Those who not only want a safe method for preventing pregnancy, but a proven way to moderate their painful periods as well.
Who it’s not best for: Mirena causes amenorrhea, or the suppression of your normal menstrual cycle. Some people prefer to have their period every month. If you fall into this category, Mirena might not suit you.
Kyleena disseminates the lowest dose of hormones out of any IUD that lasts the same amount of time. If you’re interested in a low-hormone contraceptive, this could be a good fit for you (8). Additionally, Kyleena’s small size might make insertion and adjustment less painful for some users.
- How it works. Kyleena contains 19.5 mg of the hormone levonorgestrel, which prevents pregnancy just like it does in the Mirena. Because Kyleena slowly releases a continuous low dose of levonorgestrel into your uterus, only small amounts of the hormone enter your bloodstream.
- Effectiveness. 99.8%
- How long it lasts. Up to five years
- Side effects. You may experience pain, bleeding or dizziness during and after placement. Symptoms should pass 30 minutes after placement, otherwise, your Kyleena may have been inserted incorrectly.
Who it’s best for: As one of the smaller IUD options, Kyleena may be better tolerated by people who have a smaller uterus, including those who haven’t given birth before (9).
Who it’s not best for: Kyleena is not right for those who have untreated genital infections, get infections easily, or have certain cancers (8).
Skyla’s small size might make insertion and adjustment less painful for some users. Furthermore, due to its small size, Skyla may be better tolerated by people who have a smaller uterus, including those who haven’t given birth before.
- How it works. Skyla releases the hormone progestin into your uterus at a slow, continuous rate. Although progestin is a different hormone, it similarly thickens cervical mucus and inhibits sperm movement to prevent pregnancy, just like Mirena or Kyleena.
- Effectiveness. 99.8%
- How long it lasts. Up to three years
- Side effects. Skyla carries the same risk of side effects as other hormonal IUDs (mood changes, cramping, acne, nausea, pain during intercourse).
Who it’s best for: Skyla lasts three years, and is a good option for anyone looking to prevent pregnancy in the short-term before attempting to expand their family.
Who it’s not best for: Adversely, Skyla needs to be replaced often, so if you’re seeking a longer term more convenient option that works the same way, you might want to consider something like Mirena. Both of these IUDs slowly release hormones into your body each day, and are over 99% effective in preventing pregnancy.
Liletta is the least expensive IUD, making it the most accessible even to those who are not covered by insurance.
- How it works. Liletta releases the same amount of progestin hormone as your average birth control pill to thicken cervical mucus and limit sperm movement, thus preventing pregnancy.
- Effectiveness. 99.8
- How long it lasts. Up to four years
- Side effects. Liletta carries potential for similar side effects as other hormonal IUDs (mood changes, inflammation, cramping, acne, nausea, pain during intercourse).
Who it’s best for: Unlike other IUDs, Liletta was researched in a large study to determine its effectiveness and safety within the widest possible range of users. Most IUD studies only include women 18-35 and do not include women with larger body sizes. If brand inclusivity is important to you, consider Liletta.
Who it’s not best for: Currently, Liletta is only approved for 3 years of use, so it is not the best option for those looking to prevent pregnancy over the next 10 years. However, Liletta’s manufacturer is currently running tests to have Liletta approved for seven years of use.
If you’re looking for a non-hormonal, copper IUD, Paragard is your only option. Not only does it protect you against pregnancy without the use of hormones, but it also lasts the longest, making it a convenient long-term option for those who won’t be considering expanding their family in the near future.
- How it works. Copper wire coiled around the Paragard itself interferes with sperm mobility and thickens the cervical mucus to prevent pregnancy.
- Effectiveness. 99.9%
- How long it lasts. 10-12 years
- Side effects. Common side effects of Paragard include longer, heavier periods as well as backaches and cramps between periods (2).
Who it’s best for: Paragard is best for those who are looking for long-lasting, very effective, and non-hormonal birth control options that they don’t have to think about regularly.
Who it’s not best for: Paragard might not be the best option for folks that have endometriosis or who already suffer from heavy bleeding on their periods.
The bottom line
Whether you choose a hormonal or copper IUD, you’re investing in a highly effective method of preventing pregnancy. Just by seeking out this information on each IUD type, you’re already taking an important step toward strengthening your bodily autonomy. It’s a great option for contraception, even if you haven’t had a previous pregnancy. If you don’t think an IUD is right for you, learn about other birth control options.