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Which IUD is best for you?

There are a bunch of IUDs on the U.S. market, and they’re not one-size-fits all. Let us help you explore your options.

by Sara Kennedy, MD, MPH
almost 10 years ago

Here’s a secret: female doctors and family planning providers are way more likely to use IUDs themselves than U.S. women overall. Maybe it’s because they know the intrauterine device (IUD) is safe, low-maintenance, and super-effective.

There are two different types of intrauterine devices (IUDs): hormonal and non-hormonal. There are currently four brands of hormonal IUDs—Mirena, Skyla, Liletta, and Kyleena—and one brand of non-hormonal IUD, Paragard. You may have heard about the different brands in the media, but, fancy TV commercials aside, what’s the difference between them and is one of them right for you?

First things first: What’s the same about all IUDs?

Let’s start by looking at what hormonal and non-hormonal IUDs have in common:

  • They work. Really, really well. Both IUDs are ranked among the most effective birth control methods you could use, up there with having your tubes tied.
  • They’re safe. Pretty much anyone who wants to prevent pregnancy could use an IUD. And, to be clear, “pretty much anyone” DOES include people who have never given birth. (Bedsider’s article IUDs are A-OK will tell you more about how IUDs are safe for most people with a uterus—whether they’ve had a baby or not.) And we can add that IUDs are often safe for people with medical conditions that rule out other types of birth control.
  • They’re small. All the IUDs on the U.S. market are T-shaped, and the T itself is about as thick as a tampon string. The different IUDs vary slightly in size, but all are smaller than an Apple Watch.
  • They are affordable, especially in the long run. At present, insurers are required to cover IUDs with no out-of-pocket costs, so if you have health insurance, you should be home free. If you have to pay for an IUD up-front, it can seem expensive, but if you use it for at least a year, it is actually cheaper than most other forms of birth control. A clinic may be able to help you pay for an IUD in installments.
  • They are easy to start using. You can usually have the IUD inserted at your first visit to your health care provider. In most cases, having an IUD inserted takes about 60 seconds total.
  • An IUD will work for a long time, but you can stop using it any time you like. All five IUDs are FDA-approved to use for at least 3 years. Sklya is approved for up to 3 years of use; Mirena Kyleena are approved for up to 5 years; LILETTA is approved for up to 6 years; and Paragard is approved for up to 10 years. In practice though, LILETTA and Mirena have been found to be effective for 7 years and Paragard for 12 to 20 years. If you want to have an IUD removed sooner though, you can. Your provider should remove it for you if you want it removed. And whenever you do have the IUD removed, your chance of getting pregnant goes back to what is normal for you right away.
  • IUDs DON’T prevent sexually transmitted infections (STIs). Condoms and internal condoms (as well as dental dams, depending on what kind of sex you’re having) are still the only game in town for that.

How are the hormonal IUDs different?

All the hormonal IUDs prevent pregnancy by releasing a very small amount of a progestin hormone called levonorgestrel each day. The progestin acts locally in the uterus to prevent pregnancy. Compared to folks using the pill and some other hormonal methods, those using hormonal IUDs have much less hormone in their blood. Hormonal IUDs don’t contain estrogen, so they typically have fewer hormonal side effects than methods that do contain estrogen.

Many people who start using a hormonal IUD have irregular bleeding for the first 3-6 months after placement. This bleeding is usually more like spotting—light and not painful. But you may not be able to predict your periods for the first several months, so wear black underwear! After 6 months, some hormonal IUD users get very light periods or no period at all. Because of the different amounts of hormone, a woman using each IUD has a different chance of her period going away after one year: 20% for Mirena, 12% for Kyleena, and 6% for Skyla. If not having a period every month would make you sick to your stomach worrying that you’re pregnant, you might prefer a non-hormonal IUD.

So, what are the differences between the hormonal IUDs?

Mirena

Mirena is the hormonal IUD that’s been around the longest, and it’s one of the longest lasting (it’s been proven effective for up to 7 years in practice, though it’s officially FDA-approved for up to 5 years). It’s perfectly safe and effective for people who’ve never given birth. Mirena is commonly recommended to help manage heavy or painful periods. It may also help reduce bleeding caused by fibroids and endometriosis. For many people who use it, their periods get significantly lighter or go away completely. About 1 in 5 Mirena users stop having a period after a year, and 1 in 3 people who use it for longer stop having a period. A 2016 study found that you may be able to predict how likely it is that Mirena will make your period go away based on how heavy your pre-IUD cycle is.

LILETTA

LILETTA is a lot like Mirena—same dose of hormone, same lighter or nonexistent periods. One difference is that it’s FDA-approved for use for longer than Mirena—up to 6 years (as compared to Mirena’s 5 years), but in practice, it’s been proven effective for up to 7 years, just like Mirena. It’s also explicitly approved for people who have not given birth. The main benefit of LILETTA is that it is more affordable than the other hormonal IUDs, especially for those with grandfathered health insurance plans and those without health insurance.

Skyla

There’s a reason we’ve referred to Skyla as Mirena’s little sister. It’s slightly smaller, has a lower dose of hormones, and lasts up to 3 years instead of up to 7. Skyla can make periods lighter, but most Skyla users won’t have their period go away altogether. Only 1 in 17 stop having a period after a year, and about 1 in 8 have no period if they use it for longer. Because Skyla is slightly smaller, it has a narrower inserter, so in theory insertion may be less uncomfortable for those who haven’t had a child.

Kyleena

If Skyla is the baby of the family, Kyleena is the middle sister. It’s the same size as Skyla but releases 17.5 micrograms/day of levonorgestrel—more than Skyla’s 14 micrograms/day and less than Mirena’s and LILETTA’s 20. Kyleena lasts up to 5 years, and about 1 in 8 people who use it will stop having periods after a year.

How about the non-hormonal IUD?

The Paragard non-hormonal IUD prevents pregnancy thanks to a tiny copper filament wrapped around the T. Paragard contains no hormones of any kind—it’s the only super-effective non-hormonal birth control method around (besides sterilization). Paragard also works as highly effective emergency contraception, so if you’re considering an IUD and have had unprotected penis-in-vagina sex in the last 5 days but don’t want to be pregnant, that could be another point in its favor.

Most people who use Paragard have heavier, longer, or crampier periods, especially for the first few months. After 6 months, many Paragard users’ periods return to normal. If you already have really heavy or uncomfortable periods, or you are anemic (too little iron in your blood), you might prefer a hormonal IUD.

The bottom line? IUDs are safe, effective, and totally reversible. Whichever IUD you and your provider decide is best for you, we all win with more long-lasting, low-maintenance birth control options available.

Sara Kennedy, MD, MPH, is an Obstetrician/Gynecologist in Oakland, California. Originally from Pennsylvania, Sara has studied and lived around the world, including a residency at Northwestern University in Chicago and a master’s degree in Australia, where she met her husband! Sara is passionate about women’s health, particularly helping women in vulnerable situations obtain the knowledge and resources they need in order to control their reproductive health.

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