How to Choose the Right IUD

One Copper IUD Versus Four Progestin-Releasing IUDs

Woman holding IUD
BSIP/Getty Images

IUDs (intrauterine devices) are effective, long-term, and reversible birth control options, and there are five FDA-approved brands available on the market:

  • Mirena
  • Liletta
  • Skyla
  • Kyleena
  • ParaGard

You may be wondering which IUD is right for you. This is a decision that requires a careful and thoughtful discussion with your doctor, and knowing the basics about the different IUDs before you have this conversation can be extremely helpful.

Overview of the IUDS

All four of the IUDs are highly effective birth control methods. They are “T-shaped” devices that must be inserted into your uterus and removed from your uterus by a qualified doctor.

The main distinction among the IUDs is that one of them—the copper IUD, called the ParaGard—does not release a hormone. 

Copper IUD

ParaGard is the only hormone-free IUD and is made up of polyethylene wrapped with copper wire. How does ParaGard work to prevent pregnancy? Experts believe there are a number of different mechanisms, including: 

  • Inhibition of sperm movement and viability (sperm do not live)
  • Change in speed of the egg before it meets the sperm
  • Damage to the egg
  • Impairs implantation of a fertilized egg

Of all the IUDs, the ParaGard can be used the longest, for up to 10 years. In terms of side effects, women choosing the ParaGard should know that it may cause heavy and long periods with more cramping than usual, especially in the first several menstrual cycles.

Although, it's important to note that because the copper IUD is hormone-free, it will not alter a woman's menstrual cycle, so she will continue to have regularly scheduled periods.

Levonorgestrel IUDs

There are four levonorgestrel IUDS: Mirena, Liletta, Skyla, and Kyleena. Like the ParaGard, they are T-shaped, but unlike the ParaGard, they contain a polydimethylsiloxane sleeve that contains levonorgestrel (a progestin) on the stem.

These hormone IUDs work by thickening cervical mucus (making it difficult for sperm to travel), thinning the lining of the uterus which impairs implantation, and preventing the binding of the sperm to the egg. 

  • The Mirena initially releases 20mcg of levonorgestrel a day and is FDA approved for up to 5 years. Note that as time goes on, the levonorgestrel IUDs release less and less hormone, but they are still just as effective.  
  • Liletta initially releases 18.6mcg per day of levonorgestrel and is approved for three years of use. 
  • Skyla, also known as "Mirena's little sister," initially releases 14mcg of levonorgestrel a day and can be used up to 3 years. 
  • Kyleena was FDA-approved in September 2016 and offers the best of two worlds, a 5-year time-frame (like Mirena) but a smaller size and less hormone (like Skyla). Specifically, Kyleena initially releases 17.5mcg of levonorgestrel a day.

Because these four IUDs contain progestin, you may experience changes in your menstrual flow. For instance, you may be more likely to spot for the first few months and then have lighter and shorter periods. Your period may also stop altogether. 

Other side effects may include hormone-related symptoms like:

  • Headaches
  • Nausea
  • Breast tenderness
  • Depression
  • Decreased libido
  • Hair loss
  • Ovarian cysts

Choosing the Right IUD

One of the best ways to decide between IUDs is to determine whether or not you want to use a hormonal birth control method. If you cannot or choose not to be exposed to hormones, the ParaGard IUD may be the obvious best choice.

Keep in mind, though, that the hormone in Mirena, Skyla, Liletta, and Kyleena is only released locally (into the uterus), so it does not have the same kind of broad effect as the hormones found in birth control pills.

Other factors that can help you choose the right IUD include:

  • Length of pregnancy coverage (3 years versus 5 years versus 10 years)
  • Amount of hormone
  • Side effects (for example, some women experience heavy, painful menstrual bleeding in the first six months or so with the copper IUD)

The size of the IUD may also influence your decision. Skyla and Kyleena are a little bit smaller than Mirena, Liletta, and the ParaGard. Thus, Skyla and Kyleena's smaller size may make these IUDs easier and less painful to insert.

Their smaller size may also be better tolerated by women who have a smaller uterus, such as young teens and perimenopausal women. 

A Word From Verywell

No matter which IUD you choose, you can have the piece of mind that all five are among the most effective forms of birth control methods. In fact, they are as effective as permanent methods, like vasectomies and tubal ligation.

Furthermore, despite common misconceptions, IUDs are safe forms of contraception for nulliparous women, and they do not affect your chance of getting pregnant after having it removed.

It should be noted, that IUDs do not protect women from sexually transmitted infection. In addition, with an IUD insertion, there is a risk of expulsion (the IUD falling out) or infection, although these events are uncommon. 

All in all, these eco-friendly birth control methods are discreet and allow for sexual spontaneity. After choosing their IUD, most women are extremely satisfied with their decision.

Sources:

American College of Obstetrics and Gynecologists. (July 2011, Reaffirmed 2015). Clinical Practice Bulletin: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. 

Dean G, Goldberg AB. (2017). Intrauterine contraception: Devices, candidates, and selection. In: UpToDate, Schreiber CA, Eckler K (Eds), UpToDate, Waltham, MA. 

Bowers R. "FDA approves smaller levonorgestrel intrauterine system - A 'mini Mirena." Contraceptive Technology Update. 2013 March; 34(3):25-36. 

Gemzell-Danielsson K, Schellschmidt I, Apter D. "A randomized, phase II study describing efficacy, bleeding profile and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena." Fertility and Sterility. 2012; 96(3):616-622. 

Hardeman J. Intrauterine devices: An update. Am Fam Physician. 2014 Mar 15;89(6):445-50.

Continue Reading