ParaGard vs Mirena vs Skyla: Comparing IUDs

Comparing IUDs

ParaGard vs Mirena vs Skyla
ParaGard vs Mirena vs Skyla. Photo © 2016 Dawn Stacey

IUDs are effective, long-term, and reversible contraceptive options. For over a decade, women only had two IUD options to choose between… Mirena, the progestin-only hormonal IUD and ParaGard, the copper non-hormone IUD.

Introducing Skyla...

In January 2013, a new IUD choice became available… Skyla. Affectionally known as “Mirena’s little sister,” the Skyla IUD is made by the same company that makes Mirena.

For the most part, this "mini-IUD" works very much the same way that Mirena does.

So if you are thinking about getting an IUD, how do these options compare to one another? What makes them different?

ParaGard, Mirena, and Skyla – Similarities:

All three of these IUDs are highly effective birth control methods. They are “T-shaped” devices that must be inserted into your uterus by a qualified doctor. Skyla, Mirena, and ParaGard can also be removed at any time. Your fertility will quickly return once they are removed.

Comparing IUDs:




Works by releasing a low amount of the progestin,  levonorgestrel (20 mcg a day); thickens cervical mucus and makes it harder for sperm to move.

Works by releasing a low amount of the progestin,  levonorgestrel (14 mcg a day); thickens cervical mucus and makes it harder for sperm to move. 

Hormone-free; works because it contains a small amount of copper that makes it more difficult for sperm to move.

Measures 32 mm horizontally and 32 mm vertically.

Measures 28 mm horizontally and 30 mm vertically.

Measures 32 mm horizontally and 36 mm vertically.

Tube used to insert Mirena is 4.75 mm in diameter.

Tube used to insert Skyla is 3.8 mm in diameter.

Tube used to insert ParaGard is 4.01 mm in diameter.

Can be used for up to 5 years.

Can be used for up to 3 years.

Can be used for up to 10 years.

99.8% effective.

99.1% effective.

99.2-99.4% effective.

Labeling states that: Mirena is recommended for women who have had at least one child.

Labeling states that: Skyla can be used whether or not a woman has had a child.

Labeling was changed in 2005 and no longer contains language-discouraging use by nulliparous women.

ParaGard vs. Mirena vs. Skyla

Skyla and Mirena are both made by Bayer HealthCare Pharmaceuticals. Skyla is a little bit smaller than Mirena and ParaGard, and the tube that is used to insert Skyla is also smaller than Mirena and ParaGard's insertion tube. Skyla's smaller size may make it easier and less painful to insert.

 Research says that Skyla's smaller size may also be better tolerated by women who have a smaller uterus -- such as young teens and perimenopausal women. Also, because it is smaller than Mirena and ParaGard, Skyla may be a little less likely to be expelled (come out of the uterus) in women who have never had a baby or in younger women.

Unlike Mirena, Skyla is the only IUD whose use has been studied a lot in nulliparous women (women who have never given birth). Because of this research, the FDA has allowed Skyla's product labeling to specifically state that Skyla can be used whether or not a woman has had a child. That being said, both Mirena and ParaGard IUDs can also be safely used with women who have never given birth -- even though Mirena's labeling does not state that it is meant to be used with these women. Research consistently shows that Skyla, Mirena, and ParaGard are effective and safe contraceptive devices for nulliparous women.

    Skyla contains a lower amount of levonorgestrel than Mirena (13.5 mg vs. 52 mg). But, because both of these IUDs contain progestin, using Skyla or Mirena may cause changes in your bleeding patterns. You will be more likely to have spotting for the first few months, and then have lighter and shorter periods.

    Both Mirena and Skyla can also cause your period to stop altogether. This is more likely to happen with Mirena than with Skyla -- about 20% (1 in 5) women stop having a period after one year of Mirena use vs. about 6% (1 out of every 17) women who use Skyla for one year. Otherwise, the side effects and possible risks are about the same with both Mirena or Skyla use.

    Mirena is the only birth control method that is also FDA-approved to treat heavy periods in women who have chosen to use an IUD. The Mirena IUD helps to lower your total blood loss per cycle. Skyla is only meant for contraception use, so it is NOT FDA-approved for the treatment of heavy periods.


    Bowers R. "FDA approves smaller levonorgestrel intrauterine system - A 'mini Mirena." Contraceptive Technology Update. 2013 March; 34(3):25-36. Accessed July 9, 2014

    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. Assessed via private subscription.

    Lyus R, Lohr P, Prager S. "Use of the Mirena LNG-IUS and Paragard CuT380A intrauterine devices in nulliparous women." Contraception. 2010 May; 81(5):367-71. Accessed July 9, 2014.

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