Mirena vs. ParaGard vs. Skyla vs. Kyleena: Comparing IUDs

How to Choose the Right IUD

Choosing IUDs
Mirena vs. ParaGard vs. Skyla vs. Kyleena IUD. Photo © Dawn Stacey

IUDs are effective, long-term, and reversible birth control options. There are four FDA-approved brands of IUDs available on the market: Mirena, ParaGard, Skyla, and Kyleena. Wondering which IUD is the right one for you?

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. Then, Bayer HealthCare Pharmaceuticals mixed things up!

Along Comes 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.

Introducing the Kyleena IUD...  

In an attempt to offer women the longest pregnancy protection period with the least amount of hormones, Kyleena is added to the IUD market. FDA-approved in September 2016, Kyleena offers the best of two worlds: a 5 year time-frame (like Mirena) but a smaller size and less hormones (like Skyla)—welcome to the family Kyleena!

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

Mirena, ParaGard, Skyla, and Kyleena — Similarities

All four 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.

Kyleena, Skyla, Mirena, and ParaGard can also be removed at any time. Your fertility will quickly return once they are removed.

Comparing IUDs

Mirena IUD

Skyla IUD

ParaGard IUD

Kyleena IUD

Works by releasing 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.

Works by releasing a low amount of the progestin,  levonorgestrel (17.5 mcg a day); thickens cervical mucus and makes it harder 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.

Measures 28 mm horizontally and 30 mm vertically.

Tube used to insert Mirena is 4.4 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.

Tube used to insert Kyleena is 3.8 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.

Can be used for up to 5 years.

99.8 percent effective.

99.1percent effective.

99.2-99.4 percent effective.

Over 99 percent 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.

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

Mirena vs. ParaGard vs. Skyla vs. Kyleena

Mirena, Skyla, and Kyleena are all made by Bayer HealthCare Pharmaceuticals. Skyla and Kyleena are a little bit smaller than Mirena and ParaGard, and the tube that is used to insert Skyla and Kyleena is also smaller than Mirena and ParaGard's insertion tube. Skyla and Kyleena's smaller size may make these IUDs easier and less painful to insert. Research suggests that Kyleena and 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 these IUDs are smaller than Mirena and ParaGard, Skyla and Kyleena 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 the Mirena IUD,  Skyla and Kyleena IUD use has been studied in nulliparous women (women who have never given birth). Because of this research, the FDA has allowed both Skyla and Kyleena"s product labeling to specifically state that the Skyla IUD and the Kyleena IUD can be used whether or not a woman has had children. That being said, both the Mirena IUD and the ParaGard IUD 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 Mirena, ParaGard, Skyla, and Kyleena are effective and safe contraceptive devices for nulliparous women. All four IUDs can also be safely used if you are a breastfeeding mommy.

Hormone IUD vs. No Hormone IUD

Mirena, Skyla, and Kyleena are considered to be hormonal birth control—they all contain the progestin, levonorgestrel. The Skyla IUD and the Kyleena IUD contain a lower amount of levonorgestrel than the Mirena IUD (13.5 mg/19.5 mg vs. 52 mg). Because these IUDs contain progestin, using Mirena, Skyla or Kyleena may cause changes in your bleeding patterns.

You may be more likely to have spotting for the first few months, and then have lighter and shorter periods.

Mirena, Skyla, and Kyleena IUDs can also cause your period to stop altogether. This is more likely to happen with Mirena than with Skyla or Kyleena—about 20 percent (1 in 5) women stop having a period after one year of Mirena use vs. about 6 percent (1 out of every 17) of women who use Skyla for one year vs. 12 percent (1 in 9) of women using Kyleena for a year. Otherwise, the side effects and possible risks are about the same with Mirena, Skyla, or Kyleena 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 higher amount of progestin in the Mirena IUD helps to lower your total blood loss per cycle. Skyla and Kyleena only meant for contraception use, so they are NOT FDA-approved for the treatment of heavy periods.

ParaGard is the only IUD option that is hormone-free. Instead of hormones, the ParaGard relies on copper—which kinda acts like a spermicide. The ParaGard IUD has 176 mg of copper wire coiled around its vertical stem, and 68.7 mg of copper wrapping on each side of its horizontal arm. Because it does not contain hormones, the ParaGard IUD does not interfere with your natural menstrual cycle. That being said, you may have longer periods when using the ParaGard IUD. This IUD may cause a 50-75 percent increase in your menstrual flow. Some women may have an allergic reaction to the copper used in the ParaGard IUD.

Choosing the Right IUD

So how do you choose between Mirena, ParaGard, Skyla, and Kyleena? One of the best ways to decide between IUDs comes dow to whether or not you want to use a hormonal birth control method. If you don’t want anything to do with hormones, the ParaGard IUD is the best choice. Keep in mind though that the hormone in Mirena, Skyla, and Kylenna is only released locally (into the uterus) and don’t 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 may have to do with:

  • The length of pregnancy coverage (3 years vs. 5 years vs. 10 years)
  • The amount of hormone
  • The size of your uterus
  • Whether or not you can tolerate the side effects linked to each IUD

No matter which IUD you choose, you can have piece of mind—Mirena, ParaGard, Skyla, and Kyleena are among the most effective of all birth control methods (they are as effective as permeant methods, like vasectomies and tubal ligation). 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:

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. 

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. 

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