Understanding the Different IUD Types—And How to Find the Best Fit for You

If you’re considering an intrauterine device or IUD, you’re in good company. IUDs, which are classified as long-acting reversible contraceptives (LARCs), are one of the most commonly used and effective forms of birth control, according to the Centers for Disease Control and Prevention (CDC). Since you have several IUDs to choose from, you might be wondering: “Which IUD is right for me?”

Currently, two IUD types are available: hormonal and non-hormonal. Both are known for their set-it-and-forget-it practicality, but they work differently to prevent pregnancy. Hormonal IUDs, including Kyleena, Skyla, Mirena, and Liletta, work by releasing the hormone levonorgestrel, a form of progestin. The only non-hormonal IUD option is the copper IUD, or Paragard, which prevents pregnancy by changing the environment in your uterus to make it toxic to sperm (more on this later).

Although more options are always a good thing, especially when it comes to birth control, it can also be overwhelming. And you’ll probably want to do some extra research before making a decision. Thankfully, we’re here to help! Here’s what the experts say you should know and consider when choosing the best IUD for you.

An IUD is a tiny, T-shaped piece of flexible plastic that is inserted into your uterus by a medical provider. We mentioned earlier that the hormonal IUDs—Mirena, Skyla, Kyleena, and Liletta—all work by releasing the hormone levonorgestrel, a form of progestin. Levonorgestrel works by thickening the cervical mucus, which blocks the sperm from meeting up with an egg.¹ If a highly motivated sperm (we’re talking Tom Brady-level athleticism and ambition) does make it through, progestin also thins the lining of the uterus making implantation unlikely to occur. 

Paragard, the only non-hormonal IUD, has copper wire coiled around it. That copper produces an inflammatory response in the uterus that’s toxic to sperm and it interferes with its movement, making it nearly impossible to have a meet-and-greet with an egg, according to the American College of Obstetricians and Gynecologists (ACOG).

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Hormonal and non-hormonal IUDs have a lot in common. For example, they both do an excellent job of preventing pregnancy. They’re both small, T-shaped devices inserted into your uterus, which, by the way, requires a procedure for placement and removal. And neither one protects against sexually transmitted infections (STIs).

The differences, then, come from how each type prevents pregnancy (as we explained above), as well as their various side effects (which we’ll dig into below). The other key difference is how long you can leave the IUD in place. If you want long-lasting contraception, the copper IUD is approved for up to 10 years of use, with some doctors suggesting up to 12 years. In contrast, hormonal IUDs last for three to seven years, depending on which one you choose.

There are also a few non-contraceptive benefits to consider for each type. For the copper IUD, that includes a reduced risk of cervical cancer and the ability to use it as emergency contraception. For hormonal IUDs, the list is a bit longer. They can reduce heavy bleeding and anemia, eliminate painful periods, decrease endometriosis-related pain, and also reduce the risk for cervical cancer, uterine cancer, and pelvic inflammatory disease.

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IUDs, in general, are very effective in preventing pregnancy. That said, the levonorgestrel-based IUDs (Mirena, Skyla, Kyleena, and Liletta) are the most effective type on the market, Jen Lincoln, MD, an ob-gyn in Portland, Oregon and medical board member at The Body Agency, tells SELF.

“The hormonal IUD is 99.8% effective at preventing pregnancy, which is amazing; however, the copper IUD (Paragard) is a very close runner-up, coming in at 99.2% efficacy,” she says. While there is a slight drop in effectiveness, Dr. Lincoln says they are both fantastic forms of birth control,² and she wouldn’t let that tiny statistical difference be the thing that makes or breaks your choice between the two.

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Periods can be a real pain, especially if your flow is heavy or seems to take forever to end. The good news? Some people have a lighter period, or no period at all, with a hormonal IUD—there’s just no guarantee since everybody is different. The copper IUD on the other hand can actually make periods heavier and longer, at least for the first few months.

Okay, back to hormonal IUDs. It’s important to point out that the different hormone amounts in the various IUDs can impact your period differently. Generally, the higher the hormonal dosage within the IUD, the more likely it is your period will become lighter or stop altogether, according to the Mayo Clinic. For example, Mirena and Liletta have the most levonorgestrel, at 52 mcg, so it makes sense that they might result in less (or no) bleeding.

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It’s pretty apparent that both IUD types do an excellent job of preventing pregnancy. So, why would you choose one over the other? For many people, it comes down to the side effects. According to the ACOG, IUD side effects from a hormonal device include:

• Spotting, and potentially more or heavier days of menstrual bleeding in the first few months following insertion, but a decrease in the amount of menstrual bleeding and length of the period over time
• Breast tenderness
• Headaches
• Nausea
• Mood changes
• Bloating
• Ovarian cyst formation

It should be noted that these hormonal IUD side effects are rare, and typically go away with time.

Copper IUD side effects, on the other hand, are mostly related to bleeding—you might experience more and for longer periods of time, according to the ACOG. You may also experience more painful periods, especially during the first few months following insertion. However, because it’s hormone-free, you should not experience any side effects related to elevated progestin levels like breast tenderness, headaches, or nausea, as you may have with a hormonal IUD.

Some people also might wonder whether an IUD can cause weight gain. In general, IUDs are not known to increase your weight, though it is possible. Hormonal IUDs can cause you to retain more water due to elevated progestin, but it would likely only be a few pounds. The copper IUD doesn’t release any hormones, so it shouldn’t affect your weight.

Even so, people report weight gain while using all different IUD types. But everyone is different, and it could be that a person gains weight for reasons not directly related to their IUD. For example, one 2014 study published in The European Journal of Contraception and Reproductive Health Care found that people with vaginas using either the copper IUD or a hormonal IUD both gained about 10 pounds in 10 years, which supports the idea that you may just naturally gain weight over a period a time—say, due to a change in activity levels or metabolism—while you’re using this type of contraception.³

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IUD insertion and IUD removal are usually very quick, it takes place in the office, and is only needed every 3 to 12 years, depending on the IUD type and how long you leave it in place, Dr. Lincoln explains. In that sense, it’s truly a “set it and forget it” form of birth control for many people.

That said, she always discusses the downsides of the procedure with people who are interested in IUDs and explains that the discomfort of insertion or removal can range from a mild cramp to severe pain. “It’s hard to know which camp you fall into until you do it,” she says. “However, we have options to make insertion (which tends to cause more pain compared to removal) more comfortable.”

Your provider may recommend medications to take beforehand, such as an over-the-counter NSAID, that can help reduce cramping. Dr. Lincoln says your doctor can also use local medicine in the form of injections or topical solutions to numb parts of the cervix. “Stronger medications like narcotics, anti-anxiety medications, and even light sedation are options that we have at our disposal too,” she adds.

If you’re undergoing an IUD placement and need your provider to stop, Dr. Lincoln says you should not hesitate to tell them. “You can then regroup and make a game plan for how to move forward, such as using more medication, sedation, or even using deeper anesthesia if that's required,” she adds.

As for what to expect after insertion, Dr. Lincoln says you may experience pain similar to period cramps, which totally vary from person to person. “Some people don’t notice much, while others need to take the remainder of the day to rest and use ibuprofen or related medicines along with a heating pad to feel better,” she explains. To be on the safe side, plan to have the day free after your insertion in case your body tells you rest is necessary.

IUD removal is much quicker, easier, and typically less painful than IUD insertion (thankfully!). The difference in procedures has to do with the strings. Typically the IUD strings are left about 3 cm long after insertion, allowing your doctor to see them (and grasp them with an instrument) during the removal exam, Kelly Culwell, MD, a board-certified ob-gyn practicing in Sacramento, California, tells SELF. “If the strings can’t be seen for some reason, additional instruments or ultrasound might be necessary to locate the IUD and remove it. Unfortunately, that makes the removal process a bit more complicated, and it can be more painful,” she adds.

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Still not sure which is the best IUD for you? Dr. Lincoln says it often comes down to what kind of menstrual bleeding is acceptable to you. “The copper IUD is awesome in that it can be used for a decade and is hormone-free, but it can definitely make your periods heavier or crampier,” she says. For some people, this persists. So, if you already have a heavy period, a copper IUD might not be the best route. On the other hand, hormonal IUDs are great if you want lighter periods or no periods at all. Aside from preventing pregnancy, Dr. Lincoln says this is a reason many people will choose a hormonal IUD.

Another thing to consider, Dr. Lincoln says, is whether or not you want a reliable period. “If you’re the kind of person who wants a scheduled, predictable period, a hormonal IUD might not be the best for you, and you may want to consider something like the pill, patch, vaginal ring, or the copper IUD,” she says. One other thing to note is that it’s normal to have spotting and unscheduled bleeding after your hormonal IUD is placed, but this often gets better over a few months.

Also, if you prefer to have control over when you start or stop a method, Dr. Lincoln says you may want to look elsewhere. Stopping the use of an IUD requires an appointment with your doctor for removal. And then there’s the cost to consider. If you have insurance, Dr. Lincoln says your benefits should cover the full cost of your birth control, but if you’re paying out of pocket, the IUDs will be more expensive upfront compared to the cost of a monthly pill pack. That said, once you have the IUD inserted, it can stay in place for years with no other expenses, given that you have an overall good experience following your insertion.

It’s important to talk to your doctor about all these factors, discuss your medical history, and ask questions based on the research you’ve done. Getting exactly what you want out of your birth control is important, so never feel shy telling your doctor what that is.

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Sources:

1. StatPearls, Intrauterine Device
2. StatPearls, Contraception
3. The European Journal of Contraception and Reproductive Health Care, Weight Variation in Users of Depot-Medroxyprogesterone Acetate, The Levonorgestrel-Releasing Intrauterine System and a Copper Intrauterine Device for Up to Ten Years of Use

Related:

• Concerned About Period Clots? Here’s When to See a Doctor
• Can an IUD Fall Out During Sex?
• How I Manage Period Care When I Can Only Use One Hand