Types of IUDs: Which One Is Right for You

Dr. Butler is a huge fan of the copper IUD because it is non-hormonal and the U.S. Food anzasad Drug Administration (FDA) has approved it for up to 10 years of use after insertion (though, some doctors say it can last up to 12 years). That said, both hormonal and non-hormonal IUDs come with their own list of pleasant and potentially not-so-pleasant side effects, so you must weigh the pros and cons before deciding if the copper IUD is the right form of contraception for you. Here’s what you need to know before you pair up with Paragard.

What to Know About the Paragard Copper IUD Before You Commit

Deciding to get an IUD can feel like an empowering contraceptive commitment. But you also have a major choice to make: copper IUD or hormonal IUD? Whichever one you choose, these small, T-shaped devices are inserted into your uterus by a medical provider, and they can provide years upon years of extremely effective birth control. But they do work differently. You could opt for a hormonal IUD like Mirena, Skyla, Liletta, or Kyleena, which all use progestin to thin your uterine lining and thicken your cervical mucus, so it’s more difficult for sperm to reach an egg. And then there’s the non-hormonal outlier, the copper IUD.

What makes this one different? The copper IUD, also manufactured under the brand name Paragard, is in a class of contraceptives referred to as LARCs or long-acting reversible contraceptives, Nichole Butler, MD, FACOG, a board-certified ob-gyn for the Women’s Health Center at Weiss Memorial Hospital in Chicago, tells SELF. It’s made of soft, flexible plastic wrapped with a thin layer of copper. Every type of IUD is inserted into your uterus by a medical professional, but the copper IUD is unique in that it prevents pregnancy by changing the environment in your uterus to make it toxic to sperm. In contrast, hormonal IUDs (Mirena, Skyla, Liletta, and Kyleena) use progestin (a synthetic form of the hormone progesterone) to thin the uterine lining and thicken cervical mucus, making it difficult for sperm to reach an egg.

Dr. Butler is a huge fan of the copper IUD because it is non-hormonal and the U.S. Food anzasad Drug Administration (FDA) has approved it for up to 10 years of use after insertion (though, some doctors say it can last up to 12 years). That said, both hormonal and non-hormonal IUDs come with their own list of pleasant and potentially not-so-pleasant side effects, so you must weigh the pros and cons before deciding if the copper IUD is the right form of contraception for you. Here’s what you need to know before you pair up with Paragard.

What are the pros of the copper IUD compared to hormonal IUDs?

Having a device inserted into your vagina (and on into the uterus) gives you plenty of reasons to ask a lot of questions. Your job, with the guidance of your ob-gyn, is to determine if the benefits of the copper IUD outweigh the downsides.

Let’s start with the good stuff: “The major pros of the copper IUD are that it is long-acting, it doesn’t require you to remember to do anything every day, week, or month, and it’s non-hormonal for those who want or need to avoid hormones due to side effects or health concerns,” Kelly Culwell, MD, a board-certified ob-gyn in Sacramento, California, tells SELF.

Once you do get to see the doctor, don’t be surprised if you’re rushed out of the exam room before you get all of your questions answered, according to healthcare staffing agency Staff Care. Studies show that 41% of ophthalmologists spend just 9 to 12 minutes with a patient, and 13- to 16-minute appointments are the norm for 40% of cardiologists, 37% of pediatricians, 35% of urologists, 35% of family physicians, 34% of obstetricians and gynecologists and 30% of otolaryngologists.

Not having to remember to take a pill every day is a big benefit of both types of IUDs. “The copper and hormonal IUDs are similar in terms of the way they are inserted, and they don’t require you to remember to do anything—sometimes called a ‘set it and forget it’ method, so they are both good options for people who can’t remember to take a pill every day,” Dr. Culwell says.

Plus, IUDs are tiny, so you and your partner will not feel it during sex. (Just note that it does have two strings that hang through your cervix and into your vagina). The doctor will shorten the strings once the IUD is in place, allowing your health-care provider to periodically check to make sure it’s still there, should any issues arise.)

With that said, let’s jump into the specific benefits of the copper IUD compared to hormonal IUDs:

The copper IUD lasts a lot longer than hormonal IUDs.

When it comes to long-lasting birth control, the copper IUD comes out on top. According to the Mayo Clinic, it’s considered a long-acting method to prevent pregnancy for up to 10 years.

By comparison, hormonal IUDs are only recommended for three to seven years, depending on the brand. Of course, you can have any of them removed sooner, which is great news if you eventually decide you want to get pregnant. What’s more, fertility returns almost immediately after removal, making IUDs an excellent birth control method if baby fever ever kicks in.

Cost and efficacy are on par with hormonal IUDs.

Both the cost (which we dig into more below) and the efficacy of hormonal and non-hormonal IUDs are similar. The copper IUD’s effectiveness is seriously impressive (over 99% effective at preventing pregnancy), but the non-hormonal IUDs are pretty impressive too. According to a 2017 review published in Perspectives on Sexual and Reproductive Health, IUDs, both hormonal and non-hormonal, have the lowest failure rate of all contraceptive methods. 3 What’s more, research from 2014 published in the journal American Family Physician shows that the copper IUD fails just 0.6% to 0.8% of the time. 4 That boils down to fewer than one out of 100 people getting pregnant in the first year of using the copper IUD, which is a pretty excellent success rate.

It can be used as emergency contraception.

One other benefit that’s unique to the copper IUD is it can act as emergency contraception if needed, preventing pregnancy with nearly 100% efficacy after unprotected penis-in-vagina sex. 1 The caveat is you’ll need to get one inserted within five days after having unprotected sex to be effective, according to the Centers for Disease Control and Prevention (CDC). Additionally, the copper IUD and the hormonal IUDs are easily taken out, making it a great choice if getting pregnant becomes a priority.

It’s a good option for people who are sensitive to hormones.

Most people using a hormonal IUD don’t notice the same types of hormonal side effects that you might have with the combination birth control pill (which has estrogen and progestin), but Dr. Culwell points out that some people who are really sensitive to hormones might find they have side effects like mood changes. In that case, the non-hormonal copper IUD might be the best fit.

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What are the cons of the copper IUD compared to non-hormonal IUDs?

Now that we’ve talked through the benefits of using a copper IUD compared to the hormonal variety, let’s go through the potential cons. There really is just one big one, and it has to do with your monthly visitor.

Your period might be heavier and more painful with the copper IUD.

According to Dr. Culwell, IUD insertion, in particular, can be painful and can cause periods to be heavier or very uncomfortable, particularly for the first few months. Because of this, she says a copper IUD isn’t a great method for people with heavy and or painful periods to start with. However, if you decide to try the Paragard copper IUD, the American College of Obstetricians and Gynecologists (ACOG) says this issue typically goes away, or at least decreases after having the IUD for a year.

Hormonal IUD side effects are the opposite and often lead to less bleeding or potentially no period at all in some cases, but you may experience things like cramping and pelvic pain, breast tenderness, and/or headache. Why the difference in bleeding? Hormonal IUDs have a low dose of progestin, which Dr. Culwell says can make periods lighter, irregular, or totally absent. “The copper IUD generally doesn’t change the frequency of your period, so you have your period on your natural schedule, however, the periods can be heavier and more painful with the copper IUD in place,” she says.

A few other cons to know about IUDs as a whole

There are a few drawbacks to all IUDs to consider if you’re on the fence. The first is that you’ll need to make an appointment with your doctor for any changes you make to your contraception. That’s because, with any type of IUD, your doctor needs to insert and remove it when the time comes.

Also, if you have uterine issues, like large fibroids, it might affect the IUD’s placement. Having an infection like pelvic inflammatory disease (a condition in which bacteria infects the reproductive organs) might also be an issue, so you should definitely talk with your doctor about any extra cons associated with these conditions when deciding on an IUD. Though, it’s important to note that IUDs do not increase your risk for pelvic inflammatory disease.

Another risk is that any type of IUD may come out of the uterus (doctors call this expulsion). Notice we said may—that’s because this is not common and only happens in about 5 in 100 users in the first year of using the IUD, according to the ACOG.

While rare, any type of IUD can also cause perforation, which is when the device pushes through the wall of your uterus. According to a 2015 study published in the journal Conception, out of 61,448 people who had an IUD, only 20 of those with the copper IUD experienced a perforation. 2 If you were to deal with perforation, you would potentially experience pelvic pain or possibly no symptoms at all.

And then there’s the issue of sexually transmitted infections. The copper IUD does nothing to prevent STIs—but neither does any form of sexual protection that is not a barrier method, such as condoms or dental dams.

Types of IUDs: Which One Is Right for You?

Intrauterine devices (IUDs) are a low-maintenance birth control option. They’re generally better at stopping pregnancy than other forms of birth control, like condoms or pills.

A gynecologist puts the tiny, T-shaped device in your uterus. That’s a doctor who specializes in female reproductive health. There are two types: copper and hormonal. Here’s what you need to know.

Copper IUDs

Coppers IUDs are made of copper and plastic. They don’t have any hormones, but they start warding off pregnancy right away. Copper is a spermicide, something that kills sperm. Sperm meet the IUD before they’re able to reach an egg and fertilize it. Pregnancy can’t happen if there’s no sperm to fertilize your eggs. Copper also makes it hard for fertilized eggs to implant in your uterus.

ParaGard is the only copper IUD available in the United States. Possible side effects of copper IUDs include:

• Bleeding between periods
• Cramps
• Severe menstrual pain and heavy bleeding

Hormonal IUDs

Hormonal IUDs have a hormone called progestin levonorgestrel. They can take up to a week before they prevent pregnancy. Progestin thickens your cervical mucus and thins the lining around your uterus. This stops sperm from reaching and fertilizing eggs. The hormone can also stop ovulation. That’s when one of your ovaries releases an egg.

Kyleena, Liletta, Mirena, and Skyla are the four leading brands of hormonal IUDs.

If you decide to get a hormonal IUD, you might have these side effects as your body gets used to the hormone:

• Headaches
• Acne
• Weight gain
• Breast tenderness
• Irregular bleeding, which can improve after 6 months
• Changes in your mood
• Cramping and pelvic pain

What’s the Same

Even though copper and hormonal IUDs are made of different things, they’re alike in some ways. These include:

Effectiveness. Both copper and hormonal are more than 99% effective. Copper IUDs are 99.2% effective, while hormonal IUDs are successful 99.8% of the time. The chance of you getting pregnant is less than 1%.

Safety. IUDs are safe to use. Only an estimated 1 in 1,000 women have complications.

They don’t protect you from sexually transmitted diseases (STDs). You’ll need to wear a condom even if you have an IUD.

You can get it taken out at any time. You can have copper and hormonal IUDs removed whenever you’re ready.

What’s Different

There are two main differences between copper and hormonal IUDs. These are:

How long they last. Copper IUDs can stop pregnancy for up to 10 years. Hormonal IUDs only work 3-6 years, depending on the type and brand.

How they affect your period. You may have heavier bleeding, severe menstrual pain, and cramps if you get a copper IUD. You might even notice some bleeding in between periods. Hormonal IUDs typically ease menstrual pain and heavy bleeding. They may even stop ovulation and your period altogether.

How to Choose

Your doctor can help you decide which IUD is better for you. Here are a few things to think about:

Your goals. Avoiding pregnancy is usually the main one. You may want to try a hormonal IUD if you’re looking to ease period pain or to lighten your periods. Copper might be the way to go if you want to keep the IUD in as long as possible.

Cost. A copper IUD costs a little more than $1,200 without insurance. Hormonal IUDs are a little more than $1,500. If you have health insurance, most companies will pay for some or all of the costs.

Comfort. You may feel better about more hormones in your body than you do metal, or the other way around. You may prefer a specific brand. Talk to your doctor about what you’re OK with before you choose an IUD.

Show Sources

KidsHealth (TeensHealth): “The IUD.”

University of Michigan: “Contraception Cost, Insurance, and Payment.”

U.S. Department of Health and Human Services: “Intrauterine Devices (IUD).”

Mayo Clinic: “Copper IUD (ParaGard),” “Hormonal IUD (Mirena).”

UC San Diego Health: “What’s Important to You? Personalizing Your IUD Choice.”

The American College of Obstetricians and Gynecologists: “Your First Gynecologic Visit.”

Cleveland Clinic: “Do the Benefits of IUD Outweigh the Potential Side Effects?”