IUDs are among the most effective birth control options there is — over 99% — and once one is in, you mostly forget about it for years. The main decision isn't really "should I get an IUD," it's "which one." That comes down to a single fork: hormonal or copper. Here's how to think about it.
The two families
There are two kinds of IUD, and almost every question about "which one" is really a question about these two:
- Hormonal IUDs release a small amount of progestin (levonorgestrel) right where it's needed. In the US these are Mirena, Liletta, Kyleena, and Skyla. They tend to make periods much lighter, and often stop them altogether.
- The copper IUD (Paragard) has no hormones at all. It works by releasing a tiny amount of copper. Periods continue as normal, and can be heavier or crampier — especially in the first few months.
They're all about equally effective
This is the part people worry about and shouldn't: all IUDs, hormonal and copper, are more than 99% effective at preventing pregnancy. Effectiveness is not the thing that separates them. The differences that matter are about your periods, hormones, and how long the device lasts.
The biggest practical difference: your period
For most people, this is the deciding factor.
- Hormonal IUDs usually make periods lighter, shorter, and less crampy over time, and many people stop having periods entirely. If you have heavy or painful periods, this can be a major bonus — the full-dose hormonal IUD (Liletta, which we stock, has the same 52 mg of levonorgestrel as Mirena) is widely used to bring heavy bleeding down.
- The copper IUD (Paragard) does not change your hormones, so you keep ovulating and having regular periods. The trade-off is that periods can become heavier and crampier, particularly at first.
Hormones, or no hormones
If you want or need to avoid hormones — by preference, or for a medical reason — the copper IUD (Paragard) is the hormone-free option. If you're open to hormones but want as little as possible, the lower-dose hormonal IUDs (Kyleena and Skyla) release less progestin than Mirena and Liletta.
How long each one lasts
Duration is a real differentiator, and the approved timeframes have gotten longer in recent years:
- Mirena and Liletta: up to 8 years.
- Kyleena: up to 5 years.
- Skyla: up to 3 years (it's also the smallest device).
- Paragard (copper): up to 10 years.
All of them are removable any time before that, and your fertility returns quickly after removal regardless of which you had.
A few other considerations
- Size: Kyleena and Skyla are technically a millimeter or two smaller than Liletta, Mirena, and Paragard. Honestly, for most people that difference is more marketing than medicine — all of them fit the large majority of bodies comfortably, whether or not you've been pregnant. That said, some younger patients simply feel more at ease knowing theirs is a touch smaller, and that's a perfectly valid reason to factor it in. We'll be straight with you about when size actually matters and when it doesn't.
- Emergency contraception: both the copper IUD (Paragard) and the full-dose 52 mg hormonal IUD (Liletta) work as emergency contraception when placed within 5 days of unprotected sex. The copper IUD was the long-standing go-to, but studies now show the 52 mg hormonal IUD is just as effective for this — not inferior — so you can choose the one you'd want long-term and let it double as EC.
- Insertion: whichever you choose, the placement is similar, and the discomfort people worry about is very manageable with the right approach. We offer real comfort and sedation options — more on our [sedation gynecology page](/sedation-gynecology).
What we stock in our office
We keep Liletta (the full-dose hormonal IUD) and Paragard (the copper IUD) on hand, so those can usually be placed without any wait. Liletta is clinically very similar to Mirena — same hormone, same dose — and we can special-order a Mirena if you specifically want that brand. The lower-dose hormonal options (Kyleena, Skyla) exist too; just ask us about availability. The short version: most people do great with the Liletta or the Paragard, and we'll help you land on the right fit.
So which one?
A rough starting point:
- Heavy or painful periods, or you'd love to skip periods: a hormonal IUD — for us that's the Liletta (or a special-ordered Mirena).
- You want hormone-free birth control: the copper IUD (Paragard).
- You want the lowest possible hormone dose: the lower-dose options (Kyleena, Skyla) are worth a conversation. (They're also slightly smaller — but for most people that's a marketing point more than a real one, so we wouldn't choose on size alone.) We can order one in.
But this really is a conversation, not a flowchart — your history, your goals, and how you feel about periods all factor in. We'll talk it through and help you choose. Learn more about IUDs and insertion with us, or book a visit or call (301) 241-8181.