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Choosing the Right IUD: Mirena vs. Paragard vs. Skyla


Intrauterine devices, better known as IUDs, are an extremely effective method of birth control. An IUD is a small, T-shaped device that’s placed in your uterus. An IUD must be prescribed by your doctor, who will place it in your uterus during a simple outpatient procedure.

Five brands of IUDs approved by the Food and Drug Administration are available today. Mirena, Skyla, Liletta, and Kyleena are plastic IUDs that release hormones to prevent pregnancy. Paragard contains copper and does not release hormones.

Which one could be right for you? Let’s compare Mirena, Skyla, and Paragard to explore how these IUDs are similar and different.

How IUDs work

IUDs are made of a plastic called polyethylene. They’re T-shaped, with a string attached to the bottom of the T. The string makes it easier for your doctor to remove the IUD. It also helps you make sure that the IUD is in place every month.

Learn more: Inserting an IUD and checking placement »

IUDs are long-term birth control. They can stay implanted in your uterus for several years. However, they can be easily removed if you want to become pregnant.

The devices differ in the contents that help prevent pregnancy.

Mirena and Skyla

Mirena and Skyla slowly release hormones into your body each day. These hormones may make you ovulate less often. The hormones also thicken cervical mucus, which makes it harder for sperm to pass into your uterus. And they also help prevent sperm from binding to an egg and attaching in your uterus.

Skyla contains 13.5 mg of the progestin hormone levonorgestrel. About 14 mcg of the hormone is released every day for the first 25 days. After that, the device releases 5 mcg levonorgestrel per day for the next three years.

Mirena contains 52 mg of levonorgestrel. About 20 mcg of this hormone is released every day when the device is first inserted. The rate drops to about 10 mcg per day as it reaches expiration.


Paragard doesn’t have any hormones. Instead, it has 176 mg of copper wire coiled around the vertical stem of the T-shape. It also has 68.7 mg of copper wrapped around each side of the horizontal arm.

The copper produces an inflammatory reaction within your uterus. It creates a harmful environment for sperm. This environment helps prevent the sperm from fertilizing an egg and may prevent an egg from attaching in your uterus.

Size28 mm x 30 mm32 mm x 32 mm32 mm x 36 mm
TypeProgestin hormoneProgestin hormoneCopper
Effective for up to3 years5 years10 years
Notable side effectMay cause changes in your periodMay cause changes in your periodMay cause bleeding and discomfort

Side effects

Mirena and Skyla have the same side effects. You may have changes in your period, such as increased menstrual bleeding, discomfort, or no period at all. You may also have:

  • acne
  • headache
  • breast tenderness
  • ovarian cysts
  • depressed mood
  • pain in your abdomen or pelvic area

With Paragard, you may have an allergic reaction to the copper. Other side effects include:

  • heavy menstrual bleeding
  • discomfort
  • a longer period
  • backaches and cramps when you’re not having a period

All three devices can fall out or shift position, increasing the risk of pregnancy. They could also tear your uterus. In addition, all three can cause pelvic inflammatory disease, but this is rare.


IUDs are the most effective birth control method besides tubal ligation and vasectomy. None of these options protect against sexually transmitted infections, however.

Studies have shown that these three IUDs have similar effectiveness. Both the copper and hormonal IUDs are more effective at preventing pregnancies than other forms of birth control, besides sterilization. Overall, IUDs are more than 99% effective at preventing pregnancy. This means that less than one in 100 women who use an IUD gets pregnant each year.


One of the main risks of using an IUD is the slight chance that you will have an ectopic pregnancy if you do get pregnant while using it. However, the risk of ectopic pregnancy when you’re not using an IUD is higher.

There is also the small risk that the IUD may shift position or fall out, increasing the risk of unwanted pregnancy.

What to do if your IUD falls out »

If you have certain health issues, other risks apply. Certain conditions can cause problems if you use a hormonal IUD or copper IUD. You should not use any IUD if you have conditions such as current or past:

  • cervical, breast, or uterine cancer
  • pelvic inflammatory disease
  • unexplained uterine bleeding

If you have liver disease, you should not use a hormonal IUD.

Talk with your doctor

Both the hormonal IUDs and the copper IUD are effective methods of birth control. The key differences between Mirena, Skyla, and Paragard are what they’re made of, how they work, how long they last, and possible side effects.

For instance, Mirena and Skyla release hormones into your body, so if you prefer to avoid hormones, you might choose Paragard. That said, the hormones in Mirena and Skyla are only released locally and don’t have the same kind of broad effect as the hormones in birth control pills. On the other hand, if you already have heavy bleeding and cramping during your period, you may not want to use Paragard, which could worsen your bleeding.

To find out more about IUDs, talk to your doctor. They can give you more information about these devices and point you toward an IUD that may work well for you. Be sure to ask your doctor any questions you might have, such as:

  • Are there any benefits to the hormonal IUDs Liletta or Kyreena versus Mirena or Skyla?
  • Is there any reason why I should avoid using an IUD that has hormones?
  • What other long-term birth control options would you suggest for me?

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