IUD vs Implant: What’s the Best Option for Long-Acting Birth Control?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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When it comes to birth control, long-acting intrauterine devices (IUDs) and hormonal implants are not only convenient for many women—they are also 20 times more effective than pills, patches, and rings. With insurance coverage of contraception likely to be phased back out in the next couple of years, many women are asking about long-acting, reversible birth control methods.

Studies show that 45% of pregnancies in the United States are unintended. Long-acting reversible methods of birth control have many upsides: they are highly effective, well tolerated and require only a one-time placement. For those of you who don’t want to take a daily birth control pill or count on barrier methods like condoms or diaphragms you have three ways to go.

  1. Hormonal IUDs. These contain no estrogen, just synthetic progesterone (progestin). There are four levonorgestrel-releasing IUDs, including two that contain 52 mg of levonorgestrel (Mirena). Kyleena contains 19.5 mg and Skyla, which is a smaller device, contains 13.5 mg. These IUDs work by inhibiting ovulation and thickening cervical mucus which prevents penetration of sperm. Mirena and Kyleena stay in place for 5 years, Skyla for 3. Liletta is used for 3 – 5 years, but its duration of action is still being investigated. Mirena is the most popular. With the hormonal IUDs you will often not have a period at all—upside. Almost all women can safely use IUDs. Prior to receiving an IUD you will need to be up to date on your pap and STD screening.
  2. Non-hormonal copper IUDs. The ParaGard copper-containing IUD is non-hormonal. Copper-containing IUDs release copper ions, which are toxic to sperm. ParaGard stays in place for 10 years. Copper IUDs tend to cause heavier periods unlike the hormonal IUDs, making them less popular.
  3. Under the skin (subdermal) hormonal implants. Placed under the skin in your upper arm, Nexplanon is available in the U.S. and slowly releases a type of progestin called etonogestrel. Nexplanon works to prevent pregnancy by inhibiting ovulation and thickening cervical mucus. It can be left in place for 3 years and is highly effective at preventing pregnancy. Unpredictable vaginal bleeding and spotting is common with Nexplanon so if you like to know exactly when you are going to bleed this is not a great choice for you.

What about the risk of infection (pelvic inflammatory disease) with IUDs?

Current studies show a very low risk of pelvic inflammatory disease with both the copper and hormonal IUDs. Less than 1% among 57,728 women studied had problems with infection after insertion.

What about fertility?

Infertility has not been shown to be associated with IUD use.

What about increased risk of clot/deep venous thrombosis?

None of the methods on this list contain estrogen so they don’t carry the risk of clot that combined estrogen and progesterone contraceptives do.

Dr O.

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Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med 2016;374:843-852.

Hubacher D, Lara-Ricalde R, Taylor DJ, Guerra-Infante F, Guzmán-Rodríguez R. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med 2001;345:561-567

Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF. Fertility after intrauterine device removal. Eur J Contracept Reprod Health Care 2015; 20: 223-230.

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