Paragard vs. Mirena for Birth Control: How Do They Compare?
Key takeaways:
Paragard and Mirena (levonorgestrel) are T-shaped birth control devices that are inserted into the uterus by a trained healthcare provider. Mirena can help prevent pregnancy for up to 8 years. Paragard can help prevent pregnancy for up to 10 years.
Paragard and Mirena are both over 99% effective at preventing pregnancy. Paragard is a hormone-free form of contraception, while Mirena contains a form of progesterone.
If you have health insurance, the cost of Paragard or Mirena is likely to be fully covered under the Affordable Care Act, along with their insertion and removal. A patient assistance program for Mirena is also available for those who qualify.
Table of contents
There are several different intrauterine devices (IUDs) on the market. IUDs are considered one of the most effective long-acting reversible forms of birth control. They have very low failure rates (less than 1%). In some cases, IUDs can help with heavy menstrual bleeding. IUDs are also low-maintenance, because you don’t have to remember to take a pill every day.
Two well-known IUDs are Paragrad and Mirena (levonorgestrel). But what’s the difference between them? Let’s discuss.
What is Paragard?
Paragard is a T-shaped IUD that has copper wrapped around it. It doesn’t use hormones to prevent pregnancy. It’s considered a long-acting reversible contraceptive (LARC). Paragard is highly effective at preventing pregnancy and requires no day-to-day maintenance. It has to be inserted and removed by a healthcare provider.
Search and compare options
How does Paragard work to prevent pregnancy?
Paragard prevents pregnancy by creating a toxic environment for sperm. The copper on the device makes it harder for sperm to swim. This means sperm are less likely to reach and fertilize an egg. It’s also thought that this type of IUD helps prevent fertilized eggs from implanting into the uterus. Because it doesn’t contain hormones, Paragard doesn’t prevent you from ovulating (releasing an egg).
Paragard can be inserted at any time during your menstrual cycle. It starts working immediately after placement. This means that there’s no need to use a back-up contraceptive, such as condoms, after it’s inserted.
What is Mirena?
Mirena is a T-shaped IUD that slowly releases a progestin hormone called levonorgestrel. It’s also a type of LARC. In addition to preventing pregnancy, Mirena is also FDA-approved to treat heavy menstrual bleeding. Like Paragard, it needs to be inserted and removed by a healthcare provider.
How does Mirena work to prevent pregnancy?
Mirena is thought to prevent pregnancy in a few different ways:
It thickens mucus around the cervix, which helps stop sperm from entering the uterus.
It makes it harder for sperm to survive and swim in the uterus.
It thins the lining of the uterus, making it harder for a fertilized egg to implant.
Mirena can also be inserted at any point during your menstrual cycle. But it takes a few days to start preventing pregnancy. You may need to use a barrier contraceptive (such as condoms) for 7 days after insertion. Ask your healthcare provider whether you’ll need to use back-up protection.
How often do Paragard and Mirena need to be replaced?
Paragard can provide effective birth control for up to 10 years. But it can be removed earlier than that if you decide you want to become pregnant.
When used only for birth control, Mirena can last up to 8 years. When used to treat heavy menstrual bleeding, it can last up to 5 years. It’s important to note that it can take 3 to 6 months to see lighter periods. Like Paragard, Mirena can be removed earlier if preferred.
How effective are Paragard and Mirena for preventing pregnancy?
Paragard and Mirena are two of the most effective birth control devices on the market. They’re both over 99% effective at preventing pregnancy. This means that fewer than 1 in every 100 users of these IUDs get pregnant.
Between the two, Mirena has a slightly lower failure rate. Mirena’s failure rate is 0.2%. This means that 2 out of every 1,000 users on average get pregnant during the first year of using Mirena. Paragard’s failure rate is 0.6% to 0.8% during the first year of use (meaning 6 to 8 out of every 1,000 users get pregnant, on average).
Neither Paragard nor Mirena protects against sexually transmitted infections (STIs). The best way to help prevent STIs is to use a barrier method of protection, such as condoms.
What are the known side effects of Paragard and Mirena?
Since Paragard is hormone-free and Mirena contains levonorgestrel, they have different side effects. Below are some common side effects for each one. These are not complete lists. For more detailed information, talk to your healthcare provider.
Mirena side effects
It’s normal to see some spotting and bleeding between periods during the first 3 to 6 months after starting Mirena. Many users experience lighter and less bleeding after that. In some cases, Mirena stops menstrual bleeding completely. However, if you start having heavy bleeding after it’s been light for a while, call your healthcare provider.
Other common side effects of mirena include:
Headaches
Acne
Breast pain or tenderness
Mood changes
Menstrual cramps
Vaginitis (vaginal inflammation or infection)
Vaginal discharge changes
Stomach pain
Paragard side effects
When Paragard is first inserted, it’s common to experience heavier or longer periods. This side effect usually lessens after the first 6 months of use.
Other common side effects of Paragard include:
Anemia (a low number of red blood cells)
Pain during sex
Spotting or breakthrough bleeding
Backache
Vaginitis
What are the serious side effects of Paragard and Mirena?
There are serious risks that come with having an IUD. These are rare, but it’s helpful to be aware of them.
Serious side effects of Paragard and Mirena include:
Expulsion (the IUD is pushed out of the uterus)
Ectopic pregnancy (a pregnancy that starts outside of the uterus)
An infection called sepsis, which affects multiple cells and organs
Pelvic inflammatory disease (PID)
Perforation (the IUD moves through the wall of the uterus)
Embedment (the IUD gets stuck in the wall of the uterus)
Knowing that your IUD is still properly inserted is important for catching some serious side effects early. IUDs have two or three thin threads that hang out of your cervix. Check for the strings once a month. Contact your healthcare provider if you’re unable to feel the strings or if they’ve changed in length.
You should also contact your healthcare provider if you’re experiencing any signs of infection, such as:
Fever
Burning or pain with urination
Unusual changes in the color, odor, or texture of your vaginal discharge
Severe stomach or pelvic pain
Confusion
Severe drowsiness
Who shouldn’t use Paragard or Mirena?
Paragard and Mirena aren’t right for everyone. They’re not recommended if:
You think you might be pregnant
You have uterine fibroids (non-cancerous growths in or around the uterus)
You have a current infection of the cervix
You get infections easily, such as urinary tract infections (UTIs)
You currently have, or have a history of, cancer of the uterus or cervix
You should also not use Paragard if you have Wilson’s disease. This rare health condition causes copper to collect in the body. The copper in Paragard can worsen this condition.
How much do Paragard and Mirena cost?
If you have health insurance, Paragard and Mirena — as well as their insertion and removal procedures — are likely to be fully covered under the Affordable Care Act. For uninsured people, these IUDs may cost about $1,000. Your healthcare provider may also charge additional fees for insertion and removal. Check with your provider’s office to see how much they charge for the two procedures.
If you’re uninsured or underinsured, you may be eligible for Mirena’s patient assistance programs, which offer the IUD at no charge.
There are other options for helping with the cost of birth control. Try calling your local women’s health clinic or family planning center. They may charge less or offer other resources.
The bottom line
Paragard and Mirena are two well-known IUDs. They offer effective and low-maintenance birth control. Paragard is hormone-free and can prevent pregnancy for up to 10 years. Mirena releases the hormone levonorgestrel and can prevent pregnancy for up to 8 years. Mirena can also treat heavy menstrual bleeding for up to 5 years. Both IUDs are over 99% effective for birth control. But Mirena has a slightly lower failure rate than Paragrad.
Because Mirena includes a hormone and Paragard doesn't, their common side effects are different. But they share similar serious side effects, including IUD movement and serious infections. Talk to your healthcare provider to find out if Mirena or Paragard is a good birth control option for you.
Why trust our experts?
References
American College of Obstetricians and Gynecologists. (2021). Long-acting reversible contraception: Implants and intrauterine devices.
Bayer HealthCare Pharmaceuticals Inc. (2022). Mirena [package insert].
Centers for Disease Control and Prevention. (2022). Contraception.
CooperSurgical, Inc. (2019). Paragard [package insert].
HealthCare.gov. (n.d.). Health benefits & coverage.
