IUD vs. Implant: What’s the Best Option for Long-Acting Birth Control?
Intrauterine devices (IUDs) and implants are very effective for birth control. But they don’t work quite the same way, and there are some side effects to be aware of.
Skyla
Used for Birth Control
Used for Birth Control
Skyla IUD (levonorgestrel) is a progestin intrauterine device (IUD). It's approved for females of reproductive age to prevent pregnancy for up to 3 years. Skyla IUD (levonorgestrel) is inserted into the uterus by a provider in their office. Some of the more common side effects of this IUD include vaginal irritation or infection, acne, and spotting. Skyla IUD (levonorgestrel) contains the lowest hormone dose compared all other hormonal IUDs.
What is Skyla IUD (levonorgestrel)?
What is Skyla IUD (levonorgestrel) used for?
- Prevent pregnancy for up to 3 years
How Skyla IUD (levonorgestrel) works
Skyla IUD (levonorgestrel) is a small device placed in the uterus that slowly releases a progestin hormone called levonorgestrel. This hormone prevents pregnancy by stopping your ovaries from releasing an egg. Levonorgestrel also makes it difficult for sperm to reach the egg and for a fertilized egg to implant in the uterus.
Drug facts
| Common Brands | Skyla |
|---|---|
| Drug Class | Progestin |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
More on Skyla IUD (levonorgestrel) essentials
Side effects of Skyla IUD (levonorgestrel)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Vaginal inflammation or irritation (20%)
- Acne (14%)
- Stomach pain (13%)
- Ovarian cyst (13%)
- Headache (12%)
- Menstrual cramps (9%)
- Heavier menstrual bleeding (8%)
- Breast pain or discomfort (5%)
- Nausea (6%)
Less Common Side Effects
- Depression
- Hair loss
- Expulsion (the device comes out on its own)
- Genital discharge
- Migraines
- Upper genital tract infection
Skyla IUD (levonorgestrel) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Ectopic pregnancy: severe, unexplainable pelvic pain along with unusual vaginal bleeding
- Severe infection: fever, chills, confusion, fatigue
More on Skyla IUD (levonorgestrel) side effects
The following Skyla IUD (levonorgestrel) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Absent, missed, or irregular menstrual periods
longer or heavier menstrual periods
mild bloating
stomach or pelvic pain
stopping of menstrual bleeding
unusually heavy or unexpected menstrual bleeding
uterine bleeding between menstrual periods
vaginal bleeding or spotting
Less common
Blurred vision
cramps
dizziness
headache
itching of the vagina or genital area
nervousness
pain during sexual intercourse
pale skin
pounding in the ears
slow or fast heartbeat
swelling
thick, white vaginal discharge with mild or no odor
trouble breathing
unusual bleeding or bruising
unusual tiredness or weakness
white or brownish vaginal discharge
Rare
Chills
confusion
dizziness, lightheadedness, fainting
fast heartbeat
fast, weak pulse
pale, cold, clammy skin
rapid, shallow breathing
sudden increase in stomach or shoulder pain
sweating
unusual or large amount of vaginal bleeding
Incidence not known
Clear or bloody discharge from the nipple
dimpling of the breast skin
dull or aching stomach pain
foul-smelling vaginal discharge
increased blood pressure
increased urge to urinate
inverted nipple
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
lump in the breast or under the arm
pain during urination
persistent crusting or scaling of the nipple
redness or swelling of the breast
severe stomach pain or cramping
sharp pain on insertion
shivering fever
sores on the skin of the breast that does not heal
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Back pain
breast tenderness or pain
decreased interest in sexual intercourse
full or bloated feeling
hives or welts, itching, or rash
increased hair growth, especially on the face
increased weight
loss in sexual ability, desire, drive, or performance
pressure in the stomach
redness of the skin
skin rash, encrusted, scaly, and oozing
swelling of the stomach area
thinning of the hair
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Skyla IUD (levonorgestrel)
Pros
- More effective than oral birth control pills to prevent pregnancy
- One of the smallest IUDs
- Contains a lower dose of hormone compared some other IUDs, like Mirena
- Possible birth control option while breastfeeding
Cons
- Can raise your risk of an ectopic pregnancy
- Breakthrough bleeding, acne, and headache are common side effects
- Not safe to use if you have liver problems or have ever had breast, uterine, or cervical cancer
- Doesn't work for as long as other IUDs
Pharmacist tips for Skyla IUD (levonorgestrel)
- You might feel some pain, dizziness, or have some light vaginal bleeding after the Skyla IUD (levonorgestrel) has been placed, but it should be temporary. If these symptoms don't lessen after a few days, tell your provider. They'll want to see if Skyla IUD (levonorgestrel) is placed properly.
- After the Skyla IUD (levonorgestrel) has been placed, there will be 2 thin threads hanging inside the vagina. Your provider might recommend that you check for these threads once a month with a clean finger. Never tug or pull on the threads when you're checking for them. If you can't feel them, call your provider right away because it might be a sign that Skyla IUD (levonorgestrel) isn't positioned properly.
- If you haven't had a period for 6 weeks, call your provider. It's typical for some people to stop having their periods after using Skyla IUD (levonorgestrel) for a year or longer. But keep in mind that having no menstrual bleeding can also be a sign of pregnancy. Your provider will want to check to see if you're pregnant, especially if you've an ectopic pregnancy.
- The Skyla IUD (levonorgestrel) can be used while breastfeeding. But your provider will likely ask you to wait at least 6 weeks since you gave birth to minimize injury to the uterus. The medication from the device will not hurt your baby, but you might notice a slight drop in your milk supply.
- It's possible for your body to push the Skyla IUD (levonorgestrel) back out of the uterus into the vagina. If this happens, call your healthcare provider right away and use a back-up method of protection (condoms, diaphragms) until you have a new device placed.
- Let your provider know right away if you experience high blood pressure, blood clotting problems (e.g., heart attack or stroke), migraines, or severe headaches while using Skyla IUD (levonorgestrel). If so, your provider might need to remove the IUD.
- The Skyla IUD (levonorgestrel) doesn't protect you from human immunodeficiency virus (HIV) or other sexually transmitted infections (STIs). Only abstinence and condoms can help protect you from STIs. Talk to your provider right away if this is a concern for you.
- If you're thinking about becoming pregnant, talk with your provider about removing Skyla IUD (levonorgestrel). After the IUD is out, it's possible for you to become pregnant the next time you ovulate, which can take days or a few weeks.
- If you need to get any magnetic resonance imaging (MRI) scans done, let your care team know that you have Skyla IUD (levonorgestrel) in place. Depending on the MRI machine, you might need to have the IUD removed before the scan.
More on Skyla IUD (levonorgestrel) tips
Risks and warnings for Skyla IUD (levonorgestrel)
Skyla IUD (levonorgestrel) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Ectopic pregnancy
- Risk factors: Previous ectopic pregnancy | Past surgery performed on your fallopian tubes | Current pelvic infection
Ectopic pregnancies happen when a fertilized egg implants somewhere other than your uterus. They're very rare, but can be life-threatening and sometimes need to be treated with surgery. Progestin-only contraception, including the Skyla IUD (levonorgestrel) IUD, can raise your risk of ectopic pregnancies. Pregnancy is rare with all IUDs, but if you do become pregnant while the Skyla IUD (levonorgestrel) IUD is inserted, the chance of it being an ectopic pregnancy is high. If you experience unexplained or severe pelvic pain along with unusual vaginal bleeding, let your provider know.
If you do become pregnant after the Skyla IUD (levonorgestrel) IUD was placed, contact your provider right away. Your provider will recommend for you to remove Skyla IUD (levonorgestrel) because keeping it in place raises your risk for complications such as miscarriage and infection.
Sepsis (blood infection)
- Risk factors: Placement of device in an unhygienic environment
Sepsis is when bacteria infect your bloodstream, and it can be life-threatening. Your risk of getting this infection goes up if Skyla IUD (levonorgestrel) wasn't placed using proper antibacterial technique. Sepsis would typically happen shortly after the device was inserted, sometimes even within a few hours. Tell your provider right away if you have pelvic pain, a high fever, or any other symptoms of being sick shortly after the device was placed.
Pelvic inflammatory disease (PID)
- Risk factors: History of or current pelvic inflammatory disease | Current sexually transmitted infections | Multiple sex partners
IUDs raise your risk of developing pelvic inflammatory disease (PID) because there's always a small chance bacteria can get into your uterus when the device is placed. Because of this, the Skyla IUD (levonorgestrel) IUD isn't safe to use if you've ever had or are prone to PID. If you start to experience any unusual pelvic pain, funny-smelling discharge, unusual vaginal bleeding, sores or cuts in your genital area, or a high fever, call your provider right away.
Uterine injury
- Risk factors: Placing the Skyla IUD (levonorgestrel) IUD less than 6 weeks after giving birth
There's a very small chance that the Skyla IUD (levonorgestrel) IUD can uterine injury (perforation), which is extremely dangerous. It also prevents the Skyla IUD (levonorgestrel) IUD from working properly, meaning you can get pregnant if this happens. The risk of perforation is higher if you've the Skyla IUD (levonorgestrel) IUD placed less than 6 weeks after you give birth to a baby. Your provider will need to remove the IUD if there's an injury, and this might require surgery. Tell your provider right away if you can't feel the threads that hang freely inside your vagina after it has been placed.
Body ejecting the device
- Risk factors: Placing the Skyla IUD (levonorgestrel) IUD less than 6 weeks after giving birth
There is a small chance the body can eject the Skyla IUD (levonorgestrel) IUD from the uterus back into your vagina. If this happens, the device won't work and you can get pregnant. Your risk of having this happen is higher if you have the IUD placed less than 6 weeks after you gave birth. If you notice your menstrual bleeding suddenly becomes heavier than usual and it's been more than 3 to 6 months since your provider placed the device, this could be a sign your body is ejecting the Skyla IUD (levonorgestrel) IUD. Tell your provider if this happens and use non-hormonal protection (condoms, diaphragms) until your provider places a new device or tells you the device is in the right place.
Irregular periods
The Skyla IUD (levonorgestrel) IUD can cause you to experience irregular menstrual periods. Most women will have heavier or longer periods for the first 3 to 6 months after the device is placed, followed by very light or no periods. But, you might notice changes of any kind to your menstrual cycle while using the Skyla IUD (levonorgestrel) IUD. If you are worried about the changes to your periods, talk to your provider, especially if you are having sudden or unusually heavy bleeding after the first 3 to 6 months. This could be a sign that the device is not in the correct place.
Ovarian cysts
Since Skyla IUD (levonorgestrel) is located within the uterus, it can sometimes lead to the development of ovarian cysts. Although most ovarian cysts don't cause any symptoms, some might cause pelvic pain or pain during sex. In most cases, the cysts go away on their own after a few months, but your provider will keep an eye on things just to make sure. Surgery is usually not required for these.
Possible risk of cancer
People who have or have had breast cancer shouldn't use hormonal birth control, including Skyla IUD (levonorgestrel). Certain types of breast cancer can be sensitive to hormones, and might grow in the presence of hormones.
Skyla IUD (levonorgestrel) dosage
Typical dosage for Skyla IUD (levonorgestrel)
Skyla IUD (levonorgestrel) will need to be placed inside your uterus by your provider at their office. Once placed, it can prevent pregnancy for 3 years.
Interactions between Skyla IUD (levonorgestrel) and other drugs
Skyla IUD (levonorgestrel) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Skyla IUD (levonorgestrel). Please note that only the generic name of each medication is listed below.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amoxicillin
- Ampicillin
- Amprenavir
- Apalutamide
- Aprepitant
- Armodafinil
- Artemether
- Bacampicillin
- Betamethasone
- Bexarotene
- Bosentan
- Brigatinib
- Carbamazepine
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefdinir
- Cefditoren
- Cefixime
- Cefpodoxime
- Cefprozil
- Ceftazidime
- Ceftibuten
- Cefuroxime
- Cenobamate
- Ceritinib
- Clavulanic Acid
- Clobazam
- Cloxacillin
- Colesevelam
- Cyclacillin
- Cyclosporine
- Dabrafenib
- Darunavir
- Dexamethasone
- Dicloxacillin
- Doxycycline
- Efavirenz
- Elagolix
- Elvitegravir
- Encorafenib
- Enzalutamide
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosphenytoin
- Griseofulvin
- Guar Gum
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Minocycline
- Mitotane
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nelfinavir
- Nevirapine
- Octreotide
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pitolisant
- Prednisone
- Primidone
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tizanidine
- Topiramate
- Ulipristal
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acitretin
- Amitriptyline
- Atazanavir
- Clomipramine
- Diazepam
- Doxepin
- Eslicarbazepine Acetate
- Imipramine
- Lamotrigine
- Licorice
- Lorazepam
- Perampanel
- Prednisolone
- Selegiline
- Tacrine
- Temazepam
- Triazolam
- Troleandomycin
- Voriconazole
- Warfarin
Skyla IUD (levonorgestrel) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Skyla IUD (levonorgestrel) will not be safe for you to take.
- Pregnancy or suspicion of pregnancy
- Use as emergency contraception
- Certain abnormal uterine anatomy
- Acute pelvic inflammatory disease (PID) or a history of PID
- Postpartum endometritis or infected abortion in the past 3 months
- Uterine or cervical cancer
- Breast cancer or other progestin-sensitive cancer
- Uterine bleeding without a known cause
- Untreated inflammation of the cervix or vagina, or other lower genital tract infections
- Liver disease or liver tumor
- A previous intrauterine device (IUD) that hasn't been removed
What are alternatives to Skyla IUD (levonorgestrel)?
There are a number of medications that your doctor can prescribe in place of Skyla IUD (levonorgestrel). Compare a few possible alternatives below.
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