How to Navigate: Hormonal vs. Non Hormonal IUDs
Updated: Nov 15, 2022
My first time starting birth control was when I was 16. I remember not knowing how to go about it on my own, so I asked my mom if it was okay to go on the pill because “my periods were irregular,” a lie I told her because I was too scared to tell her I was starting to have sex (Sorry - that’s a story for another blog). Anyways, my mom agreed to take me to the doctor. . I was surprised that It wasn't much of a “consultation” - I basically told my doctor I wanted to start the pill and she wrote me a prescription. I do not remember being coached on side effects or any alternative options. Being more naive about the importance of doing my own research, without much consideration, I started taking the pill. Pretty quickly, I felt like it wasn't right for me - I was constantly forgetting to take it, frequently paranoid about getting pregnant, and frustrated dealing with the array of side effects. Still, I felt there was no other adequate option to protect against unwanted pregnancy, so I just stuck with it. This experience lasted about 6 years, until I heard about the IUD.
When I realized there are other viable methods besides the pill, I was ready to make the switch. I was nervous because I wasn't sure what would happen to my body when I stopped the pill, yet excited to try something new like the IUD. I remember researching all the different brands, how they work, and trying to figure out the best one for me. I ended up going with Mirena, and I am happy to say that 3 years later, it worked out!
That being said, this is my own personal experience. Everyone is different and has different preferences. So, let’s talk science backed research all about IUDs so that you can make informed decisions.
Find out which birth control option is right for you.
We're here to help.
First off, what is an IUD ?
The IUD stands for intrauterine device, it is a small T-shaped piece of plastic that sits in the uterus. IUDs are also known as LARCs – long-acting, reversible contraceptives, because they are exactly that! IUDs remain active anywhere from 3-12 years and when you decide to remove your IUD, your fertility will go back to normal.
There are two types of IUDs: Hormonal and Non-Hormonal.
As the name suggests, the non-hormonal IUD contains no hormones. In fact, the non-hormonal IUD uses the properties of copper to prevent pregnancy. It works by damaging and changing the way sperm move, preventing the sperm from reaching the egg. As we know, if sperm does not reach the egg, no fertilization can occur, therefore no pregnancy.
Because there are no hormones being released, this may be a better option for people who would prefer a non-hormonal contraceptive, have experienced unwanted side effects from other forms of hormonal birth control, or cannot use hormonal birth control for medical reasons. Before deciding on a birth control method, talk to your doctor about medical conditions that may interfere with hormonal birth control.
Additionally, an important factor to note about the copper IUD is that it can be used as an emergency contraceptive - actually it is the most effective emergency contraceptive method. If you get the IUD inserted within 120 hours (5 days) after having unprotected sex, it is over 99% effective against pregnancy! In comparison, emergency contraceptive pills like Plan B will vary in effectiveness depending on time taken since unprotected sex.
In Canada, there are multiple brands and types of copper IUDs that contain various amounts of copper and last a range from 3-12 years . Popular brands include Flexi-T 300, Liberte, Mona Lisa, and Nova-T.
The hormonal IUD uses a synthetic version of progesterone, called progestin, to prevent pregnancy. The progestin hormone contained in IUDs is called levonorgestrel. The IUD releases tiny amounts of levonorgestrel straight into the reproductive system. Progestin prevents pregnancy by thickening the mucus in the cervix to stop sperm from reaching or fertilizing an egg. It also thins the lining of the uterus to partially suppress ovulation. In other words, it prevents the egg from leaving the ovaries and the sperm from reaching the egg. No sperm + no egg = no pregnancy.
Since the hormonal IUD does contain hormones, there are some risks of side effects that you would see with other forms of hormonal birth controls such as acne, bloating, or breast tenderness. However, most birth control users notice these effects only last the first few months. There are actually some important benefits to consider about the hormonal IUD, most notable, many people experience lighter periods or no period all together. This might be a deciding factor for someone who naturally experiences longer, heavier periods. Plus did I mention that hormonal IUD users have noticed it has helped with cramps as well! In addition to reduced bleeding and cramps, there are other medical benefits of the hormonal IUD. Research suggests that hormonal IUD may prevent endometrial cancer and alleviates symptoms of endometriosis and PCOS.
In Canada, the three main hormonal IUDs are Jaydess, Mirena, and Kyleena.
Jaydess contains 13.5mg of levonorgestrel and last up to 3 years
Mirena contains 52mg of levonorgestrel and can last up to 5 years
Kyleena contains 19.5mg of levonorgestrel and works up to 5 years
Why hormonal when I can go non-hormonal?
This mostly depends on personal preferences - unless your doctor suggests one over the other based on medical reasons. As stated above, there are benefits and disadvantages to both. Here are some pros and cons that IUD users have mentioned for their reasoning behind their own choice.
As your birth control best friend, we'll tell you the hard truth.
Tough love, honey.
Contains small amount of hormones released directly into uterus
Contains no hormones - may be better for individuals who prefer a non-hormonal method or whose doctor advises against the use of hormonal birth control
May reduce bleeding to light spotting or stop bleeding all together
May cause longer and heavier bleeding
May help reduce period cramps and pain
May increase period cramps and pain
You may experience side effects from hormones such as acne, headaches, breast tenderness - however, this is less common than other methods of hormonal birth control
Does not carry the same risk of hormonal side effects
Can remain in place for 3 to 5 years
Can last for 3 to 12 years
Cannot be used as an emergency contraceptive
Can be used as an emergency contraceptive up to 5 days after unprotected sex
Does not protect against STIs
Does not protect against STIs
Benefits of both kinds of IUDs
1. Once it's in, it's in.
What I like best about the IUD is that once it's inserted, you don't really have to think about it for a long time. Hormonal IUDs can work up to 5 years and the copper IUD can last up to 12 years! Once the IUD is inserted, there is no need to worry about taking the pill or changing the ring (my biggest ailment with the pill). However, it is important to remember that the IUD does not protect against STIs.
Both the copper and hormonal IUD are extremely effective. The hormonal IUD is 99.8% effective against pregnancy and the copper IUD is 99.2% effective. This is an extremely small difference between the two, you can be confident with both!
Although the IUD may seem more costly as you are paying everything up front, once you break it down by month, the IUD is much more cost effective than other forms of birth control - especially with insurance.
Disadvantages of the IUD - and what to do about them:
1. Getting the IUD inserted – Pain and cramping
As with many aspects of birth control, getting the IUD inserted affects everyone differently. Based on my personal experience, it felt like a really bad period cramp that lasted a couple days. In preparation, it may be helpful to get yourself some over-the-counter medication like Advil or Aleve, a heating pad, and anything else that helps you relax after the procedure. It is also advised not to have sex, use a tampon, or put anything in your vagina for at least 24 hours after insertion.
2. After IUD is inserted
Most women experience light spotting after the IUD is inserted. This may last 6-8 months while your body is getting used to it. The hormonal IUD tends to cause lighter or no period, while the copper IUD may cause periods to be longer and heavier. Prepare yourself with some pads, panty liners, or to be environmentally friendly, trying out machine washable period-proof underwear like KT by Knix.
Pelvic Inflammatory Disease (PID)
Although rare, it is important to acknowledge risks. In a very small number of people, the IUD can irritate the uterus and cause pain in the cervix. However, PID is only a risk during the first month after the IUD is inserted.
3. Feeling cramps
Some people experience worsening cramps with the IUD, but do not worry, there are ways to help! As I mentioned in #1, OCT pain medication and a heating pad may reduce pain, but there are other ways to help too! Exercise might very much be the last thing you want to do when you are feeling cramps, but it actually might help with the pain by releasing endorphins!
4. Other hormonal side effects
If you notice you start breaking out as your body adjusts to the IUD, it might be a good idea to focus on a skin care routine. I always suggest going with gentle, natural products. I personally love using witch hazel or micellar water every morning and night.
Headaches/migraines are associated with hormonal forms of birth control. If this happens, it is always helpful to rest in a quiet, cool, dark room. Essential oils like peppermint, rosemary, or lavender oil may also help! I like to apply a thin layer to my temples, forehead, and back of my neck before winding down. Also, remember to drink lots of water or tea to keep yourself hydrated.
5. If your IUD moves or is dislodged
An IUD moving or falling out is rare but important to know about. In about 1 of 1,000 users, an IUD can get stuck or puncture the uterus. This would usually occur during insertion, and if it happens, the IUD should be removed immediately. If your IUD becomes dislodged, you may experience spotting, pain, or discomfort and you should make an appointment with your doctor. Please remember once the IUD is out, your fertility will go back to normal and you should use a back-up method to protect against pregnancy.
Feel confident and comfortable with the birth control option you use.
Reya, your birth control best friend
Editors: Lisa Hou, Dallas Barnes