Which IUD to choose: hormonal or copper?

9 Jul 2020

The hormonal IUD and the copper IUD have different modes of action and side effects in the body. Your choice for one or the other must be made with full knowledge.

The IUD, also called an intrauterine device (IUD), is a T-shaped contraceptive device that is inserted into the uterus. It is prescribed by a doctor or midwife. Its contraceptive action lasts from 5 to 10 years for the copper IUD and from 3 to 5 years for the hormonal IUD. This device can be removed at any time if you want to become pregnant or have a medical problem. Please note that this method of contraception does not protect against sexually transmitted infections (STDs).

What are the differences between the copper IUD and the hormonal IUD?

The copper IUD renders sperm inactive, thus acting as a spermicide. It also creates slight inflammation that prevents the fertilized egg from implanting in the uterus.
The hormonal IUD locally diffuses levonorgestrel (a synthetic hormone similar to progesterone). Under its action, the cervical mucus thickens and becomes impermeable to sperm. The endometrium also changes (the lining that lines the inside of the uterus thickens and peels off during menstruation). It is well maintained to prevent the egg from implanting. Consequently, the rules are less abundant, even non-existent. Menstruation is suppressed in 9 out of 10 women with a hormonal IUD.

The copper IUD: for whom?

The copper IUD is recommended for women who do not want a hormonal-based contraceptive and who have menstrual periods that are not painful when not using hormonal contraceptives.

In fact, the IUD only has a mechanical effect thanks to the action of copper on sperm. However, it can cause annoying side effects such as:

  • Increased flow during menstruation;
  • Increased duration of menstruation;
  • Increased pain during menstruation.

Contraindications to the copper IUD

The installation of a copper IUD is not possible in case of:

  • Pregnancy
  • Malformation of the uterus or cervix too wide
  • Genital infection in progress or dating less than 3 months
  • unexplained vaginal bleeding
  • Allergy or hypersensitivity to copper
  • fibroma
  • Cervical or endometrial cancer
  • Postpartum (wait 48 hours to 4 weeks after delivery)

The hormonal IUD: for whom?

The hormonal IUD is recommended for women who have long, heavy, and painful periods during normal times.

The hormonal action has a great advantage over menstruation:

  • Reduced blood flow;
  • Reduction of menstrual pain;
  • Reduction of annoying symptoms related to the menstrual cycle.

However, it has two drawbacks. Bleeding can occur within 3 to 6 weeks after placement. Installing a hormonal IUD can also cause skin problems. That is why it is not recommended for acne prone women.

Contraindications to the hormonal IUD

A hormonal IUD cannot be inserted in case of:

  • The pregnancy
  • Genital infection in progress or dating less than 3 months
  • Postpartum (wait 48 hours to 4 weeks after delivery)
  • Cardiovascular diseases (deep vein thrombosis or pulmonary embolism in progress)
  • unexplained vaginal bleeding
  • Hormone-dependent tumors
  • liver disease

Which is more effective?

The theoretical effectiveness of a contraceptive measure is measured using the Pearl index. Corresponds to the percentage of unwanted pregnancies in a year of optimal use of the method. It is 0.6 to 0.8% for the copper IUD and 0.2% for the hormonal IUD. Therefore, the hormonal IUD would be more effective than the copper IUD, even if the difference in contraceptive effectiveness is not significant.

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