Key Takeaways:

• Both copper and hormonal IUDs are highly effective at preventing pregnancy, but they work in different ways and suit different needs and lifestyles.
• IUDs are low-maintenance, long-term options (lasting 3–10 years) and are over 99% effective. They can be hormonal (e.g., Mirena®, Kyleena®) or hormone-free (e.g., Paragard®).
• Copper IUDs are hormone-free and preserve your natural cycle, while hormonal IUDs can lighten or stop periods and help with menstrual discomfort.
• Other birth control options like the pill, patch, or vaginal ring may be a better fit if you want more control over starting or stopping contraception.
• Neither method protects against STIs—consider pairing with condoms if needed.

Hormonal vs. copper IUD

Deciding between a hormonal IUD and a copper IUD can seem complicated, but it all comes down to your needs and preferences; nothing more.

Both types are very effective long-term birth control options, but they protect against pregnancy in very different ways. A hormonal IUD releases synthetic hormones locally to prevent pregnancy, while a copper IUD creates an environment that’s simply unfriendly to sperm.

Hormonal IUDs can also reduce or even stop periods, which can be a game-changer if you experience heavy or painful bleeding. Copper IUDs are completely hormone-free and can provide protection for up to 10 years—ideal if you prefer to avoid hormones altogether.

Ultimately, the best choice depends on your priorities. Your health history, lifestyle, and personal preferences all matter. A healthcare provider can help you weigh the pros and cons of each option so you feel confident choosing the method that works best for your body.

What are intrauterine devices?

Intrauterine devices (IUDs) are small, T-shaped devices that sit in your uterus to prevent pregnancy. They’re over 99% effective, making them one of the most reliable long-term birth control options.

Think of an IUD as a tiny, powerful protector for your uterus. Once it’s in place, you don’t have to remember daily pills or juggle other contraceptive methods. There are two main types: copper and hormonal. The top hormonal IUDs include Mirena®, Kyleena®, Liletta®, and Skyla®, while the most common copper IUD is Paragard®.

These devices are all reversible, convenient, and long-lasting, and your fertility typically returns quickly after removal.

What is a copper IUD?

A copper IUD, like Paragard®, is completely hormone-free and can provide protection for up to 10 years. The copper wire creates an environment that’s unfriendly to sperm—they can’t survive long enough to reach an egg. Even if fertilization occurs, the copper helps prevent a fertilized egg from implanting in the uterine lining.

An added benefit? A copper IUD can also be used as emergency contraception if inserted within five days of unprotected sex, giving you extra peace of mind if something unexpected happens.

What is a hormonal IUD?

Hormonal IUDs release a small amount of progestin directly into your uterus. Because the hormone is delivered locally, the dose is much lower than what you’d get from a birth control pill, but still highly effective.

Different hormonal IUDs last for different lengths of time:

• Mirena®: up to 8 years
• Kyleena® and Liletta®: up to 7 years
• Skyla®: up to 3 years

Hormonal IUDs can also help reduce heavy or painful periods, making them a good fit if menstrual changes are something you’re looking for.

How copper IUD works

A copper IUD prevents pregnancy through a simple but highly effective mechanism. Copper ions released into the uterus create an environment that’s safe for you but really hostile to sperm. Because it’s completely hormone-free, lots of people choose a copper IUD if they want reliable contraception without the hormones.

The copper wire wrapped around the IUD continuously releases ions that interfere with sperm cells, damaging their tails and heads. This makes it nearly impossible for sperm to swim or fertilize an egg. Even the strongest swimmers can’t get past this copper “obstacle course,” giving you dependable, long-term protection.

Once in place, a copper IUD works immediately, too. It prevents sperm from swimming properly, blocks their path to an egg, and changes your uterine environment to make implantation very unlikely. Its effectiveness stays consistent from the first day through up to 10 years!

How hormonal IUD works

A hormonal IUD delivers a small, steady amount of the hormone progestin directly into your uterus each day. This targeted approach gives you reliable pregnancy protection exactly where it’s needed, with much lower hormone exposure than oral contraceptives.

Progestin in a hormonal IUD works in three ways:

1. Thickening cervical mucus: This creates a barrier that sperm can’t get through.
2. Thinning the uterine lining: It makes the lining less receptive to implantation.
3. Sometimes preventing ovulation: In some users, it can stop the ovaries from releasing eggs.

Popular hormonal IUDs include Mirena® and Kyleena®, while for a non-hormonal option, Paragard® is widely recommended. Nurx providers can give you guidance on all the different birth control options to help you find the best fit for your body and lifestyle.

Progestin release

Hormonal IUDs contain levonorgestrel, which is released through a special membrane at a controlled rate. The highest release occurs in the first few months, then levels off to a steady, lower dose for long-term protection.

Changes to cervical mucus

That progestin transforms your cervical mucus, making it thicker, stickier, and less hospitable to sperm. While your usual, fertile cervical mucus is thin and stretchy, the hormonal IUD turns it into a strong barrier, preventing sperm from reaching an egg.

Benefits of IUDs

Both types of IUDs are really effective, long-term birth control options, and each comes with some different benefits. Whether you’re considering a hormone-free method or one that delivers targeted hormones, understanding what each can offer helps you make a choice that fits your health, lifestyle, and personal goals.

Copper IUD benefits

The copper IUD is completely hormone-free, letting your body maintain its natural hormone balance. Paragard®, the leading copper IUD, can protect you for up to 10 years.

• You continue to ovulate and keep your natural menstrual cycle.
• Fertility returns immediately after removal.
• It’s the most effective form of emergency contraception when inserted within five days of unprotected sex.

This makes the copper IUD a great choice for anyone who prefers hormone-free birth control or wants long-term protection without any of that daily maintenance.

Hormonal IUD benefits

Hormonal IUDs, like Mirena® and Kyleena®, release a small amount of progestin directly in the uterus, giving strong pregnancy protection with fewer systemic hormones than oral contraceptives.

• Many people experience lighter periods, or even stop having periods entirely, after a few months.
• Helps reduce heavy bleeding and painful cramps, and can ease symptoms of conditions like endometriosis.
• Localized hormone delivery often means fewer side effects compared to birth control pills.

Hormonal IUDs are ideal if you want long-term contraception while also addressing menstrual discomfort or other reproductive health concerns. However, there are loads of options when it comes to hormonal birth control, and a Nurx provider can help you decide which type fits your body and lifestyle best.

Side effects

Both copper and hormonal IUDs are highly effective, but it’s helpful to know what to expect so you feel prepared and confident in your choice. Insertion can be uncomfortable for a few minutes, often described as intense cramping, but most people find it tolerable.

Copper IUDs

• May cause heavier periods and stronger cramps during the first few months.
• Some people notice spotting between periods.
• Does not affect hormone levels, so other hormone-related side effects are uncommon.

Hormonal IUDs

• Irregular bleeding or spotting is common during the first few months.
• Periods often become much lighter, and some people stop having periods entirely.
• Possible side effects can include breast tenderness, headaches, or mood changes due to hormone exposure.

Differences in bleeding and cramping

• Copper IUDs tend to increase menstrual flow and cramping.
• Hormonal IUDs usually lighten periods or stop them altogether over time.

Remember, neither copper nor hormonal IUDs protect against sexually transmitted infections, so using condoms is still important if STI prevention is something you need to consider.

Choosing the right IUD for you

Deciding between a copper or hormonal IUD comes down to your unique needs, lifestyle, and health history.

• Your periods: If your periods are already heavy or painful, a copper IUD may make them more intense at first. Hormonal IUDs, on the other hand, often lighten periods or stop them altogether, which can be a relief if cramps or bleeding are challenging.
• Lifestyle and convenience: Copper IUDs can protect you for up to 10 years, making them ideal if you want long-term, hormone-free contraception. Hormonal IUDs like Mirena® or Kyleena® offer shorter durations but can make periods more manageable or even eliminate them.
• Health considerations: Your medical history matters. Certain conditions may make one type a safer or more comfortable choice than the other.

Working with a healthcare provider can help you weigh these factors and choose the IUD that fits best with your body and your life.

Making the best IUD choice for you

Hormonal vs. copper IUD? It’s an important decision, but it doesn’t have to stress you out.

Both types provide over 99% effectiveness and long-term protection, giving you peace of mind without daily effort.

Hormonal IUDs, like Mirena® or Kyleena®, can reduce or even stop periods, which may be a relief if you struggle with heavy bleeding or cramps. Copper IUDs, like Paragard®, are completely hormone-free and can protect you for up to 10 years, making them ideal if you want to avoid hormonal contraception.

The right choice depends on your lifestyle, health history, and personal preferences. For some people, other options like the birth control pill, patch, or vaginal ring might be a better fit, especially if you prefer more control over starting or stopping contraception. Partnering with a healthcare provider ensures you pick the option that fits your body and your life.

Ready to explore your birth control options? Connect with a Nurx provider today for personalized guidance and expert support every step of the way.

Frequently Asked Questions (FAQ):

Which is better, copper or hormonal IUD?

Both types are highly effective, with over 99% protection against pregnancy. Copper IUDs are hormone-free and can last up to 10 years, but they may cause heavier periods and more cramping. Hormonal IUDs, like Mirena® or Kyleena®, can lighten periods, reduce cramps, and last between 3–8 years, though they may come with hormonal side effects.

Why don’t doctors recommend copper IUD?

Copper IUDs may not be recommended for people with heavy menstrual bleeding, certain uterine conditions, or a copper allergy. Because they can increase bleeding and cramping, providers need to consider these factors before suggesting this option.

Is copper or hormonal IUD easier on your period?

Hormonal IUDs are generally easier on periods, often reducing flow and cramping over time. Copper IUDs, being hormone-free, can sometimes make periods heavier and more uncomfortable, especially in the first few months after insertion.

Does the copper or hormonal IUD last longer?

Copper IUDs offer the longest protection—up to 10 years. Hormonal IUDs last 3–8 years, depending on the brand, giving you flexible options depending on your long-term birth control goals.

The information provided is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon this content for medical advice. If you have any questions or concerns, please talk to a medical professional.