Hormonal or Copper IUD: How to decide

Long Acting, Reversible Contraception (LARC) is a convenient and effective contraceptive option for many women. However, once you’ve decided to commit to LARC it can be difficult to determine which option is the most suitable for you; especially when it comes to deciding between the hormonal and the copper IUD. So we’ve put together some information on both of them to help you break it down (and if you can’t be bothered reading there’s a handy infographic at the end).

Like most LARC methods, IUDs are incredibly effective. It is important to note, however, that there is a very slight difference between the two.

The copper IUD has an efficacy rate of 99.2% with typical use. This means that for every 1000 people, there will be 8 that have an unintended pregnancy. Typical use refers to how most people use it, whilst perfect use refers to how effective the method is when used exactly as intended.

By contrast, the hormonal IUD has an efficacy rate of 99.8% in both typical and perfect use, which means it will only fail 2 people in every 1000.

This is a very, very small difference, but if you know you’re exceptionally fertile, or especially worried about unplanned pregnancy, it can be a deciding factor.

For many people the choice around whether or not to rely on hormones for their contraception is a fraught one. Hormones can affect people in a wide variety of different ways, so it’s important to know what you’re putting into your body.

The copper IUD does not contain any hormones at all, and works by using the properties of copper to affect sperm motility and egg survival (for more information check out our Copper IUD Facts page).

The hormonal IUD by comparison contains a small amount of progestogen that is released directly into your reproductive system with only trace amounts making its way into your blood stream. This causes the mucus of the cervix to thicken which prevents the sperm from entering the uterus to fertilise the egg. It also controls the lining of the uterus, preventing it from becoming thick enough for you to become pregnant.

The dosage of progestogen released by the hormonal IUD daily is much smaller than that found in the oral contraceptive pill, or the progestogen only “mini” pill (for more information, check out our Hormonal Contraception Guide).

As with any form of medication or medical procedure, there are always potential side effects. The hormonal and copper IUD may both have less, or simply different side effects to other forms of contraception, but it’s important to know what those are before making your decision.

The hormonal IUD contains enough progestogen to reduce period pain and bleeding; however, the first 3 to 6 months can include sporadic spotting and bleeding. It’s possible that the hormonal IUD might cause your period to stop altogether. Because of the hormones in it, it’s possible it may cause side effects, like acne, but these are uncommon and usually settle.

The copper IUD does not contain hormones, so therefore doesn’t run the risk of acne or other hormonal side effects. However it is known to sometimes increase bleeding and discomfort with your periods.

Both IUD types run a small risk of moving, being expelled and/or rarely perforating the uterus. According to “Contraception: An Australian Clinical Practice handbook. 4thEdition” expulsion is most common in the first year, at a rate of around 5%, while perforation is currently estimated to occur in 1 of every 500 cases.

It’s unlikely that your decision is going to be based on budget alone, but if all other factors are equal it might be the thing that makes up your mind.

A hormonal IUD lasts for 5 years, and starts at around $240 with a Medicare rebate (this includes the device and insertion).

A copper IUD can last up to 10 years and starts at around $280 with a Medicare rebate (this includes the device and insertion).

Comparatively this means the 10 year copper IUD costs about $28 a year, across its lifespan, whilst the hormonal IUD comes in a little dearer at $48 a year.

Now that you have all the facts, you’re in a better position than ever to make a decision about which IUD is the right device for you and your body. Feel free to use the infographic below as a reference for discussions with your GP or partner.

Originally published at on March 19, 2018.



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