Birth Control & Family Planning

Hormonal vs. Copper IUD: Which One Is Right for You?

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

Both hormonal and copper IUDs prevent more than 99% of pregnancies, and either can be taken out whenever you want. The big difference is what they do to your period: hormonal IUDs usually make bleeding lighter, while the copper IUD is hormone-free but often makes periods heavier and crampier, at least at first. For most people the choice comes down to three things: your period, how you feel about hormones, and how long you want to be covered.

There's no perfect birth control, only the one that fits your life right now. Here's how to figure out which IUD that is.

Start with your period

This is the question clinicians usually ask first, and it settles the decision for a lot of people.

• Heavy or painful periods already? A hormonal IUD often makes them lighter, and some people stop bleeding altogether. Mirena is FDA-approved to treat heavy menstrual bleeding.
• Light, easy periods, and you want to keep a natural cycle? Copper may suit you, as long as you're okay with your period getting heavier for a while.
• Want no periods at all? Hormonal is more likely to get you there, though it's not guaranteed.

How each one works

Both are small, flexible, T-shaped devices placed in the uterus by a clinician. Two thin strings hang through the cervix so the IUD can be removed later. After that there's nothing to remember.

Hormonal IUDs release a small amount of a progestin called levonorgestrel. It thickens cervical mucus so sperm can't reach an egg, thins the uterine lining, and may stop ovulation in some users. Brands in the U.S. include Mirena, Liletta, Kyleena and Skyla.

The copper IUD (Paragard) has no hormones. Copper sets off an inflammatory reaction in the uterus that's toxic to sperm and eggs, preventing fertilization. Your natural cycle continues.

Side by side

Hormonal brands and how long they last

Approved durations have been extended over the years as new data came in. As of recent FDA labeling:

• Mirena: up to 8 years; also approved to treat heavy menstrual bleeding
• Liletta: up to 8 years
• Kyleena: up to 5 years
• Skyla: up to 3 years; smallest size

Ask your clinician to confirm the current approval for the brand you get, and put the removal-or-replace date in your phone calendar the day it goes in. Years go faster than you think.

What the first few months are really like

Hormonal

• Irregular bleeding or spotting for the first 3 to 6 months. This is the most common reason people consider taking it out early, and it usually settles. Keep panty liners in your bag.
• Lighter periods over time, or none
• Cramping after insertion
• Less commonly: headaches, breast tenderness, acne or mood changes
• Ovarian cysts, which usually go away on their own

Copper

• Heavier, longer periods
• More cramping during periods
• Spotting between periods early on

For many people, copper bleeding improves after the first 6 to 12 months. If you're starting copper and your periods were already on the heavy side, ask about iron levels.

Risks with either

Serious problems are uncommon, but your clinician will go over them:

• Expulsion: the IUD slips partly or fully out. More likely in the first year and after childbirth.
• Perforation: rarely, the IUD pushes through the wall of the uterus during insertion.
• Infection: a small increased risk in the first few weeks after insertion. IUDs don't protect against STIs, so use condoms if you're at risk.
• Pregnancy: rare, but if it happens, there's a higher chance it's ectopic (outside the uterus).

Myths people still ask about

• "IUDs make you gain weight." Weight gain isn't a common side effect of either. Copper has no hormones, and the hormonal IUD's progestin dose is small and mostly local.
• "You have to have had a baby." No. IUDs are used by people who've never been pregnant.
• "It'll hurt my fertility." Fertility returns quickly after removal. There's no waiting period.
• "My partner will feel it." Sometimes a partner notices the strings. A clinician can trim them.

Who's a good fit for each

A hormonal IUD may suit you if you:

• Have heavy or painful periods
• Want fewer or no periods
• Are fine with a low dose of progestin

A copper IUD may suit you if you:

• Want to avoid hormones completely
• Want the longest-lasting option
• Need emergency contraception and want ongoing birth control too
• Have regular, manageable periods

The CDC's Medical Eligibility Criteria list a few situations where an IUD may not be safe, such as a current pelvic infection, unexplained vaginal bleeding or certain uterine shape problems. A copper allergy or Wilson's disease rules out the copper IUD.

The appointment, step by step

1. Counseling. Your clinician reviews your history and answers questions. Some practices place the IUD the same day; others schedule a second visit.
2. Pregnancy check. Your clinician confirms you're reasonably sure you're not pregnant. An IUD can go in at any point in your cycle when that's the case.
3. STI testing if needed, usually at the same visit without delaying placement.
4. Insertion. It takes a few minutes. Many people feel strong cramping or sharp pain, and experiences vary a lot. Ask ahead what pain control the office offers. See our full guide to IUD insertion pain.
5. Follow-up. Many people don't need a routine follow-up visit. You may be shown how to check for the strings.

Bring a pad and plan an easy rest of the day. A hormonal IUD placed within the first 7 days after your period starts works right away; at other times, use backup for 7 days. The copper IUD works immediately.

Coverage in New York

IUDs are covered by New York Medicaid. New York law requires state-regulated insurance plans to cover FDA-approved contraceptives without a copay. Plans from some large employers follow federal rules instead, so call your plan if you're unsure.

When to call your provider

Call your provider right away if you have:

• Severe belly or pelvic pain
• Fever or unusual vaginal discharge
• Pain or bleeding during sex
• You can feel the hard plastic of the IUD, or the strings seem much longer or shorter
• A positive pregnancy test
• Very heavy bleeding that soaks a pad or tampon every hour

Finding an IUD provider in New York

Most OB/GYNs, nurse practitioners and midwives place IUDs. If you have a medical condition that complicates birth control, a Complex Family Planning specialist can help. Search the directory or browse women's health NPs in Manhattan.

Frequently asked questions

Sources

• CDC — U.S. Medical Eligibility Criteria for Contraceptive Use, 2024
• CDC — U.S. Selected Practice Recommendations for Contraceptive Use, 2024
• ACOG — Long-Acting Reversible Contraception: Implants and Intrauterine Devices (Practice Bulletin 186)
• ACOG — Long-Acting Reversible Contraception (LARC): IUD and Implant (patient FAQ)
• FDA — Product labeling for intrauterine devices

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.