January 29th 2010

ParaGard Dukes It Out With Mirena

At the end of each month, SexReally will feature a post discussing contraception, sex, and related topics from the perspective of a healthcare provider. The posts will be written by several different medical professionals, so scroll down to read the bio of this month’s author!

*****

Here’s a secret you may not know about doctors: female doctors use IUDs 2-5 times more often than women who aren’t doctors. Maybe it’s because doctors know the intrauterine device (IUD) is safe, low-maintenance, and super-effective.

There are two different types of intrauterine devices (IUDs): Mirena and ParaGard. You may have heard about these two options in the media, but, fancy TV commercials aside, what’s the difference between them and is one of them right for you?

They’re different in some important ways:

Mirena

• A Mirena prevents pregnancy by releasing a very small amount of a hormone called progesterone each day. This progesterone acts locally in the uterus to prevent pregnancy, instead of going throughout your whole body, the way the pill or some other hormonal methods do. The Mirena also contains no estrogen, so it has fewer hormonal side effects than a typical Pill.
• Many women who start using the Mirena IUD have irregular bleeding for 3 – 6 months. This bleeding is usually more like spotting- light and not painful. But you may not be able to predict your periods for the first several months, so wear black underwear!
• The good news about the Mirena? Once you get through the first 6 months, your periods usually stop altogether or are regular, light, short and not painful. If not having a period every month would make you sick to your stomach worrying that you’re pregnant, you might prefer a ParaGard.

ParaGard

• Most women who use ParaGard have heavier, longer, or crampier periods, especially for the first few months. After 6 months, many women’s periods return to normal. If you already have really heavy or uncomfortable periods, or you are anemic (too little iron in your blood), you might prefer a Mirena.
• A ParaGard prevents pregnancy thanks to a tiny copper filament wrapped around the T. ParaGard contains no hormones of any kind—it’s the only super-effective non-hormonal birth control method around.

Still, the two IUDs have a lot in common:

• They work. Really, really well. Both IUDs are ranked among the most effective birth control methods you could use, up there with having your tubes tied.
• They’re safe. Pretty much anyone who wants to prevent pregnancy for a year or more could use an IUD.
• They’re small. They’re both shaped like a T, and the T itself is about as thick as a tampon string. The whole thing is smaller than an iPod Shuffle.
• They are affordable. IUDs are covered by many insurers, and you may be able to get a free IUD if you go to a family planning clinic. If you have to pay for an IUD up-front, it can seem expensive. But if you use it for at least a year, it is actually cheaper than most other forms of birth control, and definitely cheaper than having a baby! A clinic may be able to help you pay for an IUD in installments.
• They are easy to start using. You can usually have the IUD inserted at your first visit to your doctor. Having an IUD inserted feels similar to having a Pap smear, and takes about 60 seconds total. An IUD works for a long time, but you can stop using it any time you like. The Mirena (with progesterone) lasts for up to 5 years. The ParaGard (with copper) lasts for up to 10 years. Whenever you decide to have the IUD removed, you can get pregnant the next month.
• They DON’T prevent sexually transmitted infections (just like the pill, patch, ring, and Depo). Condoms are still the only game in town if you want to prevent STIs.

The bottom line? Both methods are safe, effective, and easy to reverse. In a boxing match between ParaGard and Mirena, both would win.

*****

Sara Kennedy, M.D., M.P.H., is an Obstetrician/Gynecologist and a clinical fellow in Family Planning at the University of California, San Francisco. Originally from Pennsylvania, Sara has studied and lived around the world, including a residency at Northwestern University in Chicago and a master’s degree in Australia, where she met her husband! Sara is passionate about women's health, particularly helping women in vulnerable situations obtain the knowledge and resources they need in order to control their reproductive health.