In the world of contraception, two camps clash. On one side, the copper IUD, the star of hormone-free methods, promising a return to a natural cycle. On the other, the hormonal IUD, touted for its near-absence of periods and its therapeutic benefits. You're torn between the two. That's understandable. Even gynecologists have their favorites and sometimes steer the choice without really explaining. This article compares them. point by point These two devices address what truly matters in your daily life: periods, libido, mood, price, and pain. For each criterion, there's a winner. But be aware, there's no single "best" IUD. There's only the one that suits you best, right now, with your body and your life.
The main thing to remember
- Identical effectiveness : 99%+ for both, no winner here
- Rules Hormonal factors crush the competition (flow divided by 2, or even disappearing completely)
- Libido Copper often wins, but not always
- Mood/PMS Controversial draw, opposite effects according to women
- Fertility return Copper therapy is immediate, hormonal therapy takes 1-3 months
- Price Copper costs half as much and lasts twice as long.
- Flagship brands Mirena (hormonal 52mg) and Mona Lisa (copper) dominate the French market.
- The real question Can/do you want to tolerate hormones?
How They Work (In Real Life)
Before comparing, a quick reminder about how they work. Because no, the IUD does not "sterilize" and is not an old wives' tale contraceptive.
Round 1: Impact on the Rules
🏆 WINNER: Hormonal IUD (overwhelming victory)
If your period is ruining your life, it's not even a match.
Copper IUD: The Torrent
Studies confirm it, and so do testimonials. The copper IUD increases menstrual flow by an average of 50 to 55%. In practical terms, if you had 60 ml of blood per cycle, you'll go up to 90 ml. If you already had heavy periods, welcome to hell.
- Duration : 7-9 days of menstruation compared to 3-5 days before (recurring testimonies)
- Abondance The first two days may require reapplication every 2-3 hours.
- Pain 38% of women report more cramps in the first 3 months
- Anemia 20% develop iron deficiency, 10% develop overt anemia after 12 months
- Evolution It improves after 6-12 months, but rarely a return to pre-IUD "normal"
Hormonal IUD: The Near Disappearance
With Mirena (the highest dose), 30 to 50% of women stop having periods altogether after 6 months. The others experience light and short bleeding.
- Reduced flow by 90% compared to the departure
- Amenorrhea (absence of periods) in 30-50% of Mirena users, less with Kyleena and Jaydess
- Spotting during the first 3-6 months, then stabilization
- Menstrual pain often reduced or even eliminated
- Therapeutic indication for endometriosis, adenomyosis, fibroids
The verdict If you have heavy or painful periods, or endometriosis, the hormonal IUD is a treatment, not just contraception. Copper IUDs worsen these problems. It's a clear match.
Round 2: Libido & Sexual Desire
🏆 WINNER: Copper IUD (default)
But it's more subtle than it seems.
On paper, the copper IUD should win hands down. Zero hormones = zero impact on libido. In practice, it's more nuanced.
Copper IUD: The Return of Desire (Often)
Many women report a return of libido after years on the pill. Natural peaks of desire around ovulation return, and the body functions according to its own hormonal rhythm.
Forum testimony "Since I stopped taking hormones, it's WOW! My libido has exploded compared to when I was on the pill. I finally feel like myself again."
But be warned, if your periods become a nightmare with a copper IUD (pain, heavy flow), your libido can also suffer. It's hard to feel aroused when you're losing liters of blood.
Hormonal IUD: The Progestin Effect
Progestins (even at low local doses) can decrease libido in some women. However, the effect is generally much less pronounced than with a conventional birth control pill, because the doses are microscopic.
- Mirena releases approximately 14 micrograms of levonorgestrel per day
- A progestin-only pill contains 300 to 500 times more of hormones
- The action is local (uterus) with little systemic absorption
- Some women notice no change, others a moderate decrease
Round 3: Mood, PMS & Mental Health
⚠️ DRAW (Controversial)
According to the women, one or the other is a nightmare or a savior.
This is the most divisive criterion. Testimonies differ radically depending on the profiles.
Copper IUD: Amplified PMS
Hundreds of testimonies report PMS becoming unmanageable while using a copper IUD. Extreme irritability, crying spells, and dark thoughts in the days leading up to menstruation.
Blog testimonial "I literally question my entire life every month when I get my period: my relationship, my job, my life choices... It's very hard for me and my partner. These effects have never been explained to me by my midwife."
Hypothesis: Chronic inflammation caused by copper + unbuffered natural hormonal fluctuations = more pronounced PMS in some women.
Hormonal IUD: The Risk of Depression
Several recent studies show an association between hormonal IUDs and an increased risk of depression, with a dose-dependent relationship. The higher the levonorgestrel dose of the IUD, the greater the risk. The ANSM (French National Agency for Medicines and Health Products Safety) has received hundreds of reports of psychiatric side effects (anxiety, panic attacks, depression).
Conversely, some women feel more emotionally stable under Mirena, because natural hormonal fluctuations are smoothed out.
The verdict It's impossible to say for sure. If you're sensitive to hormones (history of depression while on the pill), be wary of hormonal supplements. If you naturally experience severe PMS, copper can worsen it. It's a minefield on both sides.
Round 4: Contraceptive Efficacy
⚖️ PERFECT EQUAL
Both are among the most reliable contraceptives available.
In terms of pure contraceptive effectiveness, it's virtually impossible to distinguish between them. Both boast success rates exceeding 99%, as measured by the Pearl Index.
The difference between theoretical and practical effectiveness is nothing For IUDs. Unlike the pill, where missed doses reduce effectiveness from 99,7% to 91%, the IUD doesn't require any daily action. Once inserted, it works 24/24 without you having to think about it.
The verdict It's a complete tie. Both are among the top three most effective contraceptive methods in the world (along with the implant and sterilization). If you become pregnant while using an IUD, it means the device has shifted or been expelled, not that it has failed.
Round 5: Back to Fertility
🏆 WINNER: Copper IUD (slight advantage)
Immediate vs. a few weeks' delay.
If you want a baby quickly after removal, copper has a slight advantage. But rest assured, neither type of IUD has no negative impact on long-term fertility.
Copper IUD: Immediate Return
The copper IUD never disrupted your menstrual cycle. It simply made the uterus hostile to sperm. As soon as it is removed, the copper disappears and your fertility returns instantly.
- Pregnancy possible from the 1st cycle after removal
- 91,5% of nulliparous women conceive within 4 years (Wilson study, 1989)
- 95,7% of multiparous women conceive within 4 years
- Average design time : 3 months (comparable to women who have never used contraception)
- No residual effects Copper does not accumulate in the body
Hormonal IUD: Quick Return But Not Immediate
Levonorgestrel disappears quickly after withdrawal (mainly local action), but your cycle may take a few weeks to regulate, especially if you had stopped having periods.
- Return of ovulation 1 to 3 months on average
- Possible pregnancy from the first cycle for some, 1-3 months for others
- Design rate : identical to copper after 12 months (83% of pregnant women)
- No studying shows no long-term negative impact on fertility
- Cycle regulation It can take 1 to 3 cycles to return to normal periods.
The verdict Copper wins for speed (immediate), but after 3-6 months, conception rates are identical. If you're planning a pregnancy within a year of removal, there's no need to worry with either option.
Round 6: Pain During Placement
⚖️ DRAW
The pain depends on you and the practitioner, not on the type of IUD.
Bad news: IUD insertion can be painful. Good news: the same is true for copper and hormonal IUDs. Studies do not show no significant difference between the two.
In a study comparing Mirena and copper IUDs, the rates of adverse effects in the month following insertion were almost identical. 5,2% for Mirena vs 4,9% for copperThe pain experienced on a scale of 0 to 100 was also comparable.
What Really Affects Pain
Factors that determine whether the pose will be bearable or a nightmare:
- Nulliparity If you have never given birth, your cervix is narrower, and the position may be more uncomfortable.
- Personal sensitivity Some women only feel discomfort, others experience intense cramps.
- Practitioner's expertise An experienced gynecologist/midwife makes all the difference
- Cycle timing Inserting during menstruation (when the cervix is more open) can facilitate insertion.
- Local anesthesia Not widely available in France, but a game changer for many.
- Prior pain relief Ibuprofen taken 1 hour beforehand can alleviate cramps.
After insertion, cramps may persist for a few hours to a few days. This is normal and the same for both types of IUD.
The verdict It's a complete draw. If you're worried about pain, insist on local anesthesia or sedation. It's your right, and some centers offer it routinely.
Round 7: Weight Gain
🏆 WINNER: Copper IUD
No hormones = no hormonal weight gain.
The copper IUD has no effect on weight. The hormonal IUD can cause moderate weight gain (1-3 kg) in some women, due to water retention and increased appetite. However, this effect is much less pronounced than with a combined oral contraceptive pill.
Round 8: Acne & Skin
⚠️ DRAW (Depending on your base skin)
Both can worsen acne, but in different ways.
Copper IUD Return of the natural cycle = return of premenstrual hormonal breakouts if you had them before starting the pill. If you were taking the pill for acne, copper may not be effective.
Hormonal IUD Progestins can worsen acne in some women (the androgenic effect of levonorgestrel). Others see their skin improve. It's a genetic lottery.
Round 9: Price & Lifespan
🏆 WINNER: Copper IUD (unbeatable value)
Half the price and twice as long.
Round 10: Other Decisive Criteria
Brands: Who Does What?
Not all IUDs are created equal. TailleDosage, duration, everything varies. Your gynecologist often has their favorites (and sometimes commercial agreements), but you can ask for a specific model.
Hormonal IUDs (All Bayer)
Copper IUDs
Do you need menstrual protection that is compatible with your IUD?
Whether you have a copper IUD (heavy periods) or a hormonal IUD (irregular spotting), period panties adapt to all flows.
So, which one to choose?
Let's stop looking for the "best" universal IUD. It doesn't exist. The right IUD for you exists, right now, with your body, your priorities, and your constraints.
Choose the copper IUD
- You categorically refuse hormones (due to medical history, beliefs, or negative experiences).
- Your current periods are normal to light.
- You want to maintain your natural cycle and its variations (libido, energy)
- You want the cheapest and longest-lasting contraception
- You may need emergency contraception
- You tolerate natural hormonal fluctuations well
Choose the hormonal IUD.
- Your periods are heavy, long, or painful.
- You have endometriosis, adenomyosis, or fibroids
- You dream of no longer having periods at all
- You have anemia or a predisposing condition (iron deficiency).
- You tolerate progestins well (no negative effects on mood observed before)
- You are childless and want the smallest version (Kyleena/Jaydess)
⚠️ Be careful
- Copper IUD History of anemia, already heavy periods, severe PMS, endometriosis
- Hormonal IUD History of depression/anxiety while taking hormones, hypersensitivity to progestins
The Real Question to Ask Yourself
Forget the theoretical pros and cons. Ask yourself this brutally honest question: What would ruin your daily life the most? Heavy and painful periods every month, or the risk of hormonal effects on your mood and libido?
If the answer is obvious, you have your preference. If you're still hesitating, start with the one that scares you the least. An IUD isn't a tattoo. If it doesn't work out, it can be removed. Three months of trying it out is better than three years of regret.
And above all, demand that your doctor explain ALL possible side effects, not just the ones that suit you.
Sources & Scientific References
This article is based on scientific studies and real-world usage data.
Studies on the effects of the copper IUD
- Goh TH, et al. (1980). A longitudinal study of serum iron indices and haemoglobin concentration following copper-IUD insertion. Contraception. PMID: 7449387
- Lowe RF, et al. (2012). Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices. Contraception. DOI: 10.1016/j.contraception.2012.08.034
- Hubacher D, et al. (2009). Side effects from the copper IUD: do they decrease over time? Contraception. PMC2702765
Contraceptive effectiveness and comparative studies
- HAS (2013). Summary document - Contraceptive methods: Focus on the most effective methods. High Health Authority. HAS Link
- Li Y, et al. (2024). Contraception with levonorgestrel-releasing intrauterine system versus copper intrauterine device: a meta-analysis of randomized controlled trials. eClinicalMedicine (The Lancet). DOI: 10.1016/j.eclinm.2024.102827
- Turok DK, et al. (2021). Levonorgestrel vs. copper intrauterine devices for emergency contraception. New England Journal of Medicine. DOI: 10.1056 / NEJMoa2022141
- Mansour D, et al. (2015). Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception. DOI: 10.1016/j.contraception.2015.01.011
Return to fertility after withdrawal
- Wilson JC (1989). A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices. Am J Obstet Gynecol. PMID: 2916624
- Andersson K, et al. (1992). Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception. PMID: 1493717
- Girum T, et al. (2018). Return of fertility after discontinuation of contraception: A systematic review and meta-analysis. Contraception and Reproductive Medicine. DOI: 10.1186/s40834-018-0064-y
- Doll H, et al. (2019). Levonorgestrel IUD: is there a long-lasting effect on return to fertility? Fertility Research and Practice. PMC7000571
Data on hormonal IUDs
- VIDAL (2018). KYLEENA 19,5 mg, a new levonorgestrel intrauterine system. VIDAL link
- ANSM (2022). IUDs containing the most hormones may present a greater risk of depressive disorders. National Agency for the Safety of Medicines. ANSM link
- Mavranezouli I, et al. (2006). Levonorgestrel-releasing IUD versus copper IUD in control of dysmenorrhea, satisfaction and quality of life. Iranian Journal of Reproductive Medicine. PMC4163262
Psychiatric effects of hormonal IUDs
- Elsayed M, et al. (2023). The potential association between psychiatric symptoms and the use of levonorgestrel intrauterine devices: A systematic review. World Journal of Biol Psychiatry. PMID: 36426589
- Larsen SV, et al. (2024). Association between intrauterine system hormone dosage and depression risk. Am J Psychiatry. DOI: 10.1176/appi.ajp.20230181
- Slattery J, et al. (2018). Cohort study of psychiatric adverse events following exposure to levonorgestrel-containing intrauterine devices in UK general practice. Drug Saf. PMID: 29785475
- Zeiss R, et al. (2020). Depressive Disorder With Panic Attacks After Replacement of an Intrauterine Device Containing Levonorgestrel: A Case Report. Front Psychiatry. PMC7485277
- Skovlund CW, et al. (2023). Levonorgestrel intrauterine device and depression: A Swedish register-based cohort study. Psychoneuroendocrinology. DOI: 10.1016/j.psyneuen.2023.106449
Surveys and usage data
- Fédération Romande des Consommateurs (2021). "We're fed up with them!" - Investigation into IUDs. FRC link
Medical Warning: This article is for informational purposes only and is not a substitute for professional medical advice. Choosing a contraceptive method should be done in consultation with a healthcare professional who is familiar with your complete medical history.
