Differences Between Skyla and Kyleena IUDs
Kyleena contains more levonorgestrel (19.5 mg) than Skyla (13.5 mg) and is approved for 5 years of use compared to Skyla's 3 years, making Kyleena the superior choice for patients seeking longer-term contraception with slightly higher hormone levels.
Key Differences
| Feature | Skyla | Kyleena |
|---|---|---|
| Hormone content | 13.5 mg levonorgestrel | 19.5 mg levonorgestrel |
| Duration of use | 3 years | 5 years |
| Size | Smaller T-frame | Smaller T-frame (similar to Skyla) |
| Efficacy | >99% | >99% |
Mechanism and Efficacy
Both Skyla and Kyleena are hormonal intrauterine devices (IUDs) that:
- Release levonorgestrel directly into the uterine cavity
- Cause endometrial suppression
- Thicken cervical mucus
- Have typical and perfect use failure rates of less than 1% 1
- Are considered long-acting reversible contraception (LARC) methods
Clinical Considerations for Selection
When to Choose Kyleena
- For patients needing longer-term contraception (5 years vs. 3 years)
- When slightly higher hormone levels are desired
- For patients who may benefit from more significant reduction in menstrual bleeding (due to higher hormone content)
When to Choose Skyla
- For patients who prefer or need lower hormone exposure
- For nulliparous adolescents or women with smaller uterine cavities
- When shorter duration of contraception is desired
Side Effects and Bleeding Patterns
Both IUDs may cause:
- Unscheduled spotting or light bleeding, especially during the first 3-6 months 2
- Potential dyspareunia that may require evaluation
- Potential for hormonal side effects (though minimal compared to systemic hormonal methods)
Kyleena, with its higher hormone content, may provide better control of menstrual bleeding compared to Skyla, though both cause less menstrual bleeding than non-hormonal IUDs 2.
Insertion and Removal
Both devices:
- Require insertion by a trained clinician
- Have similar insertion procedures
- Can be removed at any time with rapid return to fertility
- Have risk of pelvic infection highest in the first 20 days after insertion 2
Special Considerations
Contraindications for Both
- Current purulent cervicitis
- Active gonorrhea or chlamydia infection
- Current pelvic inflammatory disease (PID)
- Pregnancy
- Uterine anomalies that distort the cavity 2
Important Clinical Pearls
- Both IUDs can be used in nulliparous women
- Neither IUD causes tubal infertility
- Fertility returns rapidly after removal of either device
- Both provide excellent contraception with minimal systemic effects
- The risk of ectopic pregnancy is reduced compared to no contraception, though any pregnancy that does occur has a higher chance of being ectopic 3
Conclusion
When choosing between Skyla and Kyleena, the primary considerations should be the desired duration of contraception and the appropriate hormone level for the individual patient. Kyleena offers a longer duration of use with slightly higher hormone levels, while Skyla provides a shorter duration with lower hormone exposure.