What is the difference between the Monalisa (intrauterine device) Copper IUD (intrauterine device) approved for 3 years and 10 years of use?

Differences Between MonaLisa Copper IUD 3 Years and 10 Years

The primary difference between the MonaLisa Copper IUD 3-year and 10-year versions is the duration of approved use, with both having similar effectiveness but the 10-year version offering longer-term contraception without requiring replacement as frequently. 1

Key Differences

• Duration of Use: The main difference is the approved duration - 3 years versus 10 years
• Design: May have slight variations in copper content or placement that allow for different durations of effectiveness
• Size: The 3-year version may be smaller, similar to other shorter-duration copper IUDs designed for nulliparous women

Effectiveness and Performance

• Both versions provide highly effective contraception with pregnancy rates less than 1% in the first year of use 2
• The TCu380A (10-year copper IUD) has been shown to be more effective in preventing pregnancy than smaller or lower copper content IUDs 3
• Continuation rates for copper IUDs are generally high, with approximately 50% of women still using them after 5 years 2

Side Effects and Considerations

• Both versions share similar side effect profiles:

  • Increased menstrual bleeding (most common side effect)
  • Dysmenorrhea (menstrual cramping)
  • Risk of expulsion (4-9% in the first year)
  • Risk of perforation (rare)
  • Increased risk of infection in first 20 days after insertion 1, 2

• Smaller copper IUDs (which the 3-year version may be) have shown:

  • Higher continuation rates (78.7% vs 70.2% at 12 months)
  • Lower rates of removal for bleeding/pain (8.1% vs 16.2%)
  • Lower expulsion rates (4.8% vs 8.9%) compared to standard-sized copper IUDs in nulliparous women 4

Clinical Implications and Recommendations

• The 3-year version may be preferable for:

  • Women who want shorter-term contraception
  • Nulliparous women with smaller uterine cavities
  • Women who experience significant side effects with larger IUDs

• The 10-year version may be preferable for:

  • Women seeking long-term contraception
  • Those who want to minimize the number of insertion procedures
  • Women who tolerate the device well

Important Considerations for Providers

• Proper fundal placement is crucial for both versions to maximize effectiveness and minimize expulsion risk 1
• Follow-up should be scheduled 4-6 weeks after insertion to verify proper positioning 1
• Backup contraception should be advised for at least one week after insertion 1
• Both versions can be used for emergency contraception, though this application is underutilized in clinical practice 5, 6

Common Pitfalls to Avoid

• Failing to counsel patients about expected bleeding changes in the first 3-6 months
• Not considering uterine cavity size when selecting between different IUD options
• Requiring multiple visits for IUD insertion, which can be a barrier to access
• Removing an IUD without immediate replacement if continued contraception is desired, as many women do not return for delayed reinsertion 1