What are the differences between the Kaleeya (levonorgestrel-releasing) IUD and the Copper (intrauterine device) IUD for a female patient of reproductive age seeking contraception?

Kyleena vs Copper IUD Comparison

Both the levonorgestrel-releasing IUD (Kyleena) and copper IUD are highly effective contraceptive options with failure rates below 1%, but they differ significantly in their effects on menstrual bleeding, hormonal side effects, and specific clinical indications. 1, 2

Contraceptive Efficacy

• Both IUDs are equally effective with typical failure rates of less than 1% per year, comparable to sterilization 1, 2
• The copper IUD is effective for at least 10-12 years 1
• Levonorgestrel IUDs vary by formulation: Kyleena is approved for 5 years, while other formulations (Mirena, Liletta) range from 3-7 years 2
• Both provide immediate return to fertility upon removal 1, 2

Key Differences in Menstrual Effects

Copper IUD:

• Increases menstrual bleeding and cramping, particularly during the first several months after insertion 3, 1, 4
• Menstrual blood loss increases by approximately 50% 5
• May require NSAIDs for 5-7 days during bleeding episodes 3

Levonorgestrel IUD (Kyleena):

• Decreases menstrual bleeding significantly and may lead to amenorrhea in 35% of women after 2 years 4, 6
• Provides therapeutic reduction in both bleeding and pain 2
• Particularly beneficial for patients on anticoagulation therapy who need to minimize bleeding 3

Hormonal Considerations

Copper IUD:

• Completely hormone-free option with no systemic hormonal effects 1
• No increased risk of venous thromboembolism (VTE) 3, 1
• Ideal for patients with contraindications to hormones, including those with antiphospholipid antibodies or history of thromboembolism 3

Levonorgestrel IUD:

• Contains progestin only (no estrogen), so no increased VTE risk 3, 2
• May cause hormonal side effects including headache, acne, breast tension, and functional ovarian cysts 4
• Strongly recommended over combined estrogen-progestin contraceptives in patients with SLE, antiphospholipid antibodies, or thrombotic risk factors 3

Special Clinical Situations

When to Prefer Copper IUD:

• Patient desires completely hormone-free contraception 1
• Patient has concerns about hormonal side effects 1
• Need for emergency contraception (highest efficacy when inserted within 5 days of unprotected intercourse) 3, 1
• Patient with history of hormonal contraceptive intolerance 1

When to Prefer Levonorgestrel IUD:

• Heavy menstrual bleeding or dysmenorrhea requiring treatment 2, 6
• Patient on anticoagulation therapy 3
• Adolescents requiring long-term menstrual suppression when estrogen is contraindicated 2
• Patient desires lighter or absent periods 2, 6

Safety Profile (Both IUDs)

• Safe for immunocompromised patients, including those with HIV or on immunosuppressive therapy 1, 2
• Safe for nulliparous adolescents and do not cause tubal infertility 1, 2
• Small increased risk of pelvic infection only during first 20 days after insertion 1, 2
• No routine follow-up visit required after insertion 3

Common Contraindications (Both IUDs)

• Current or recent (past 3 months) pelvic inflammatory disease 1, 2
• Current gonorrhea, chlamydia, or purulent cervicitis 3, 1
• Pregnancy 3, 1
• Uterine anomalies that distort the cavity incompatible with insertion 1

Management of Bleeding Irregularities

Copper IUD Users:

• NSAIDs for 5-7 days for unscheduled spotting, light bleeding, or heavy/prolonged bleeding 3

Levonorgestrel IUD Users:

• NSAIDs for 5-7 days OR hormonal treatment with combined oral contraceptives or estrogen for 10-20 days (if medically eligible) 3
• Bleeding pattern changes do not correlate with contraceptive failure—reassurance is key 2

Clinical Pitfalls to Avoid

• Do not delay IUD insertion in immunocompromised patients due to theoretical infection concerns—evidence shows no increased risk 3, 1, 2
• Counsel extensively about expected bleeding changes before insertion, especially for levonorgestrel IUD users who may experience initial spotting 4, 6
• Do not use combined estrogen-progestin contraceptives in patients with antiphospholipid antibodies or thrombotic risk—both IUDs are strongly recommended instead 3
• For copper IUD users with persistent heavy bleeding, consider switching to levonorgestrel IUD rather than removing contraception entirely 3, 2