What brand‑name levonorgestrel‑releasing intrauterine devices (IUDs) are available?

Brand-Name Levonorgestrel-Releasing IUDs Available in the United States

There are currently three FDA-approved brand-name levonorgestrel-releasing IUDs available in the United States: Mirena (52 mg), Liletta (52 mg), and Skyla (13.5 mg). 1

Specific Products and Characteristics

Mirena (52 mg levonorgestrel)

• Releases 20 micrograms of levonorgestrel per 24 hours 2, 1
• FDA-approved for 5 years, but clinically effective for up to 7 years 1, 3
• Most extensively studied levonorgestrel IUD with over 10,000 women-years of follow-up data 4
• Pearl pregnancy rate of 0.09 per 100 woman-years 5, 6

Liletta (52 mg levonorgestrel)

• FDA-approved for 3 years of use 1
• Contains the same 52 mg levonorgestrel reservoir as Mirena 1
• Releases levonorgestrel at a similar rate to Mirena 1

Skyla (13.5 mg levonorgestrel)

• Releases 14 micrograms of levonorgestrel per 24 hours 7
• FDA-approved for 3 years of use 1
• Lower-dose option that became available in 2013 2
• May offer advantages due to lower hormonal absorption, though efficacy for heavy menstrual bleeding has not been established like the 20 mcg/day devices 2

Clinical Considerations

Contraceptive Efficacy

• All levonorgestrel IUDs have failure rates of less than 1% with both typical and perfect use 1
• The contraceptive mechanism works by preventing fertilization through inhibiting sperm motility and thickening cervical mucus, occurring before implantation 1

Therapeutic Benefits Beyond Contraception

• The 20 mcg/day levonorgestrel devices (Mirena) achieve 71-95% reduction in menstrual blood loss 2, 8
• The American College of Radiology recommends Mirena as first-line medical management for heavy menstrual bleeding 3
• Many women experience lighter periods or amenorrhea with use 1
• Only the 20 mcg/day device (Mirena) has been evaluated and proven effective for treatment of abnormal uterine bleeding 2

Important Safety Profile

• Rapid return to fertility after removal 1, 3
• Safe for nulliparous adolescents and does not cause tubal infertility 1, 3
• Small risk of pelvic infection only during first 20-21 days after insertion 1, 3

Common Pitfall to Avoid

Do not assume all levonorgestrel IUDs are equivalent for treating heavy menstrual bleeding. Only the 20 mcg/day devices (Mirena and potentially Liletta) have established efficacy for menorrhagia treatment, while Skyla's lower dose has not been studied for this indication 2. When prescribing specifically for heavy bleeding rather than contraception alone, choose Mirena given its extensive evidence base 2, 3, 8.