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Skyla vs mirena weight gain: Differences, similarities, and which is better for you

by alexxlab

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Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Skyla and Mirena are intrauterine systems used for contraception. These devices are placed in the female uterus to help prevent pregnancy. They are commonly referred to as IUDs (intrauterine devices). Hormonal IUDs are just one type of contraceptive method. Other forms of birth control include barrier methods (male and female condoms), oral contraceptive pills (OCPs or birth control pills), and spermicides. 

IUDs have an interesting history. Dating back to 1909, the first IUDs were very crude. Various formulations of the early devices did not have persistent use due to their association with infection risk, ectopic pregnancy, infertility, and early hysterectomy. Prior to Mirena and Skyla, Paragard was the most common IUD on the market. Mirena came to market in the year 2000 as the first of its shape and kind. Skyla followed in 2013. Both release the contraceptive hormone, levonorgestrel (LNG), though in different amounts. This is why they are referred to as hormonal IUDs. There are non-hormonal IUDs that do not release any hormones such as the copper IUD. There are also other hormonal IUDs on the market such as Kyleena and Liletta. Skyla and Mirena are good hormonal birth control options for patients who are looking for estrogen-free, long-acting birth control.

There are many differences and similarities between Mirena and Skyla detailed below.

What are the main differences between Skyla vs. Mirena

Skyla (levonorgestrel) is a contraceptive method available by prescription only. It is an intrauterine device containing 13.5 mg of levonorgestrel. Once inserted into the uterus, it begins releasing at a rate of 14 mcg/ day for the first 24 days. By one year, the release rate slows to 6 mcg/day. By year three, the rate typically slows to 5 mcg/day. Skyla should be replaced at the end of the third year. Skyla should only be placed by trained healthcare providers. There are multiple mechanisms by which Skyla prevents pregnancy. First, it causes a thickening of the cervical mucus which inhibits sperm passage to the cervix. It also inhibits sperm motility and function. Finally, this method of birth control alters the endometrium (the lining of the uterus). 

Mirena (levonorgestrel) is also a contraceptive device only available by prescription and can be used to prevent pregnancy for up to five years. Mirena also carries an additional approval by the Food and Drug Administration (FDA) to be used to slow heavy menstrual bleeding (menstrual periods). When used for this purpose, it can remain inserted for up to seven years. Like Skyla, it should only be inserted by a trained healthcare professional. 

Mirena contains 52 mg of levonorgestrel in each device. Initially, Mirena releases 20 mcg a day for approximately three months. From there it declines to 18 mcg/day after one year, 10 mcg/day after five years, and 8 mcg/day after seven years. It should be removed and replaced after five years for pregnancy prevention, or removed and replaced after seven years if utilized to slow heavy menstrual bleeding. Skyla and Mirena share common mechanisms of action.

Conditions treated by Skyla and Mirena

Skyla and Mirena are each a type of intrauterine system used to prevent pregnancy. Mirena also has an approved indication to be used to slow heavy menstrual bleeding. Mirena has been used off-label for endometriosis patients to ease symptoms. 

It is important to note that while most emergency contraceptive pills are also composed of levonorgestrel, IUDs are not to be used as a type of emergency contraception. 

Is Skyla or Mirena more effective?

Skyla and Mirena were studied in thousands of subjects in clinical trials prior to coming to market. The manufacturers of Skyla report a 0.9% pregnancy rate and therefore a 99.1% success rate of preventing pregnancy when used as intended. The manufacturers of Mirena report a 0. 7% pregnancy rate and therefore a 99.3% success rate of preventing pregnancy.

When considering Mirena to treat menorrhagia, there are comparisons of it to hysterectomy or endometrial ablation. One systematic review suggests that satisfaction overall is higher with hysterectomy. However, Mirena is more cost-effective than either option, and may be a good first choice when considering the other methods are much more invasive. 

This is not intended to be medical advice. Only your doctor can help you decide what is best for you.

Coverage and cost comparison of Skyla vs. Mirena

Skyla is a prescription-only device that is typically not covered by Medicare. It is covered by some commercial plans. Commercial plans must have at least one type of hormonal IUD in their coverage formulary, though which one they choose may vary. The average retail price for Skyla is about $1322. A free SingleCare coupon can lower the cost to approximately $872.

Mirena is also a prescription-only device that is typically not covered by Medicare. It is covered by some commercial plans. The out-of-pocket cost for Mirena is about $1300. A Mirena coupon offered by SingleCare can provide a discounted price of $1043.

Common side effects of Skyla vs. Mirena

The most common possible side effects of both Skyla and Mirena are pain, cramping, and bleeding after placement, changes in menstrual bleeding, missed menstrual cycles, and ovarian cysts. Less common side effects include abdominal pain, acne, headaches, and inflammation of the vaginal area. 

Both Skyla and Mirena can cause rare, serious side effects as well including ectopic pregnancy, pelvic infection, other serious infections, pelvic inflammatory disease (PID), and perforation.

Source: Skyla (DailyMed) Mirena (DailyMed)

Drug interactions of Skyla vs. Mirena

Because the contraceptive effect of hormonal IUDs is mediated by the direct release of levonorgestrel into the uterine cavity, the mechanism is unlikely to be interrupted by drug interactions. Bayer Healthcare Pharmaceuticals, the manufacturer of both Skyla and Mirena, have not done drug-to-drug interaction studies.

Warnings of Skyla and Mirena

Skyla and Mirena both carry a risk of ectopic pregnancy. While the risk is very low, if you suspect you become pregnant while having an IUD in place, you should contact your healthcare provider immediately.

If a woman does become pregnant with an IUD like Skyla or Mirena in place and it isn’t removed immediately, it can lead to sepsis, premature labor, and premature delivery. Unfortunately, there are risks associated with removal including spontaneous abortion.

Cases of Group A Streptococcal sepsis (GAS) have been reported shortly after insertion. This is why aseptic insertion technique by a trained healthcare provider is necessary in order to reduce this risk. GAS can be fatal if not treated quickly.

Women with a history of pelvic inflammatory disease (PID) should not have a hormonal IUD placed unless there has been a case of a successful intrauterine pregnancy.

Perforation or puncturing of the uterus is a risk with Skyla and Mirena. This can lead to migration of the device, perforation of the intestine, and abscesses.

Partial or complete expulsion from the body can occur. If this occurs, the risk of getting pregnant goes up immediately, and not everyone is aware when this happens. This can be confirmed by ultrasound. It should be suspected if you notice an increase in bleeding.

Women with a history of or suspected case of breast cancer should not use any hormonal contraceptives, including hormonal IUDs like Skyla and Mirena. These patients should inquire about birth control options that are hormone-free.

Skyla and Mirena may lead to irregular bleeding or menstrual periods.

 

Skyla and Mirena will not prevent sexually transmitted infections (STIs) or HIV/AIDS transmisson.

Frequently asked questions about Skyla vs. Mirena

What is Skyla?

Skyla (levonorgestrel) is a hormonal intrauterine device contraceptive method available by prescription only. It contains 13.5 mg of levonorgestrel, and is approved to prevent pregnancy for 3 years.

What is Mirena?

Mirena (levonorgestrel) is a hormonal intrauterine device contraceptive method available by prescription only. It contains 52 mg of levonorgestrel, and is approved to prevent pregnancy for 5 years. It can also be placed for the purpose of slowing menstrual bleeding and is approved to be placed for this purpose for 7 years.

Are Skyla and Mirena the same?

Skyla and Mirena are both hormonal IUDs approved for use in preventing pregnancy. They each release the same hormone, levonorgestrel, but the amount of hormones is not the same and is not released over the same period of time.

Is Skyla or Mirena better?

Skyla prevents pregnancy 99.1% of the time with proper placement. Mirena’s success rate is slightly higher at 99.3%.

Can I use Skyla or Mirena while pregnant?

No, you should not have an IUD placed while you are pregnant. Your healthcare provider is required to check your pregnancy status prior to insertion.

Can I use Skyla or Mirena with alcohol?

It is safe to consume alcohol in moderation while you have a hormonal IUD in place. Side effects like nausea may be compounded by alcohol.

Does Skyla have fewer side effects than Mirena?

Skyla and Mirena have similar side effects, though some are more or less common with each choice.

Does Skyla make you gain weight?

Weight gain is not expected with Skyla, and Bayer does not report this as a side effect. There is little to no systemic absorption of the levonorgestrel to cause weight gain.

What are the side effects of Skyla?

The most common side effects of Skyla are bleeding after placement, changes in menstrual bleeding, missed menstrual cycles, and ovarian cysts.

Skyla vs. Mirena: A comparison

Skyla and Mirena are hormonal intrauterine devices (IUDs) that contain progestin levonorgestrel. The main difference between Skyla and Mirena is their implant duration. Mirena can also help treat heavy menstrual bleeding.

People with a Skyla IUD keep the device in place for up to 3 years, whereas those with a Mirena IUD keep it for 5–6 years.

In this article, we look at how they work and compare their effectiveness and potential side effects. We also discuss the insertion and removal processes.

The following table summarizes the main differences between Skyla and Mirena:

PurposeHormoneDosageDuration of useSuccess rate
MirenaContraception.
Treatment for heavy menstrual bleeding.		Progestin levonorgestrel20 mcg daily5–6 years99.3%
SkylaContraception.Progestin levonorgestrel14 mcg daily3 years99.1%

Skyla and Mirena are forms of hormonal IUDs that can help prevent pregnancy.

Skyla

According to the National Library of Medicine (NLM), Skyla is an IUD that contains 13.5 milligrams (mg) of levonorgestrel.

People with this device receive 14 micrograms (mcg) per day of levonorgestrel after 24 days.

After 3 years, the dosage reduces to approximately 4 mcg per day. At this time, people should remove or replace the Skyla device.

The Food and Drug Administration (FDA) approve Skyla to prevent pregnancy for up to 3 years.

Mirena

Similarly to Skyla, Mirena is an IUD that contains levonorgestrel. However, the NLM state that it has 52 mg of levonorgestrel.

Each day, the IUD releases 20 mcg.

After 5 years, the rate lowers to around 10 mcg daily, and after 6 years, it releases 9 mcg per day.

A person can also use Mirena to help treat heavy menstrual bleeding.

Both Skyla and Mirena release levonorgestrel into the uterus.

To prevent pregnancy, levonorgestrel-releasing IUDs:

  • thicken the mucus in the cervix, which prevents the passage of sperm into the uterus
  • cause the lining of the womb to become thinner

In some people, it also prevents ovulation.

Planned Parenthood state that IUDs are more than 99% effective.

Skyla

The NLM say that the pregnancy rate in the 3 years of use was 0.9%, meaning Skyla has a 99.1% success rate.

Mirena

The NLM state that two studies looking at 45,000 females in total found that pregnancy rates after 12 months’ use were less than or equal to 0.2%. Over 5 years, the pregnancy rate was roughly 0.7%. This means that Mirena has a success rate of 99.3%.

Since both IUDs release different amounts of the same hormone, the side effects are similar.

Common side effects include:

  • pain, bleeding, and dizziness during and after the insertion procedure
  • expulsion
  • missed menstrual periods
  • changes in bleeding patterns
  • ovarian cysts

Other potential side effects may include:

  • heavy menstrual bleeding
  • discharge
  • vulvovaginitis
  • breast pain
  • abdominal or pelvic pain
  • headache
  • back pain
  • acne
  • depression

More serious side effects are rare, but may include:

  • ectopic pregnancy
  • intrauterine pregnancy risks
  • pelvic inflammatory disease
  • perforation of the uterine wall
  • infection

According to a 2016 article, a major difference in side effects between Skyla and Mirena is the bleeding pattern.

Both IUDs may trigger unscheduled spotting and bleeding in the first 3–4 months. Loss of period or amenorrhea rates were much lower in people using Skyla compared with Mirena.

When to see a doctor

After insertion of either Mirena or Skyla, people should contact a healthcare provider if they:

  • think they are pregnant
  • have pelvic pain or pain during sex
  • have unusual vaginal discharge or genital sores
  • have unexplained fever, flu-like symptoms, or chills
  • might have a sexually transmitted infection
  • cannot feel the threads from the IUD
  • develop severe or migraine headaches
  • have yellowing of the skin or eyes
  • experience a stroke or heart attack
  • have a partner who tests positive for HIV
  • experience persistent and severe vaginal bleeding

The NLM state that, for both Skyla and Mirena, no drug interaction studies are available.

However, some drugs and herbal products may decrease the concentration of the progestin levonorgestrel hormone. These may include:

  • barbiturates
  • bosentan
  • efavirenz
  • carbamazepine
  • griseofulvin
  • felbamate
  • nevirapine
  • phenytoin
  • oxcarbazepine
  • rifampin
  • rifabutin
  • topiramate
  • St. John’s wort

Any drug or food product that inhibits or induces the metabolism of levonorgestrel may affect the amount of hormone in the blood.

A person can get an IUD from their local Planned Parenthood health center, or they can talk to a nurse or doctor.

Doctors or other healthcare professionals with specialized training may be able to perform insertion procedures for IUDs.

The insertion processes for Skyla and Mirena are similar.

What to expect

To start, the healthcare professional must confirm that the person is not pregnant and has no medical conditions that mean an IUD is unsuitable for them.

Before insertion

The person must position themselves in the lithotomy position, which means sitting with their legs flexed at 90 degrees at the hips. Stirrups help maintain this position.

Next, the medical professional will gently insert the speculum to see and cleanse the cervix.

They will then grasp the upper or lower lip of the cervix with forceps and apply traction to stabilize and align the cervical canal with the uterine cavity.

Before the insertion procedure, the medical professional will:

  • check the cervix
  • measure the depth of the uterine cavity
  • confirm the cavity direction
  • detect any uterine abnormalities

For Mirena IUD insertion, the uterus should measure 6–10 centimeters (cm). Inserting the Mirena into a uterus that measures less than 6 cm may increase the chance of:

  • expulsion
  • bleeding
  • pain
  • perforation
  • pregnancy
During the insertion

Once the doctor completes these first steps, a person is ready for the insertion process.

A doctor will ensure the device is sterile, before loading it into the insertion tube. They will use an inserter to implant and release the device into the correct area of the uterus.

The doctor will then cut the threads that are attached to the IUD to a certain length. Medical professionals will use these threads whenever they remove the device.

Doctors recommend removing and replacing Skyla after 3 years and Mirena after 6 years if people use them to prevent pregnancies. A person who uses Mirena to control menstrual bleeding should remove the IUD after 5 years.

The removal procedure is similar for both Mirena and Skyla.

Using forceps, a trained medical professional will gently pull on the IUD threads. If the medical professional cannot find them, the person may require an ultrasound to scan the pelvis.

How long until a person can become pregnant after removal?

A person can get the Skyla or Mirena removed at any time.

Skyla: A person can become pregnant as soon as a healthcare professional removes Skyla. Approximately 3 in 4 females will become pregnant within the first year of removal.

Mirena: A person can become pregnant as soon as a doctor removes the device. Approximately 8 in 10 females become pregnant within the first year of removal.

According to Planned Parenthood, an IUD can cost a person anywhere between $0–1,300.

However, many health insurance plans, some government programs, and Medicaid may cover the cost, or a portion.

Most Planned Parenthood centers will accept Medicaid and health insurance. Many centers will also charge less depending on a person’s income.

People might use Skyla or Mirena during breastfeeding if they gave birth more than 6 weeks ago.

According to the NLM, there may be small amounts of progestin in the breastmilk. However, there appear to be no reports of adverse effects in breastfed infants.

Researchers also demonstrate that starting an IUD immediately after giving birth is safe and effective, even while nursing.

Skyla and Mirena are IUDs that release levonorgestrel. The main difference between them is how much of the hormone they deliver.

Skyla releases 14 mcg every day while Mirena releases 20 mcg daily.

Each IUD has a different duration of action. People using Skyla should plan to remove and replace the IUD after 3 years if they wish to continue treatment.

People using Mirena should plan to remove and replace the device after 5 or 6 years, depending on its purpose.

We answer 8 questions about the Mirena coil that you were embarrassed to ask

We answer 8 questions about the Mirena coil that you were embarrassed to ask

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  • We answer 8 questions about the Mirena coil that you were embarrassed to ask

Women who want a stable and reliable contraceptive effect without any extra effort often choose intrauterine devices (IUDs). They range from inert constructions that are considered obsolete and practically not used, to modern hormonal coils, such as Mirena.

Mirena is an intrauterine device coated with the hormone levonorgestrel. Unlike metal-containing spirals of the previous generation, which acted due to local inflammation of the cervix, it has a complex contraceptive effect:

● thickens the mucus in the cervical canal, preventing the penetration of spermatozoa;

● stimulates the production of uterine glycoprotein glycodelin A, which starts the process of death of a small part of the spermatozoa that enter the uterus;

● causes changes in the inner layer of the uterine wall to prevent implantation of the egg in those very rare cases when fertilization does take place.

Triple action ensures the high reliability of Mirena for the prevention of unwanted pregnancies. The Pearl Index – the main indicator of the effectiveness of contraception, is 0.1-0.3, which is a very good value, second only to surgical sterilization. Moreover, the effectiveness of contraception is the same for women of different age groups. And that’s not all the benefits: in addition to the contraceptive effect, Mirena has a therapeutic effect in case of heavy menstruation and a number of other pathologies that require hormone therapy.

Thanks to reliable contraception and a beneficial effect on the female body, Mirena deservedly occupies a leading position in the ranking of intrauterine devices used in Russia. However, despite its popularity, many women have questions about the use of Mirena, and patients do not always dare to talk about a sensitive topic with a doctor. Therefore, today we have prepared answers to typical questions that concern women who want to try intrauterine contraception.

№1 — how to prepare for the spiral setting?

It must be understood that any intrauterine devices have a number of contraindications for use. First of all, these are acute gynecological diseases, bleeding from the genital tract, congenital or acquired deformities of the uterus, malignant neoplasms of the genital organs and mammary glands. Therefore, before the procedure, the doctor conducts a standard examination on the gynecological chair and prescribes a number of tests: a cytological smear from the cervix to exclude cancerous and precancerous changes, a smear and blood tests for sexually transmitted infections (STIs).

#2 – how long can the coil be used?

The recommended period for wearing a spiral is 5 years. After this period, the spent IUD is removed from the uterus, and if necessary, it can be replaced with a new spiral to continue contraception. Many patients use intrauterine contraception for many years without any health problems, if you follow the regular visits to the doctor and take into account all contraindications.

№3 – does the coil protect against venereal infections?

No, none of the IUD options provide protection against STIs. The only reliable method of preventing these infections is barrier contraception – male and female condoms, as well as latex wipes during oral sex. Therefore, for women who often change sexual partners, it is recommended to additionally use a condom or choose barrier contraception as the only method.

№4 – does Mirena affect the possibility of getting pregnant in the future?

The spiral does not cause irreversible inhibition of ovarian function, therefore, after its removal, the woman’s reproductive function is restored. In 96% of patients, conception becomes possible in the first 12 months after stopping contraception. It should be borne in mind that a small percentage of women experience complications that can still lead to infertility and miscarriage.

№5 – can Mirena increase the risk of gynecological diseases?

The hormonal coil has fewer adverse reactions than copper-based IUDs, but complications are not excluded. One of the most common are inflammatory and infectious diseases of the genital organs, the risk of which increases with prolonged use of the spiral. Wearing an IUD increases the likelihood of an ectopic pregnancy and, in rare cases, can cause uterine perforation.

However, due to the content of levonorgestrel, the spiral has a number of therapeutic effects:

● reduces the amount of menstrual bleeding in women with polymenorrhea;

● prevents the development of iron deficiency anemia with heavy menstrual bleeding;

● prevents hyperplastic processes in the endometrium in women in late reproductive age and premenopause;

● has a beneficial effect on the course of uterine fibroids, adenomyosis, premenstrual syndrome.

No. 6 – can Mirena fall out?

Any intrauterine device can change its position: fall out into the vagina or move deeper into the uterine cavity. In both cases, Mirena loses its contraceptive effect. In addition, such a complication is fraught with damage and even perforation of the wall of the affected organ.

The reasons for the fallout are:

● small size of the uterine cavity and increased tone of the myometrium, due to which the IUD is pushed into the vagina;

● incorrect installation of the contraceptive and the lack of ultrasound control a week after the procedure;

● incorrect selection of the spiral without taking into account the anatomical features of the female genital tract;

● Intense physical activity.

Displacement of the contraceptive can occur when using large sex toys, traumatic intercourse, inaccurate insertion of a tampon into the vagina. If a woman feels a foreign body in the vagina, notices an elongation of the spiral threads, suffers from pain in the lower abdomen and other symptoms, you should immediately contact a gynecologist who will check the condition of the spiral.

№7 – does Mirena interfere with sex?

The spiral is located inside the uterus, only 2 thin threads enter the vagina, which are needed to control the correct position of the IUD. They are not felt by a woman either in everyday life or during intimacy. A man also cannot feel the threads from the spiral during sexual intercourse, so this type of contraception is considered comfortable for both partners. If discomfort occurs, this indicates a displacement of the spiral.

№8 — what to do if the coil fell out during intercourse?

If sexual intercourse ends with ejaculation, a woman has a small risk of becoming pregnant. This can be avoided by immediately contacting a gynecologist and consulting him about emergency contraception.

And finally, we want to remind you that gynecologists at ID-Clinic receive patients and give online consultations where you can discuss exciting questions about contraception. You can ask our doctors the most delicate questions and be sure that you will receive a detailed and ethical answer, and that all the information you provide will remain confidential. To make an appointment for a consultation, it is enough to leave a request in the online form.

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  • SmirnovaUlyana Sergeevna

    Gynecologist,
    Sexologist