The question of which IUD is best has no general answer, and that is not a dodge. The four devices commonly used in the Netherlands differ mainly in one thing: what they do to your period. Want lighter bleeding or none, and a hormonal IUD comes into view. Want no hormones, and the copper IUD is the only option, usually at the price of a heavier period.
Everything below that, meaning size, lifespan and how much levonorgestrel it carries, is a matter of matching the device to your situation. Here they are side by side.
The four devices side by side
| Device | Hormone | Lasts | Bleeding after a year | Often chosen for |
|---|---|---|---|---|
| Hormonal IUD 52 mg | 52 mg levonorgestrel | up to 8 years | Usually much lighter, sometimes absent | Heavy menstrual bleeding |
| Hormonal IUD 19.5 mg | 19.5 mg levonorgestrel | up to 5 years | Lighter, a period more often remains | Narrower cervix, no previous births |
| Hormonal IUD 13.5 mg | 13.5 mg levonorgestrel | up to 3 years | Slightly lighter | Lowest hormone dose wanted |
| Copper IUD | None | 5 to 10 years | Often heavier and longer | Preference for hormone-free |
Doses come from the patient leaflets and the Dutch Farmacotherapeutisch Kompas. Brand names vary by country and pharmacy, so the dose is a more reliable handle than the name.
Why that hormone dose matters less than you think
An IUD with 52 mg of levonorgestrel holds nearly four times the hormone of a 13.5 mg one. Yet the difference in what reaches your bloodstream is far smaller than that ratio suggests, because the drug works mainly locally in the uterus.
The difference you do notice is in your bleeding. The higher the dose, the more strongly the uterine lining stays thin, and the greater the chance your period becomes very light or stops. So choosing the lowest dose to escape heavy bleeding rarely delivers.
When is a copper IUD the better choice?
The copper IUD is the only hormone-free option with this reliability. That makes it logical if you responded badly to earlier hormonal contraception, if you want to avoid hormones for medical reasons, or simply if you want to keep your own cycle.
The price you usually pay is a heavier and sometimes longer period, especially in the first year. For most women that eases afterwards. If your bleeding was already substantial, this is the option that may enlarge the problem rather than shrink it.
The question that gets forgotten: what does this do to your iron?
This is the side of the decision that rarely appears on a comparison page. Menstrual blood loss is the leading cause of iron deficiency in women of reproductive age, and the two IUD types push it in opposite directions.
| Choice | Effect on blood loss | What that does to your iron stores |
|---|---|---|
| Hormonal IUD 52 mg | Usually much less | Ferritin can rise over the following years |
| Copper IUD | Often more, certainly year one | Ferritin can fall further |
Ferritin is your iron store and falls before your haemoglobin does, so you can build a deficiency while a standard anaemia test still reads normal. Anyone considering a copper IUD who is already tired gains more from an iron deficiency test beforehand than from one afterwards. The iron values reference table shows which numbers belong where.
How do you actually choose?
In practice it comes down to three questions, in this order. Do you want hormones or not. Do you want your period lighter, or do you want to keep it. And how many years do you want to stop thinking about it.
Answer those three and usually only one or two options remain. The rest is a conversation with your GP about your history. Also read hormonal IUD side effects and copper IUD experiences for what to expect per type in the first year.
Frequently asked questions
Which hormone is in the hormonal IUD?
Levonorgestrel, a progestogen. There is no oestrogen in it, which is why a hormonal IUD also suits women who cannot use oestrogen.
How long does a hormonal IUD last?
Three to eight years depending on the dose. The highest dose has the longest lifespan.
Is an IUD safe if you have not had children?
Yes, that is no longer a barrier. A smaller model is sometimes chosen for a narrower cervix, because placement is then more comfortable.
Can you get pregnant with an IUD?
It rarely happens. All IUDs sit among the most reliable forms of contraception, precisely because no daily action is involved.
References
- NHG-Standaard Anticonceptie, Dutch College of General Practitioners
- Farmacotherapeutisch Kompas, levonorgestrel-IUD and copper-IUD monographs
- Thuisarts.nl, information on the IUD
- World Health Organization, Medical Eligibility Criteria for Contraceptive Use
- Cochrane Database of Systematic Reviews, reviews on intrauterine contraception
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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Lunarahealth
Dr. Naimi, BIG-registered physician, oversees the medical standards behind our content and assessments. Read our medical policy
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