Copper IUD or Hormonal Coil: Which to Choose? | HAP.GENT
Copper IUD or hormonal coil: which is right for you?
A coil provides reliable contraception for years, without having to remember a pill every day. But should you choose a copper IUD or a hormonal coil? Both offer very effective protection against pregnancy. The main difference is often your period: copper can make bleeding heavier, while a hormonal coil usually makes it lighter.
Copper IUD: contraception without hormones
A copper IUD releases copper ions that interfere with sperm function and prevent fertilisation. It contains no hormones, which may appeal to you if you specifically want hormone-free contraception.
The main drawback is that periods can become heavier, longer or more painful, particularly during the first few months. If you already have heavy periods or significant period pain, this matters when choosing. A copper IUD is hormone-free, but it can still cause side effects. [1]
Depending on the model, a copper IUD usually works for five to ten years. It provides protection immediately after insertion and can also be fitted as emergency contraception within five days of unprotected sex. Contact a doctor as soon as possible if you need this. The replacement date depends on the specific device. [1,2]
Hormonal coil: usually lighter periods
A hormonal coil releases levonorgestrel, a progestogen. It thickens the mucus in the cervix, making it harder for sperm to pass through, and keeps the lining of the womb thin. Periods therefore usually become lighter, and cramps may improve. [1]
A hormonal coil provides immediate protection when inserted within the first seven days after your period starts. If it is inserted at another time, use additional contraception, such as condoms, or avoid vaginal intercourse for the first seven days. Different advice may apply when replacing an existing coil or switching from another contraceptive method; your doctor will explain what applies to you. [6]
Irregular bleeding and spotting between periods are common during the first three to six months. Bleeding usually becomes lighter afterwards. Sometimes periods stop altogether. With a hormonal coil, this is not harmful in itself. [1,3]
Acne, headaches, breast tenderness and mood changes have been reported. It is not always clear whether the coil causes an individual symptom. Discuss persistent or troublesome symptoms with your doctor. [3]
Hormonal coils are not all the same. The following durations of use currently apply for contraception in Belgium:
Mirena and Levosert: eight years.
Kyleena: five years.
Jaydess: three years.
Devices containing 52 mg of levonorgestrel, such as Mirena and Levosert, are also used to treat heavy menstrual bleeding. The duration of use for this purpose differs from the duration for contraception. [4]
The differences at a glance
Copper IUD
Hormones: none.
Effectiveness: more than 99%.
When protection starts: immediately after insertion.
Periods: may become heavier and more painful.
First few months: increased bleeding or cramps are possible.
Duration: usually five to ten years, depending on the model.
Worth considering if: you want hormone-free contraception.
After removal: fertility returns quickly.
Hormonal coil
Hormones: levonorgestrel.
Effectiveness: more than 99%.
When protection starts: immediately when inserted within the first seven days after your period starts; otherwise, seven days of additional protection are needed.
Periods: usually become lighter and may stop altogether.
First few months: irregular bleeding and spotting are possible.
Duration: three, five or eight years, depending on the brand.
Worth considering if: you want lighter periods.
After removal: fertility returns quickly.
Sources: [1–4,6].
Which option suits you?
If your periods are light and not particularly painful, and you want to avoid hormones, a copper IUD may suit you. If your periods are heavy or painful, a hormonal coil often offers more benefits. If having a monthly period matters to you, discuss the possibility that your periods may stop with a hormonal coil.
Your medical history also matters. If you have breast cancer or have had it in the past, hormonal contraception requires an individual assessment. Unexplained vaginal bleeding, an active pelvic infection or abnormalities of the womb may also need investigation first. [5]
A copper IUD should not be used if you have a known copper allergy and is not recommended if you have Wilson’s disease, a rare disorder affecting how the body handles copper. Tell your doctor about these conditions before choosing or having a coil fitted. [7]
Insertion and possible problems
Insertion can be painful with either type of coil. Discuss pain relief options beforehand. Possible complications include the device coming out, infection shortly after insertion, or damage to the wall of the womb. Neither type protects against sexually transmitted infections. [1]
Seek prompt medical advice if you develop worsening lower abdominal pain, fever, unpleasant-smelling discharge or very heavy bleeding. If you have a positive pregnancy test while using a coil, contact a doctor the same day: an ectopic pregnancy must be ruled out. Pregnancy with a coil is very rare, but if pregnancy does occur, it is relatively more likely to be outside the womb. [3,6]
If you can suddenly no longer feel the threads, or they feel different, use additional contraception until you have received medical advice. Emergency contraception may be needed if you have had unprotected sex. [3]
Advice and ultrasound coil checks at HAP.GENT
At HAP.GENT, we discuss which coil best suits your preferences, menstrual pattern and medical history. We also offer ultrasound checks of both copper IUDs and hormonal coils.
We start with an abdominal ultrasound, moving a probe over your lower abdomen. Please arrive with a full bladder: drink approximately half a litre to one litre of water about an hour before your appointment, and do not pass urine afterwards. If you have been advised to restrict your fluid intake, contact us beforehand to discuss preparation.
If the womb and coil are not clearly visible—for example, when the womb tilts backwards—we can complete the examination with a transvaginal ultrasound, with your consent. You can empty your bladder before this part of the examination. [8]
When booking, please mention that you would like advice about choosing a coil or an ultrasound coil check.
Sources
WHO — Intrauterine devices, 22 January 2026.
NHS — Side effects and risks of a hormonal coil.
BCFI — Intrauterine contraceptives, Belgian medicines reference.
NHS — Who can get a hormonal coil?.
CDC — Intrauterine contraception.
FSRH — Guideline on intrauterine contraception.
Cambridge University Hospitals — Ultrasound scan of the pelvis.