Hormonal or Copper IUD: How to decide

Long Acting, Reversible Contraception (LARC) is a convenient and effective contraceptive option for many women. However, it can be difficult to decide which option is the most suitable for you. Especially when it comes to deciding between the Hormonal and the Copper IUD. So we’ve put together some information on both of them to help you break it down. And don’t worry; if you can’t be bothered reading there’s a handy infographic at the end. 


Like most LARC methods, IUDs are incredibly effective. It is important to note, however, that there is a very slight difference between the two.

The Copper IUD has an efficacy rate of 99.2% with typical use. This means that for every 1000 people, there will be 8 that have an unintended pregnancy. Typical use refers to how most people use it, whilst perfect use refers to how effective the method is when used exactly as intended.

By contrast, the Hormonal IUD has an efficacy rate of 99.8% in both typical and perfect use, which means it will only fail 2 people in every 1000.

This is a very, very small difference. But if you know you’re exceptionally fertile, or especially worried about unplanned pregnancy, it could be a deciding factor.


The choice around whether or not to rely on hormones for contraception can be a fraught issue for many people. Hormones can affect people in a wide variety of different ways. This means it’s important to know what you’re putting into your body.

The Copper IUD doesn’t contain any hormones at all and works by using the properties of copper to affect sperm motility and egg survival.

The Hormonal IUD, by comparison, contains a small amount of progestogen that is released directly into your reproductive system. Usually, only trace amounts of hormones make it into your bloodstream. These hormones cause the mucus of the cervix to thicken, which prevents the sperm from entering the uterus to fertilise the egg. 

The Hormonal IUD releases much smaller hormonal doses than the oral contraceptive pill, or the progestogen-only Mini Pill. You can check out our explanation of hormone levels in contraception here.

Side Effects

As with any form of medication or medical procedure, there are always potential side effects. The Hormonal and Copper IUD may both have fewer or simply different side effects to other forms of contraception. But it’s important to know what those are before making your decision.

The Hormonal IUD contains enough progestogen to reduce period pain and bleeding; however, the first 3 to 6 months can include sporadic spotting and bleeding. It’s possible that the Hormonal IUD might cause your period to stop altogether (it does this for around 20% of users). Because of the hormones in it, it’s possible it may cause side effects, like acne. These are uncommon and usually settle after the first 6 months.

The Copper IUD doesn’t contain hormones, therefore, doesn’t run the risk of acne or other hormonal side effects. It is known to sometimes increase bleeding and discomfort with your periods though. 

Both IUD types run a small risk of moving, being expelled and/or perforating the uterus, however, these are rare instances. Expulsion is most common in the first year, at a rate of around 5%, while perforation is currently estimated to occur in 1 of every 500 cases [Contraception: An Australian Clinical Practice handbook. 4th Edition]. 

Cost and Duration

It’s unlikely that your decision is going to be based on budget alone. But if all other factors are equal, it might be the thing that makes up your mind.

A Hormonal IUD lasts for 5 years and starts at around $240 with a Medicare rebate (includes the device and insertion).

A Copper IUD can last up to 10 years and starts at around $280 with a Medicare rebate (includes the device and insertion).

Comparatively, this means the 10-year Copper IUD costs about $28 a year, across its lifespan, whilst the Hormonal IUD comes in a little dearer at $48 a year.


Now that you have all the facts, you’re in a better position than ever to make a decision! Feel free to use the infographic below as a reference for discussions with your GP or partner.