The types of<unk> s available, and the names they go by, differ by location. In the United States, there are two types available: * Nonhormonal: Copper-containing<unk>  (ParaGard and others) * Hormonal: Progestogen-releasing<unk>  (Mirena and others) The WHO ATC labels both copper and hormonal<unk> s as<unk> s. In the United Kingdom, there are more than 10 different types of copper<unk> s available. In the United Kingdom, the term<unk>  refers only to these copper<unk> s. Hormonal<unk>  contraception is labeled with the term<unk>  system (IUS). + Copper Mirena Skyla Liletta Kyleena Hormone (total in<unk>  None 52 mg levonorgestrel 13.5 mg levonorgestrel 52 mg levonorgestrel 19.5 mg levonorgestrel Initial amount released None 20 μg/day 14 μg/day 18.6 μg/day 16 μg/day Approved effectiveness 10 years (12 years) 5 years (10 years) 3 years 3 years (5 years) 5 years Mechanism of action Copper toxic to sperm -Levonorgestrel thickens cervical mucus to prevent sperm from reaching egg -Prevents ovulation at times Advantages among<unk> s -No hormones -Emergency contraception -Various hormone level options -Lighter periods after 3 months; some users experience amenorrhea Disadvantages among<unk> s Heavier menstrual flow and cramps Ovarian cysts (although they can be asymptomatic) Non-hormonal Copper A copper T-shaped<unk>  with removal strings An<unk>  as seen on pelvic X ray Most copper<unk> s have a T-shaped frame that is wound around with pure electrolytic copper wire and/or has copper collars (sleeves). The arms of the frame hold the<unk>  in place near the top of the uterus. The Paragard TCu 380a measures 32 mm (1.26") horizontally (top of the T), and 36 mm (1.42") vertically (leg of the T). Copper<unk> s have a first year failure rate ranging from 0.1 to 2.2%. They work by damaging sperm and disrupting their motility so that they are not able to join an egg. Specifically, copper acts as a spermicide within the uterus by increasing levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids. The increased copper ions in the cervical mucus inhibit the sperm's motility and viability, preventing sperm from traveling through the cervical mucus, or destroying it as it passes through. Copper can also alter the endometrial lining, but studies show that while this alteration can prevent implantation of a fertilized egg ("blastocyst"), it cannot disrupt one that has already been implanted. Advantages of the copper<unk>  include its ability to provide emergency contraception up to five days after unprotected sex. It is the most effective form of emergency contraception available. It works by preventing fertilization or implantation but does not affect already implanted embryos. It contains no hormones, so it can be used while breastfeeding, and fertility returns quickly after removal. Copper<unk> s also last longer and are available in a wider range of sizes and shapes compared to hormonal<unk> s. Disadvantages include the possibility of heavier menstrual periods and more painful cramps.<unk> s that contain gold or silver also exist. Other shapes of<unk>  include the so-called U-shaped<unk> s, such as the Load and Multiload, and the frameless<unk>  that holds several hollow cylindrical minuscule copper beads. It is held in place by a suture (knot) to the fundus of the uterus. It is mainly available in China and Europe. A framed copper<unk>  called the IUB SCu300 coils when deployed and forms a three-dimensional spherical shape. It is based on a nickel titanium shape memory alloy core. In addition to copper, noble metal and progestogen<unk> s; people in China can get copper<unk> s with indomethacin. This non-hormonal compound reduces the severity of menstrual bleeding, and these coils are popular. Inert Inert<unk> s do not have a bioactive component. They are made of inert materials like stainless steel (such as the stainless steel ring (SSR), a flexible ring of steel coils that can deform to be inserted through the cervix) or plastic (such as the Lippes Loop, which can be inserted through the cervix in a cannula and takes a trapezoidal shape within the uterus). They are less effective than copper or hormonal<unk> s, with a side effect profile similar to copper<unk> s. Their primary mechanism of action is inducing a local foreign body reaction, which makes the uterine environment hostile both to sperm and to implantation of an embryo. They may have higher rates of preventing pregnancy after fertilization, instead of before fertilization, compared to copper or hormonal<unk> s. Inert<unk> s are not yet approved for use in the United States, UK, or Canada. In China, where<unk> s are the most common form of contraception, copper<unk>  production replaced inert<unk>  production in 1993. However, as of 2008, the most common<unk>  used by immigrants presenting to Canadian clinics for removal of<unk> s placed in China was still the SSR. Because the SSR has no string for removal, it can present a challenge to healthcare providers unfamiliar with<unk>  types not available in their region. Hormonal Hormonal<unk>  (Mirena) Hormonal<unk> s (referred to as<unk>  systems in the UK) work by releasing a small amount of levonorgestrel, a progestin. Each type varies in size, amount of levonorgestrel released, and duration. The primary mechanism of action is making the inside of the uterus uninhabitable for sperm.The contraceptive action of all<unk> s is mainly in the<unk>  cavity. Ovulation is not affected, and the<unk>  is not an abortifacient.58–60 It is currently believed that the mechanism of action for<unk> s is the production of an<unk>  environment that is spermicidal.Nonmedicated<unk> s depend for contraception on the general reaction of the uterus to a foreign body. It is believed that this reaction, a sterile inflammatory response, produces tissue injury of a minor degree but sufficient to be spermicidal. Very few, if any, sperm reach the ovum in the fallopian tube.The progestin-releasing<unk>  adds the endometrial action of the progestin to the foreign body reaction. The endometrium becomes decidualized with atrophy of the glands.65 The progestin<unk>  probably has two mechanisms of action: inhibition of implantation and inhibition of sperm capacitation, penetration, and survival. They can also thin the endometrial lining and potentially impair implantation but this is not their usual function. Because they thin the endometrial lining, they can also reduce or even prevent menstrual bleeding. As a result, they are used to treat menorrhagia (heavy menses), once pathologic causes of menorrhagia (such as uterine polyps) have been ruled out. The progestin released by hormonal<unk> s primarily acts locally; use of Mirena results in much lower systemic progestin levels than other very-low-dose progestogen only contraceptives.
Intrauterine device
Contraceptive implant
Male contraceptive
Fertility medication
Injectable birth control
Oral contraceptive pill
Combined hormonal contraception
Spermicide