Kyleena Vs Mirena Vs Nexplanon: IUD Vs Implant

Kyleena and Mirena are IUDs (intrauterine devices) while Nexplanon is a subdermal implant. In this post, we compare these contraceptive devices: Kyleena vs Mirena vs Nexplanon.

Kyleena, Mirena, and Nexplanon are all progesterone-containing contraceptive devices.

Because progesterone is better tolerated compared to estrogen, these devices are relatively safer in women with the following diseases:

• Thromboembolic disorders:

All contraceptives can cause clots and are contraindicated in women with a thromboembolic disorder or a history of a thromboembolic disorder, however, progestin-containing contraceptives are generally regarded as slightly safer than estrogen-containing contraceptives.

• Migraine with Aura:

In women with migraine with or without aura, estrogen-containing contraceptives should be avoided at all costs.

Progesterone-containing contraceptives may be used in women with migraine, although with caution.

• Cardiovascular conditions:

Estrogen-containing contraceptives should be avoided in women with heart failure. Progesterone-containing contraceptives are relatively safer alternative options.

• Use during breastfeeding:

Lactating women are usually advised progesterone-containing contraceptives as they do not inhibit milk production.

• Continuous vs Interrupted use:

Women on estrogen-containing contraceptives are advised to take a break of 5 to 7 days every month so as to allow shedding of the uterine wall as occurs during the normal menstrual cycles.

Progesterone contraceptives do not result in thickening of the uterine wall and may be used continuously for a longer duration without interruptions.

Basic Differences Between Kyleena Vs Mirena Vs Nexplanon:

Mirena and Kyleena contain Levonorgestrel, however, their dosages are different. Mirena contains Levonorgestrel in high doses compared to Kyleena IUD.

Mirena has a total of 52 mg of Levonorgestrel that is released slowly at 20 ug per day.

Kyleena has 19.5 mg of Levonorgestrel which is released at 17.5 ug per day. The rate of Levonorgestrel release reduces to 9.8 mcg after one year and 7.4 ug/day after 3 years.

Mirena is a little bigger in size with long horizontal arms compared to Kyleena which is smaller and has smaller arms.

Nexplanon implant, on the other hand, contains Etonogestrel which is a more advanced form of progesterone.

Nexplanon has a total of 68 mg of Etonorgestrel which is released slowly over a period of 5 years.

All three devices prevent pregnancy effectively by thickening the cervical mucus and blocking the entry of the sperm to interact with the ova. Nexplanon also inhibits ovulation. 

All three devices have to be inserted or implanted by an experienced healthcare provider.

Kyleena can be distinguished from Mirena on ultrasound. It has a silver lining and has a blue thread.

Kyleena Vs Mirena Vs Nexplanon: Comparing Contraceptive efficacies:

All LARC (long-acting reversible contraceptive) implants are highly effective in preventing pregnancy.

They are the second most commonly used choice of contraception. While oral contraceptive pills are effective in preventing pregnancy, the chances of unplanned pregnancy with oral contraceptives is 8 in 100.

The chances of unplanned pregnancy with subdermal implants and intrauterine devices are about 1 in 400.

As per the manufacturer’s labeling, the estimated pregnancy rates for each of the three LARC devices are given in the table below:

All three implants/ devices are pretty effective. The 5-year pregnancy rate with Kyleena is slightly higher because the dose of levonorgestrel used in Kyleena is less than Mirena.

Kyleena may be preferred in young and lean women who may require a small dose of Levonorgestrel.

Mirena may be used in healthy and overweight women as it releases a higher dose of Levonorgestrel.

Kyleena Vs Mirena Vs Nexplanon: Comparison of effects on Periods:

All the hormonal contraceptives including Mirena and Kyleen intrauterine devices as well as the subdermal implant, Nexplanon affect the flow and duration of menstrual bleeding.

A significant number of individuals develop amenorrhea or complete absence of periods with all three devices as given in the table below:

About 33.6% of the women who used Nexplanon had infrequent bleeding. Infrequent bleeding at one year with Kyleena was observed in 26% of women.

All contraceptive devices alter the flow and duration of periods. Women usually have thin periods which are irregular for about 6 months.

Some women totally stop bleeding after one year. However, heavy bleeding may occur during the first few months in a small percentage of women.

Comparing Contraindications: Kyleena Vs Mirena Vs Nexplanon:

All three contraceptive devices are contraindicated in women who are pregnant, have hormone-sensitive cancers including breast and liver cancer, active thromboembolic disorders, and have uterine bleeding of undetermined cause.

The intrauterine devices, Mirena and Kyleena are also contraindicated in women with uterine infections, endometritis, pelvic inflammatory diseases, and women with cervical or uterine cancers. 

Side effects of Kyleena vs Mirena vs Nexplanon:

• Local Side Effects:

Pelvic infections, Endometritis, Sepsis, and Ectopic pregnancy are common in women using the IUDs, Mirena or Kyleena. They are less common in women using the intradermal implant, Nexplanon.

• Irregularities in periods:

Irregularities in periods can occur with all hormonal contraceptives. They may be more common in women using Mirena or Kyleena than those using Nexplanon to prevent pregnancy.

• Breast tenderness and size:

All hormonal contraceptives are contraindicated in women with breast cancer. Changes in breast size, nipple discharge, and tenderness may develop with any of the long-acting contraceptive devices.

• Weight gain:

Weight gain is a side effect of all hormonal contraceptives. Weight gain of a few pounds can occur. 

Weight gain can be rapid as the placement of a contraceptive device can result in fluid retention.

However, with time, true weight gain occurs because of the excess fat deposition in the hips, thighs, breasts, and even tummy.

Women who have had Nexplanon implants had a weight gain of 2.8 pounds after one year and 3.7 pounds after 2 years.

• Liver and gallbladder disease:

Hormonal contraceptives should be avoided in women with advanced liver disease. In women with normal liver function at baseline, there is an increased risk of liver and gallbladder disease.

• Fluid retention:

Fluid retention is a side effect of all hormonal contraceptives. It can worsen symptoms of heart failure if used by women with cardiovascular diseases.

In conclusion:

The comparison of contraceptive devices Kyleena, Mirena, and Nexplanon highlights their unique features and suitability for different individuals.

Progestin-containing contraceptives offer advantages in terms of safety for specific medical conditions and flexibility in menstrual management.

The choice between these devices depends on factors like hormone dosage, duration of effectiveness, and individual health considerations.

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