Apri vs. Mirena

See how Apri and Mirena compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Apri is a pill you take every day, while Mirena is a T-shaped device a clinician inserts that works for up to 8 years.

  • Both prevent pregnancy, but Mirena is also FDA-approved to treat heavy menstrual bleeding for up to 5 years.

  • Apri carries added cardiovascular risks for smokers over 35, while Mirena's main procedural risks come from insertion itself.

Apri vs. Mirena Drug Summary

Apri

Apri is a combination oral contraceptive containing desogestrel and ethinyl estradiol, hormones that prevent pregnancy mainly by stopping ovulation. It comes in a 28-day pack with 21 active tablets and 7 inert ones, taken once daily at the same time. Apri is approved only to prevent pregnancy, not to treat any other condition.

Mirena

Mirena is a T-shaped intrauterine device that releases levonorgestrel, a progestin, directly into the uterus to prevent pregnancy. A clinician inserts it once, and it can stay in place for up to 8 years as the hormone release tapers over time. Mirena is also FDA-approved to treat heavy menstrual bleeding for up to 5 years in women using it for contraception.

Apri vs. Mirena Side Effects

Apri

Most common
Headache (rate not quantified in labeling)
Nausea (rate not quantified in labeling)
Breakthrough bleeding/spotting (rate not quantified in labeling)
Breast tenderness (rate not quantified in labeling)

Mirena

Most common
Unscheduled (irregular) uterine bleeding (up to 31.9%)
Abdominal/pelvic pain (up to 22.6%)
Amenorrhea (up to 18.4%)
Headache/migraine (up to 16.3%)

Apri vs. Mirena Dosage

Apri

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 tablet once daily Days 1-28
Maximum dose 1 tablet once daily Same as starting
Dose changes None Fixed dose

Mirena

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose ~21 mcg/day LNG release Day 24
Maximum dose ~7 mcg/day LNG release If needed
Dose changes 2 increases As tolerated

Apri vs. Mirena Indications

Apri

Apri is FDA-approved solely to prevent pregnancy in women who choose oral contraception. It works by combining estrogen and progestin to suppress ovulation and thicken cervical mucus. It is not approved to treat any gynecologic condition or to prevent sexually transmitted infections.

  • Prevents pregnancy when taken daily

  • Not approved for STI or HIV prevention

  • Can be stopped at any time without a procedure

  • Requires consistent daily timing for full effectiveness

Mirena

Mirena is FDA-approved to prevent pregnancy for up to 8 years and to treat heavy menstrual bleeding for up to 5 years in women using it for contraception. It releases a steady, low dose of levonorgestrel directly into the uterus. It is not approved for emergency contraception after unprotected sex.

  • Prevents pregnancy for up to 8 years

  • Treats heavy menstrual bleeding for up to 5 years

  • Not approved as emergency contraception

  • Requires in-office placement and removal by a clinician

Apri vs. Mirena Pros and Cons

Apri

Apri offers a well-established, low-cost option for daily pregnancy prevention that a woman controls herself without a clinical procedure. Its desogestrel progestin has minimal androgenic activity, which can mean fewer acne or hair-growth side effects than some other pills. Generic availability keeps it widely accessible at pharmacies.

Pros

  • Costs $30 to $99 per month with no upfront device fee

  • Generic desogestrel/ethinyl estradiol widely available

  • Can be started or stopped without a clinical procedure

  • Desogestrel progestin has minimal androgenic side effects

Cons

  • Requires taking a pill at the same time every day

  • Contraindicated for smokers over 35 due to clot risk

  • Carries increased risk of blood clots and stroke

  • Effectiveness drops significantly with missed doses

Mirena

Mirena offers long-acting, low-maintenance pregnancy prevention that does not depend on remembering a daily pill, plus it treats heavy periods for up to 5 years. It requires an in-office insertion and removal, and there is no generic version to lower the price. Because it is a one-time device, the upfront cost is much higher than a monthly pill.

Pros

  • Works for up to 8 years without any daily action

  • Also FDA-approved to treat heavy menstrual bleeding

  • No daily adherence needed once it's placed

  • Hormone levels stay low since it acts locally in the uterus

Cons

  • One-time device cost of $900 to $1,725 before insurance

  • Requires a clinician visit for insertion and removal

  • Contraindicated with certain uterine abnormalities or infections

  • Small risk of uterine perforation or device expulsion

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