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
Mirena
Apri vs. Mirena Dosage
Apri
Mirena
| 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 |
| 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
| 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
| 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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