Microgestin vs. Skyla

See how Microgestin and Skyla compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Microgestin is a daily oral contraceptive pill, while Skyla is a hormonal IUD inserted once by a clinician and effective for up to three years.

  • Skyla's most common side effects, like vulvovaginitis and pelvic pain, occur far more often than Microgestin's headache and vaginal candidiasis, reflecting its localized hormone delivery.

  • Microgestin has a much lower monthly cost, but Skyla requires no daily routine once placed and avoids the risk of a missed pill.

Microgestin vs. Skyla Drug Summary

Microgestin

Microgestin is a combination oral contraceptive containing norethindrone acetate and ethinyl estradiol, with some packs adding iron supplement tablets. It is taken once daily to prevent pregnancy, using either a 21-day or 28-day pill pack.

Skyla

Skyla is a levonorgestrel-releasing intrauterine device inserted once by a clinician to prevent pregnancy for up to three years. It delivers a low, steady dose of progestin directly in the uterus and requires no daily action from the patient.

Microgestin vs. Skyla Side Effects

Microgestin

Most common
Headache (up to 6.3%)
Vaginal candidiasis (up to 6.1%)
Nausea (up to 4.6%)
Menstrual cramps (up to 4.4%)

Skyla

Most common
Vulvovaginitis (up to 20%)
Abdominal/pelvic pain (up to 19%)
Acne/seborrhea (up to 15%)
Ovarian cyst (up to 13%)

Microgestin vs. Skyla Dosage

Microgestin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 mg/20 mcg once daily Days 1-21
Maximum dose 75 mg ferrous fumarate/day Days 22-28
Dose changes 2 increases Every 21 days

Skyla

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 13.5 mg IUS, one insertion At the start
Maximum dose 13.5 mg IUS, one insertion Same as starting
Dose changes None Fixed dose

Microgestin vs. Skyla Indications

Microgestin

Microgestin is FDA-approved solely for pregnancy prevention in women who choose an oral contraceptive. It does not protect against sexually transmitted infections, including HIV, so a barrier method is still needed for that protection.

  • Daily pill taken around the same time each day

  • Available in 21-day and 28-day (Fe) pack options

  • Combines a progestin and estrogen hormone daily

  • Does not protect against STIs, including HIV

Skyla

Skyla is FDA-approved for pregnancy prevention for up to three years after a single insertion. It is not approved for emergency contraception, use before a first period, or in women over 65, and it does not protect against STIs.

  • Single insertion, effective for up to 3 years

  • Requires a clinician for placement and removal

  • Releases progestin locally within the uterus

  • Does not protect against STIs, including HIV

Microgestin vs. Skyla Pros and Cons

Microgestin

Microgestin has decades of real-world use dating back to 1968, with predictable daily dosing and a low monthly cost. It requires remembering a daily pill and carries systemic hormone risks, including clotting concerns in some users.

Pros

  • Decades of real-world safety data since 1968

  • Roughly $20 to $50 per month without insurance

  • Can be stopped immediately if side effects occur

  • No procedure or clinician visit needed to start

Cons

  • Requires taking a pill at the same time daily

  • Systemic hormones raise clotting and stroke risk

  • Not recommended for smokers over age 35

  • Effectiveness depends on consistent daily use

Skyla

Skyla provides long-acting, low-maintenance contraception from a single insertion lasting up to three years. It requires a clinical procedure to place and remove, has a large upfront cost, and carries small risks of perforation or expulsion.

Pros

  • No daily action needed once device is placed

  • Effective for up to three years per insertion

  • Localized hormone dose limits systemic exposure

  • Studied specifically in women who haven't given birth

Cons

  • Requires an in-office insertion and removal visit

  • Roughly $1,028 to $1,329 upfront before insurance

  • Small risk of uterine perforation or expulsion

  • Higher rates of pelvic pain and acne than pills

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