Ortho Tri-Cyclen vs. Mirena

See how Ortho Tri-Cyclen and Mirena compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Ortho Tri-Cyclen is a daily pill that also treats moderate acne, while Mirena is a device placed once and left in for years.

  • Mirena requires a clinical insertion and removal procedure, while Ortho Tri-Cyclen relies on remembering a pill every day.

  • Both prevent pregnancy effectively, but Mirena additionally treats heavy menstrual bleeding for up to 5 years.

Ortho Tri-Cyclen vs. Mirena Drug Summary

Ortho Tri-Cyclen

Ortho Tri-Cyclen is a triphasic combination oral contraceptive containing norgestimate and ethinyl estradiol, taken once a day for 28 days (21 active tablets, 7 placebo). It prevents pregnancy and is also FDA approved to treat moderate acne in females 15 and older who want oral contraception.

Mirena

Mirena is a progestin-releasing intrauterine system placed inside the uterus by a clinician, where it releases levonorgestrel locally for up to 8 years. It prevents pregnancy and is also FDA approved to treat heavy menstrual bleeding for up to 5 years in women using it for contraception.

Ortho Tri-Cyclen vs. Mirena Side Effects

Ortho Tri-Cyclen

Most common
headache/migraine (not specifically quantified in label)
breast pain/tenderness or discharge (not specifically quantified in label)
vaginal infection (not specifically quantified in label)
abdominal/gastrointestinal pain (not specifically quantified in label)

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%)

Ortho Tri-Cyclen vs. Mirena Dosage

Ortho Tri-Cyclen

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.180 mg/0.035 mg daily Days 1-7
Maximum dose Placebo tablet daily Days 22-28
Dose changes 3 increases Every 7 days

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

Ortho Tri-Cyclen vs. Mirena Indications

Ortho Tri-Cyclen

Ortho Tri-Cyclen is approved to prevent pregnancy and to treat moderate acne in females at least 15 years old who also want contraception. It is not approved as emergency contraception and is not recommended for women over 35 who smoke.

  • Prevention of pregnancy

  • Treatment of moderate acne in females 15 and older

  • Once-daily oral tablet

  • Requires daily adherence for full effectiveness

Mirena

Mirena is approved to prevent pregnancy for up to 8 years and to treat heavy menstrual bleeding for up to 5 years in women who choose it for contraception. It is not approved as emergency contraception and must not be used during pregnancy or active pelvic infection.

  • Prevention of pregnancy for up to 8 years

  • Treatment of heavy menstrual bleeding for up to 5 years

  • Placed once by a clinician

  • No daily dosing to remember

Ortho Tri-Cyclen vs. Mirena Pros and Cons

Ortho Tri-Cyclen

Ortho Tri-Cyclen offers dual benefit as a contraceptive and an acne treatment, and effects reverse quickly after stopping. Because it depends on daily use, its real-world effectiveness is more sensitive to missed pills than a long-acting device.

Pros

  • Also treats moderate acne, unlike Mirena

  • Effects stop quickly after discontinuing the pill

  • No insertion or removal procedure needed

  • Generic versions cost as little as $10 to $25 per month, far less than Mirena's $900 to $1,725 one-time device cost

Cons

  • Must be taken at the same time every day to stay effective

  • Contraindicated in women over 35 who smoke

  • Carries an increased risk of blood clots

  • Does not treat heavy menstrual bleeding

Mirena

Mirena removes the daily-adherence burden by delivering hormone locally for years at a time, and it is the only hormonal IUD approved to also treat heavy menstrual bleeding. That convenience comes with a clinical insertion procedure and device-specific risks not seen with a pill.

Pros

  • No daily pill to remember for up to 8 years

  • Also treats heavy menstrual bleeding for up to 5 years

  • Lower chance of user error than a daily pill

  • One placement lasts for years instead of monthly refills

Cons

  • Requires a clinician to insert and remove the device

  • Carries a risk of uterine perforation or device expulsion

  • Upfront cash cost of $900 to $1,725 per device before insurance

  • Does not treat acne

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