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IUD vs. Birth Control Pills: What to Consider

Reviewed by Nivin Todd, MD on August 14, 2020

If you want to avoid pregnancy, you may choose an intrauterine device (IUD) or birth control pills from the many options available. You’ll want to think about your lifestyle before you choose which birth control method to use. These two types work similarly, but they have different pros and cons, side effects, and risks.

IUDs

IUDs come in two forms, copper IUDs and hormonal IUDs.

Copper IUD. The copper IUD, called ParaGard, can prevent pregnancy for up to 10 years. ParaGard is a T-shaped piece made from plastic and copper. It uses copper instead of hormones to block sperm from your eggs. It starts working to prevent pregnancy right away.

Women of all ages can use the copper IUD. It’s also safe to use while breastfeeding. Unlike other forms of birth control, such as condoms, the copper IUD doesn’t interrupt sex because the birth control is already inside you. It also doesn’t raise your chances of blood clots the way some hormonal birth control methods do.

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The doctor will put the device inside your uterus, then trim the strings at the end of it. The strings will help them remove the IUD when you’re done with it. You may feel dizzy, faint, sick to your stomach, or have a lower blood pressure or heart rate than normal while your doctor inserts the IUD. After you lie down and relax, these symptoms should go away.

The copper IUD is 99% effective and changes little about the way your natural hormonal cycle works. (This could be a benefit if it is your preference or recommended by your doctor). The doctor can remove the copper IUD at any time, and you should be able to get pregnant again right away.

Hormonal IUD. This type of IUD uses hormones to prevent pregnancy for up to 5 years. There are four available in the U.S. Right now: Mirena, Liletta, Kyleena, and Skyla.

The IUD is plastic and goes inside your uterus. It thickens the mucus in your cervix to keep sperm away from your eggs. And it thins the lining of your uterus (endometrium) so an egg can’t implant and changes your ovulation pattern.

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Women of all ages can use this IUD. It has similar benefits to the copper IUD. You can use it while you breastfeed. In fact, the doctor can insert an IUD immediately after delivery.

Hormonal IUDs take about 7 days after implantation to protect against pregnancy. They’re 99% effective. The doctor can remove a hormonal IUD at any time and you should be able to get pregnant again right away.

After 3 months on the hormonal IUD, you might have a lighter period. After a year, around 20% of women will notice that their period stops. Mirena can also ease period pain and lower your risk of pelvic infections and cancer in the lining of your uterus.

Birth Control Pills

There are two types of birth control pills, the combined pill and the minipill. The combined pill has both hormones, estrogen and progestin, while the minipill only has progestin. It takes about 7 days for either one to become fully effective, assuming you aren’t already pregnant. 

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If you use the combination pill or the minipill exactly as directed, you have less than a 1 in 100 chance of getting pregnant in the next year (99% effectiveness).

Doctors call this “perfect use” and most people are less strict. For example, you could miss your pills for a day or two, or take them at different times of the day.

For this kind of more typical use, about 9 in 100 women will get pregnant over the course of the year on the pill. You can assume you could get pregnant almost immediately after you stop. And there’s no danger to you or the baby if you get pregnant soon after stopping the pill.

Combination pills. These pills either stop your ovaries from releasing an egg or slow down the egg as it travels through your fallopian tubes. They also thicken the mucus in your cervix and thin the lining of your uterus so you don’t get pregnant.

Combination pills can help with period pain and acne, and lower the risks of ovarian, endometrial, and colorectal cancers. 

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It’s easy to skip a pill, though. That could make you more likely to get pregnant.  If you forget 2 days in a row, doctors suggest that, in addition to doubling your pills for a couple of days, you wait 7 days until you have sex again, or use a backup form of birth control.

Don’t take the combination pill if you’re at high risk for blood clots, high blood pressure, migraines, or heart disease.

Minipill. The minipill slows the egg in your fallopian tubes, thickens mucus in your cervix, and thins the lining of your uterus so an egg can’t implant. It also sometimes stops ovulation.

It’s even more important than for the combination pill to take your minipill at the same time every day. If you miss the time by even 3 hours, you could increase the chances of an unwanted pregnancy. If you forget a pill, take it as soon as you remember and use condoms or another backup method for at least 2 days. Then, take your next pill at the usual time. This could mean that you take 2 pills in 1 day.

You can take the minipill if you breastfeed or have health problems linked to blood clots, migraines, high blood pressure, or heart disease. It can also lower your chance of endometrial cancer.

Multiple Birth Control Methods at Once

Most women either use the pill or an IUD. But if you switch from the pill to a hormonal IUD, you should use both methods together for up to 7 days after you get the IUD. You don’t need to do this if you get the copper IUD because it starts working right away.

If you go from the hormonal or copper IUD to the birth control pill, you’ll need to start the pill 7 days before your doctor removes the IUD.

Cost Comparison

You may not have to pay for birth control. Family planning clinics will usually provide some form of safe birth control at little or no cost to you.

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Your insurance company may pay for some or all of your birth control, though this might or might not include all birth control options. Call your insurance provider to be sure.

If you’re paying out of pocket, an IUD may be as much as $1,300 depending on the type. Because both types can last for many years, the cost works out to about the same or less than daily methods like the pill -- $30 to $50 a month.

Side Effects and Risks

Like any medication, these methods have side effects and risks:

Copper IUD.  It’s possible you could have an ectopic pregnancy, where the embryo grows outside your uterus, but it’s rare. The IUD can fall out of your uterus, but this isn’t common, either. You may have side effects like heavier periods, bleeding between periods, and more cramps with the copper IUD. You could also get pelvic inflammatory disease (PID) if bacteria get into your reproductive tract when the doctor inserts your IUD. And if the IUD moves, it could cut your uterus or other nearby organs, but this is rare.

Hormonal IUD.  It, too, raises your odds of an ectopic pregnancy. And it can also fall out of your uterus. The side effects are usually headaches, acne, breast soreness, bleeding between periods, mood shifts, and cramping. PID is a possibility with a hormonal IUD as well. You’re also more likely to get a benign ovarian cyst. And there’s also a small chance the IUD will move and cut your uterus or nearby organs.

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Combination pills.  They could raise your chances of high cholesterol, heart attacks, stroke, and blood clots. You’re also at a higher risk of cervical and breast cancers. This goes down once you stop the pill. Side effects of combination pills are usually bleeding between periods, breast pain, higher blood pressure, headaches, nausea, and bloating.

Minipill.  You might be more likely to have an ectopic pregnancy with this pill, but it’s rare. Side effects include irregular period, acne, breast tenderness, a lower sex drive, depression, headaches, nausea, and ovarian cysts.

WebMD Medical Reference

Sources

SOURCES:

CDC: “Contraception.”

U.S. Department of Health and Human Services: “Intrauterine Device (IUD).”

Mayo Clinic: “Copper IUD (ParaGard),” “Choosing a birth control pill,” “Combination birth control pills,” “Hormonal IUD (Mirena),” “Minipill (progestin-only birth control pill),” “Pelvic inflammatory disease (PID).”

Reproductive Health Access Project: “Fact Sheet: Copper IUD.”

Cleveland Clinic: “6 Things That Can Happen When You Stop Taking The Pill,” “Birth Control: The Pill,” “Mirena, Liletta (Hormonal IUD).”

American College of Obstetricians and Gynecologists: “Endometrial Hyperplasia.”

UpToDate: “Intrauterine contraception: Insertion and removal.”

American Family Physician: “Preventing Gaps When Switching Contraceptives.”

Minerva Ginecologica: “The IUD and uterine perforation.”

Endometriosis.org: “Mirena.”

Center for Young Women’s Health: “Birth Control Pills: How to take BCPs,” “Birth Control Pills: General Information,” “Intra-Uterine Devices (IUDs),” “How long does it take the pill to kick in? Say I start the pill on Monday. Can I have unprotected sex on Friday?”

University of Michigan Health Service: “Contraception Cost, Insurance and Payment.”

The Nemours Foundation: “About the IUD.”

WomensHealth.gov: “Birth control methods.”

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