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Pondering The Pill vs IUD? Ask Yourself These 4 Things First

Whether you’re brand new to birth control or a veteran looking to change up your method, there’s a lot to consider when weighing the pill vs IUD for contraception.

We’re here to help guide you through the decision-making process. This article breaks down key questions to ask yourself when evaluating the pros and cons of the pill versus an IUD, such as:

  • “What’s my main reason for wanting to use birth control?”
  • “Do I still want to ovulate?”
  • “How much risk am I comfortable with?”
  • “Am I looking for a short or long-term solution?”

Finally, we’ll explain how your period on the pill might be different from periods with an IUD, so you know exactly what to expect.

Why use the pill or IUD?

Understanding your main motivations for wanting to use the pill or an IUD (as opposed to barrier methods like condoms) is the first step in determining which option might be right for you.

Because both birth control pills and IUDs effectively turn off your natural hormonal cycle, they’re often used to manage difficult periods or menstrual symptoms, like cramps, PMS, irregular bleeding, or heavy flows. In fact, 58% of people who take birth control pills cite easier periods—rather than contraception—as their biggest reason for using the pill in the first place. [1]

What’s your main reason for wanting the pill or IUD?

If avoiding pregnancy is at the top of your priority list, either option is a great choice.

  • Birth control pills are 99% effective at preventing pregnancy with perfect use (i.e. taking every pill in the pack, every day, at the same time of day), and 91% effective with ‘typical’ use (i.e. occasionally forgetting a pill). [2]
  • IUDs are over 99% effective at preventing pregnancy, without a daily pill to remember to take. [3]

If you’re mostly interested in using the pill or an IUD to help with problematic or painful periods, however, know that neither method is risk-free (more about this below), nor are they your only options for making periods easier.

  • Cramp Aid is a fast-acting, use-as-needed supplement designed to relieve period cramps within minutes—without drugs or their risks
  • Steady Mood is a daily multivitamin that provides multi-symptom PMS relief by supporting the hormonal cycle with key nutrients for menstrual health

Should you decide against the pill and an IUD due to side effects, long-term risks, or another reason, our Period Rescue Kit can help get period symptoms under control, and you can explore other effective forms of contraception. The Fertility Awareness Method (FAM) and Phexxi are non-hormonal birth control options that are similar to the pill and IUDs in the sense that you control them—no partner participation required like there is with condoms or pulling out.

Ovulation on the pill vs IUD

Birth control options like the pill and most types of IUDs work to prevent pregnancy by suppressing ovulation, the once-a-month event about 14 days after your period when an egg is released from an ovary.

One reason why someone would still want to ovulate—even if they’re not trying to conceive—is to make the hormone progesterone. Progesterone’s main job is to prepare the body for pregnancy, but its effects are good for you even if you never become pregnant. For example, research shows progesterone may help soothe inflammation, calm stress, and reduce signs of skin aging. [4, 5, 6]

Since it’s so involved in trying to get an egg fertilized, progesterone is only produced following ovulation. This means shutting down ovulation with birth control also shuts down progesterone production—and its benefits.

The progestins found in birth control pills and hormonal IUDs are similar to progesterone, but not the same. They don’t offer as many health benefits, and may cause side effects.

Birth control pills, shots, and patches are designed to shut down ovulation and progesterone production completely. IUDs shut down ovulation at least part of the time, allowing for partial progesterone production. Barrier methods like condoms allow you to ovulate regularly, and enjoy the benefits of natural progesterone every month.


Long-term risks of the pill versus IUD

As long as they’re given to you by a doctor, both birth control pills and IUDs are considered safe to use over the long-term. While both can cause serious side effects in rare cases, having an IUD for many years generally carries fewer risks of long-term complications versus being on the pill for a long time.

Long-term risks of the pill include:

⚠️ Cardiovascular risks
The pill may raise blood pressure and increase risk of developing blood clots. If you smoke, are over 35, or get migraine headaches with an aura, your doctor may recommend a different type of birth control.

⚠️ Cancer risks
While the pill may decrease your risk of ovarian, endometrial, and colorectal cancers, it may increase risk of breast and cervical cancers. If you have a family history of those cancers or other risk factors, your doctor may recommend a different type of birth control.

⚠️ Nutrient deficiencies
Research shows birth control pills can deplete levels of magnesium, selenium, sinc, and vitamins B2. B6, B9, B12, C, and E. [7] You can minimize risk of developing deficiencies by eating a variety of foods, eating enough, and supplementing with a multivitamin.

Long-term risks of IUDs include:

⚠️ Placement issues
In rare cases, an IUD may detach itself from the uterine wall, making it possible to become pregnant. In even rarer cases, it may perforate and pass through the uterine wall, requiring surgery to remove it.

⚠️ Infection risks
IUDs can become infected with bacteria upon insertion. If the infection isn’t treated, risk of developing Pelvic Inflammatory Disease (PID) increases, which can lead to other complications like chronic pelvic pain, abscesses, infertility, and ectopic pregnancy should you become pregnant. [8]

Long-term risks of the pill *and* IUDs include:

⚠️ STI / STD risks
Neither the pill nor IUDs protect against STIs or STDs. If you anticipate having multiple sexual partners over time, be sure to get regular STI/STD screenings or use condoms.

Coming off the pill vs removing an IUD

No matter which birth control option you choose, you won’t use it forever. Because the process of stopping either method will require some effort, it’s worth factoring in before deciding if the pill or an IUD is better for you.

Stopping birth control pills:

The pill is effective for as long as you’re taking it consistently. You can simply stop taking it whenever you choose, and your ability to become pregnant will return to what it was before you went on the pill. [9]

You have slightly more control over when you go off the pill vs an IUD, since removing an IUD requires a doctor’s appointment and painful procedure. If you’re looking for a shorter-term birth control solution, the pill may be a better fit. However, side effects of stopping birth control pills are also common. Periods may be irregular and PMS symptoms may worsen, and post-pill acne may develop about 6 months after your last pill pack.

Getting an IUD taken out:

Depending on the brand, IUDs can last 3-10 years before they’ll need to be removed by a doctor—though you can have it removed before it expires if you’d like. Once removed, you can either have a doctor replace it with a new IUD, switch to a different type of birth control, or stop using birth control entirely.

The biggest consideration in removing an IUD is the pain of the procedure itself. Note that if you want to replace your IUD, swapping it out will be doubly painful: once to remove the expired IUD, and again to insert the new one.


Periods on the pill vs periods with an IUD

Compared to periods without the pill or IUD, both methods of birth control can change your period dramatically. Hormonal IUD vs copper IUDs also have very different effects on menstruation.

  • Periods on the pill may become lighter and more regular, with fewer cramps and PMS symptoms
  • Periods with hormonal IUDs may become lighter, shorter, and less frequent
  • Periods with copper IUDs may become heavier and longer, and are sometimes more painful

Both the pill and hormonal IUDs contain progestins that thin the uterine lining. The thinner the lining, the less there is to shed each cycle, resulting in lighter flows. Just note those effects are temporary; if you struggled with bad periods before you went on the pill or got an IUD, expect them to return when you stop the pill or remove your IUD.

Also note that while copper IUDs can worsen menstrual bleeding and cramping, side effects generally subside after the first year of use. But regardless of what your period throws at you, we’ll be here to help—no matter which type of birth control you choose.


1. https://www.guttmacher.org/news-release/2011/many-american-women-use-birth-control-pills-noncontraceptive-reasons

2. https://my.clevelandclinic.org/health/drugs/3977-birth-control-the-pill

3. https://www.plannedparenthood.org/learn/birth-control/iud/how-effective-are-iuds

4. Niven, D., Rae, M., Critchley, H., & Hillier, S. (2004, March). An anti-inflammatory role for progesterone at the human ovarian surface?. In Endocrine Abstracts (Vol. 7). Bioscientifica.

5. Bitran, D., Shiekh, M., & McLeod, M. (1995). Anxiolytic effect of progesterone is mediated by the neurosteroid allopregnanolone at brain GABAA receptors. Journal of neuroendocrinology, 7(3), 171-177.

6. Holzer, G., Riegler, E., Hönigsmann, H., & Schmidt, J. (2005). Effects and side effects of 2%‐progesterone cream on the skin of peri‐and postmenopausal women: Results from a double blind, vehicle‐controlled, randomized study. Experimental Dermatology, 14(2), 156-157.

7. Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci, 17(13), 1804-13.

8. Toivonen, J. (1993). Intrauterine contraceptive device and pelvic inflammatory disease. Annals of medicine, 25(2), 171-173.

9. Barnhart, K. T., & Schreiber, C. A. (2009). Return to fertility following discontinuation of oral contraceptives. Fertility and sterility, 91(3), 659-663.

This information is for educational purposes only. It is not a substitute for professional medical advice, and is not intended to diagnose, treat, cure, or prevent any condition.

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