Choosing between an IUD and birth control implant

Remembering a daily birth control pill isn't always easy. For many women, long-acting birth control options can provide effective pregnancy prevention without the need for daily reminders.

That’s why long-acting contraception methods like intrauterine devices (IUDs) and birth control implants can be appealing. Here’s what you need to know. 

How birth control implants and IUDs work

Long-acting reversible contraceptives come in two forms. The first is an IUD, which is a small, T-shaped device that your provider inserts into the uterus. IUDs work in different ways depending on the type. Hormonal IUDs release progestin, while copper IUDs release copper ions that are toxic to sperm, preventing fertilization..

Depending on the brand, hormonal IUDs can last for several years, with one approved for up to eight years. The copper IUD is approved for up to 10 years.  

The second type is a birth control implant. This is a small plastic rod (the size of a matchstick) that your provider places under the skin of the upper arm. It steadily releases the hormone progestin. It prevents ovulation and thickens the cervical mucus, so that if ovulation were to occur, it would be difficult for sperm to reach the egg. The implant is approved to prevent pregnancy for up to five years.

Benefits of long-acting birth control  

There are various reasons women choose contraceptive methods like IUDs and implants.

“A lot of women don't want to have to remember to take a pill every day,” says Rebecca Falik, M.D., an Ob/Gyn with Sutter Health. “The long-acting mechanism is really appealing. And they're among the most effective forms of reversible birth control available. If you're going to use birth control, you want it to work.”  

These options can also be helpful for women who should avoid estrogen-containing birth control due to certain medical conditions; estrogen is in the birth control patch, ring and many pills.

Many women like hormonal IUDs because the progestin can make periods much lighter or even stop them completely. That can be a big upside for women with heavy or painful periods. Falik notes that hormonal IUDs may also help lower the risk of endometrial cancer.

The birth control implant can be a good option for a woman who doesn't want to have a pelvic exam or doesn't want a device placed inside her uterus.  

Another benefit is that both options are reversible. Once an IUD or implant is removed, it’s possible you could get pregnant right away.

Side effects and risks

As with any procedure, there can be side effects and risks, but serious complications are rare.

With the implant, some women experience side effects like headaches or irregular spotting. IUDs can also cause spotting or cramping at first, though that usually improves over time, Falik says.

There are also a few risks of the procedures. In very rare cases, an implant could be placed too deeply and migrate from its original position. An IUD could perforate the uterus and move outside the uterus.

“Those are real risks, but they're quite rare and treatable,” Falik says.  

IUDs may not be the best fit for every woman. For example, fibroids can sometimes change the shape of the uterus, which can make it harder to place an IUD or increase the chances that the body will expel it. “Many women who have fibroids, though, still do very well with the IUD” Falik explains.  

And while IUDs and implants are used to prevent pregnancy, they do not protect against sexually transmitted infections (STIs). So, depending on your situation, you may still want to use condoms.

In general, Falik says, IUDs and birth control implants are safe and effective ways to prevent pregnancy. Talk to your provider about what makes the most sense for you.