Key takeaways:

• Both IUDs and pills are highly effective at preventing pregnancy, but they work in different ways and suit different lifestyles.
• IUDs are low-maintenance, long-term options (lasting 3–10 years) and are over 99% effective. They can be hormonal or non-hormonal.
• Birth control pills offer daily control and added benefits like lighter periods and clearer skin, but require consistent use.
• Your health history, comfort with hormones, lifestyle, and period preferences can help guide the best choice.
• Neither method protects against STIs. Consider pairing with condoms if needed.

IUD vs. pill as birth control options

Weighing up your birth control options? We’ve got you.

Both IUDs and birth control pills are highly effective at preventing pregnancy, but they work in different ways—and the best option for you depends on your lifestyle, preferences, and health needs.

An IUD (intrauterine device) is a small device placed in your uterus that provides long-lasting birth control: anywhere from 3 to 10 years, depending on the type. Once it’s in place, it’s low-maintenance and doesn’t require daily attention, making it a great fit for those who want something that doesn’t require frequent thought.

The pill is a daily oral contraceptive. While it does require consistent use, many people appreciate the flexibility it offers, especially when it comes to regulating periods, easing hormonal symptoms, or giving them more control over timing.

Both options are safe and effective. The right one for you will depend on your goals, comfort level, and how involved you want to be in your birth control routine.

How they prevent pregnancy

Knowing how your birth control works can help you feel more confident in your choice. Both IUDs and birth control pills are safe and highly effective, but they prevent pregnancy in different ways.

IUDs (intrauterine devices) work from inside the uterus to prevent sperm from reaching an egg.

• Copper IUDs release a small amount of copper, which acts as a natural spermicide. The copper changes the way sperm move, making it nearly impossible for them to reach and fertilize an egg. The device also changes the uterine lining, which helps prevent implantation.
• Hormonal IUDs release a steady dose of the hormone levonorgestrel directly into the uterus. This thickens cervical mucus (blocking sperm from getting through), thins the uterine lining, and in some cases, stops ovulation entirely.

Birth control pills use hormones that work throughout your body to prevent pregnancy.

• Combination pills, like Sprintec®, contain both estrogen and progestin. Together, these hormones stop your ovaries from releasing an egg each month (ovulation), and also help thicken cervical mucus and thin the uterine lining for added protection.
• The mini pill, which contains only progestin, is a great option for those who can’t take estrogen. It mainly works by thickening cervical mucus and thinning the uterine lining, and may also prevent ovulation in some cases.

Both IUDs and birth control pills are highly effective options. IUDs are over 99% effective. Pills are 91–99% effective, depending on how consistently you take them.

IUD options

If you’re looking for long-term birth control that doesn’t require daily upkeep, IUDs (intrauterine devices) might be worth considering. These small, T-shaped devices are placed inside your uterus by a healthcare provider and can offer reliable pregnancy prevention for several years.

Here’s a simple overview of the two main types of IUDs available in the U.S. (copper and hormonal) so you can feel informed when talking to your provider about what’s best for you.

Copper IUDs

The Paragard® is the only non-hormonal IUD currently available in the U.S. It’s wrapped in a small amount of copper, which creates an environment that prevents sperm from reaching and fertilizing an egg.

• Starts working immediately after insertion
• Offers protection for up to 10 years
• Hormone-free option—your body’s natural cycle continues uninterrupted
• Can be used as emergency contraception if inserted within 5 days of unprotected sex

Keep in mind that the copper IUD doesn’t protect against STIs, so you may still want to use condoms depending on your situation.

Hormonal IUDs

Hormonal IUDs slowly release a small amount of levonorgestrel, a type of progestin, directly into the uterus. This helps prevent pregnancy by thickening cervical mucus (which blocks sperm) and thinning the uterine lining.

Here’s how long each one lasts:

• Mirena® and Liletta®: up to 7 years
• Kyleena®: up to 5 years
• Skyla®: up to 3 years

Because the hormone is released locally rather than throughout your whole system, hormonal IUDs often come with fewer side effects compared to pills. For many, periods become lighter or stop altogether, which can be a welcome change if you deal with heavy or painful cycles.

Birth control pill options

Pills are a reliable, flexible birth control method that gives you control over your reproductive health. They’re easy to start, simple to stop, and come in different formulations to meet different needs. At Nurx, we’re here to help you find the best birth control option for your body, goals, and lifestyle.

Combination pills

Combination pills contain two hormones (estrogen and progestin) and are one of the most commonly prescribed types of birth control. Brands you might recognize include Nikki®, Tri-Sprintec®, and Lo Loestrin Fe®.

Most combination pills come in 21- or 28-day packs. With the 21-day pack, you take active pills for three weeks and then have a week without hormones, when your period typically arrives. The 28-day version includes placebo pills during that final week to help keep your daily routine on track.

Many people choose combination pills not just for pregnancy prevention, but also for the added benefits. These may include:

• More regular and lighter periods
• Fewer PMS symptoms
• Clearer skin
• Reduced menstrual cramps
  Some pills are designed to target specific concerns; for example, Nikki® may help reduce bloating or mood swings.

To be most effective, combination pills should be taken at the same time each day. Missing pills (especially early in a pack) can raise your risk of pregnancy. Certain medications or supplements may also interfere with effectiveness, so it’s important to let your provider know what you’re taking.

Progestin-only pills (the mini pill)

Progestin-only pills (also called the mini pill) contain just one hormone and are often a good choice for people who can’t take estrogen. Some options include Camila®, Errin®, and Heather®.

The mini pill is taken daily, without a break; every pill in the 28-day pack is active. Timing is especially important with this option. It needs to be taken at the same time every day, with just a three-hour window to maintain effectiveness.

This pill can be a great choice if you:

• Have migraines with aura
• Are breastfeeding (it won’t affect milk supply)
• Have a history of blood clots or high blood pressure

One thing to know: bleeding patterns can be unpredictable, especially when starting out. Some people have spotting, while others stop getting periods altogether. That’s normal, but if you’re ever unsure, taking a pregnancy test can offer peace of mind.

How they affect your menstrual cycle

Your body responds to birth control in different ways depending on the method. Whether you’re considering the pill or an IUD, understanding how each option might affect your period can help you feel more prepared and empowered to make the choice that fits your life.

Copper IUDs

The copper IUD is hormone-free and works by creating an environment that prevents sperm from reaching an egg. Since it doesn’t contain hormones, your body continues its natural cycle. Long story short, you still ovulate and have regular periods.

That said, many people experience heavier bleeding and more cramping, especially in the first few months after insertion. For some, this levels out over time. If you’re considering a copper IUD and already deal with heavy or painful periods, it’s worth discussing the pros and cons with a provider.

Some people find that menstrual cups, discs, or period underwear help manage the heavier flow more comfortably.

Hormonal IUDs

Hormonal IUDs release a small amount of progestin, which thins the uterine lining and often makes periods lighter or stop altogether. Some users have no bleeding at all after one year.

While some people appreciate not having to deal with a monthly period, others feel uneasy without that regular reassurance. Both responses are valid; what matters is how the method fits into your sense of comfort and control.

Cramping and spotting can happen in the first few months, but these symptoms often improve with time.

Combination birth control pills

Combination pills (which contain estrogen and progestin) give you more control over your cycle. You’ll usually take 3 weeks of active pills, followed by a week of placebo pills that trigger a withdrawal bleed.

Most people notice lighter, shorter, more predictable bleeding on the pill. And if you want to skip your period occasionally (say, for a vacation or big event), it’s generally safe to skip the placebo week now and then. For more regular cycle skipping, your Nurx provider can guide you through safe extended cycling options.

Combination pills can also help with cramps, acne, PMS, and other cycle-related symptoms. Some top choices include Nikki®, Lo Loestrin Fe®, and Tri-Sprintec®.

Progestin-only pills

The mini pill is estrogen-free and often chosen by people who are sensitive to hormones or have specific health needs. It’s taken daily at the same time, with no placebo week.

Your cycle on the mini pill might be less predictable. You could have regular periods, occasional spotting, or no bleeding at all. That uncertainty doesn’t mean the pill isn’t working; it’s just how the body responds to a steady dose of progestin.

Apps or symptom trackers can be helpful if you’re trying to spot patterns over time. Many Nurx patients who want a low-hormone, side-effect-conscious option choose the mini pill or low-dose pills like Junel Fe®.

Side effects and risks

Every form of birth control comes with potential side effects. Knowing what to expect can help you feel more prepared and give you clarity on when to reach out for medical advice. The good news is that for most people, side effects are mild and temporary as your body adjusts.

IUDs

Although Nurx doesn’t offer IUDs, it’s helpful to understand how they compare to the birth control pill. IUD insertion can be uncomfortable, and your body may take a few weeks to adjust.

You might experience:

• Cramping during and after the procedure (similar to strong period pain)
• Spotting or light bleeding for several weeks
• Ongoing mild cramping as your uterus adapts

Some rare but more serious IUD risks include:

• Pelvic infection, especially within the first 3 weeks after insertion
• Device expulsion, which occurs in very few cases (most often in the first year)
• Ectopic pregnancy, a rare complication where a pregnancy occurs outside the uterus

Taking ibuprofen before your appointment and arranging a ride home can help ease the process.

The pill

Birth control pills are a convenient and flexible option for many people. Most side effects are mild and temporary, and starting with a lower-dose pill can help minimize them.

Common side effects include:

• Nausea
• Breast tenderness
• Mood changes

These usually improve within a few months as your body adjusts to the hormones.

The most serious but uncommon risk is blood clots, particularly with pills that contain estrogen. Your risk may be higher if you:

• Smoke
• Are over 35
• Have a personal or family history of clotting disorders

Possible warning signs of a clot include:

• Leg pain or swelling
• Chest pain or difficulty breathing
• Severe headaches or vision changes

The overall risk is low, about 1 in 1000 pill users per year.

Cost and convenience

When it comes to choosing between the birth control pill and an IUD, cost and daily routine often play a big role. The right method is the one that fits into your life: financially, practically, and personally.

IUDs

Understanding how costs compare can help you make an informed decision.

• Upfront cost: Without insurance, IUD insertion can range from $500 to $1,300. With insurance, it’s often fully covered under the Affordable Care Act.
• Long-term savings: Spread over 3 to 10 years of protection, IUDs can end up costing less than years of pill packs.
• Convenience: Once in place, you’re protected 24/7. No daily reminders or monthly refills. You’ll just need an annual check-in to make sure it’s still positioned correctly.

This “set it and forget it” method works well for people who prefer a low-maintenance option or have a lot on their plate.

The pill

The pill is one of the most flexible and widely used birth control options, and for good reason. It puts you in control, but it does come with a bit more daily effort.

• Monthly cost: With insurance, many people pay between $0 and $20 for generics. Without insurance, expect to spend about $20–$50 each month. Some brand-name options can cost more.
• Daily routine: Pills need to be taken at the same time every day to be most effective. That means setting a reminder, planning ahead for travel, and refilling your prescription regularly.

Some people find this daily rhythm grounding, while others find it tough to keep up with, especially if they work irregular hours or juggle a lot of responsibilities.

Choosing the right method for you

The best birth control choice is the one that fits your life: your body, your routine, and your goals. It’s not just about preventing pregnancy; it’s about finding what helps you feel confident, supported, and in control.

Start with your timeline

Think about how long you want protection:

• Hoping to get pregnant within a year or two? The pill might be a better fit since you can stop at any time.
• Want long-term coverage while you finish school or focus on your career? An IUD can offer worry-free protection for years.

Consider your medical history

If you have certain health conditions, like migraines with aura or a history of blood clots, you may need to avoid estrogen. In that case, options like the mini pill or certain IUDs may be better suited for you. If you experience heavy or painful periods, hormonal methods often bring relief, whereas copper IUDs might make them heavier.

Be open with your healthcare provider about your health history and any medications you’re taking. That conversation matters.

Think about lifestyle factors

There’s no one-size-fits-all method. Ask yourself:

• Are you comfortable with a daily routine, or do you prefer a “set it and forget it” option?
• Do you travel often or work irregular hours?
• Are you okay with a procedure to insert an IUD, or would you rather avoid that?

Weigh up potential side effects

Some side effects are manageable, others might not be. For example:

• Irregular bleeding? That’s common with the mini pill, but not ideal if predictable periods matter to you.
• Sensitive to mood changes or worried about weight shifts? You may want to avoid certain hormonal methods and explore non-hormonal options, like the copper IUD.

Make a list of what’s most important to you: your non-negotiables and your deal-breakers. Your provider can help match you with the best option.

Don’t let cost keep you from care

Many insurance plans cover FDA-approved birth control at no cost. Nurx accepts most insurance plans and offers affordable options for those paying out-of-pocket. We believe birth control should be accessible to everyone who wants it.

Finding what fits you

The IUD vs. pill debate really just comes down to what fits your life, body, and preferences. Both are highly effective, but they offer different benefits.

IUDs are ideal if you want long-term, low-maintenance protection. Hormonal options may lighten or stop your period, while non-hormonal IUDs offer hormone-free coverage. Insertion can be uncomfortable, but many find the convenience worth it.

The pill gives you flexibility and control. Start or stop anytime, skip periods when needed, and potentially enjoy clearer skin or lighter cycles. If you’re comfortable with a daily routine, it can be a great option.

There’s no one-size-fits-all answer. Your needs may shift, and that’s okay. What matters is finding a method that supports your health and goals.

At Nurx, we make it simple to explore your options with expert guidance and care that fits your life. Start your birth control journey today—on your terms.

Frequently Asked Questions (FAQ)

Are IUDs better for you than the pill?

It depends on your needs and preferences. IUDs are great for long-term, low-maintenance protection. Pills offer more flexibility and daily control. Both are safe and effective—what matters most is what works best for your life.

Do you gain more weight on the pill or IUD?

Most people do not experience weight gain with either the combined pill or hormonal IUD. Weight changes can happen for a variety of reasons, but they’re not guaranteed and usually not significant.

What are the disadvantages of IUD?

Some people experience cramping, spotting, or discomfort after insertion. In rare cases, the IUD can move or cause complications like uterine perforation or infection. A provider can help you understand the risks based on your health history.

What is the healthiest form of birth control?

The healthiest option is the one that aligns with your body and lifestyle. Some people prefer non-hormonal methods like the copper IUD or condoms. Others benefit from hormonal birth control because it helps regulate periods or manage symptoms. A medical provider can help guide you to the right fit.

The information provided is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon this content for medical advice. If you have any questions or concerns, please talk to a medical professional.