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IUD vs. Implant for Birth Control: What’s the Difference?

cartoon woman thinking of an IUD or implant in thought bubble

Implants and intrauterine devices (IUDs) are both safe, effective, and convenient methods of birth control. They are called long-acting reversible contraceptives or “fit and forget” birth control, meaning once you get them, you don’t have to do anything else for several years to prevent pregnancy. 

Please continue reading to understand the differences between implant vs. IUD. The goal of this article is to help you decide which birth control method is right for you.

What is the birth control implant?

A birth control implant (brand names Nexplanon, Implanon) is a small, thin rod roughly the size of a matchstick. It releases hormones and prevents you from becoming pregnant. The implant is inserted into your upper arm through a small incision by a doctor or nurse. Once in place, the Nexplanon implant protects you from pregnancy for up to five years. 

What are the advantages and disadvantages of birth control implants?

Advantages:

  • It works for up to five years.
  • It does not interrupt sexual intercourse.
  • It’s safe if you’re breastfeeding.
  • It’s reversible - fertility returns as soon as the birth control implant is taken out.
  • It can help to reduce heavy bleeding and period pain (you’ll get lighter periods).
  • It secretes the hormone progestin, so it’s an option for women who can’t use estrogen-based contraception, such as the vaginal ring, contraceptive patch, or combined contraceptive pill.

Disadvantages:

  • You need to get the Nexplanon implant inserted by a healthcare provider.
  • It doesn’t protect against sexually transmitted infections, so you may need to use a condom every time you have sex.
  • There can be side effects like breast tenderness, nausea, headache, and mood changes - these are temporary and usually last for a few months.
  • It can cause irregular bleeding or cause your periods to stop completely.
  • It can cause acne or make your acne worse.

What is an IUD?

An intrauterine device (IUD) is a small, T-shaped device placed in your uterus (womb) to prevent pregnancy. It is a long-term, reversible, convenient, safe, and effective method of birth control. 

There are two types of IUDs. A hormonal IUD releases hormones to prevent pregnancy. Hormonal IUDs are available under the brand names Mirena, Liletta, Kyleena, and Skyla. These devices work for 3-7 years to protect against pregnancy (depending on the brand).

The other type of IUD is a hormone-free copper IUD (brand name Paragard). It does not have any hormones. Rather, it is a copper-wrapped device that effectively prevents pregnancy for up to 10 years.

What are the advantages and disadvantages of IUD birth control methods?

Advantages: 

  • An intrauterine device (IUD) does not interrupt sexual intercourse.
  • It protects against pregnancy for 3-10 years, depending on the type.
  • It starts working right after it’s fitted.
  • Most people with a uterus (womb) can get an IUD.
  • There are no hormonal side effects such as breast tenderness, acne, or headaches.
  • It's safe to use if you're breastfeeding.
  • It's reversible, and fertility returns as soon as the IUD is removed.
  • It does not interfere with other medications.
  • It does not cause weight gain or increase your risk of cancer.

Disadvantages:

  • It does not protect against sexually transmitted infections, so you may need to use a condom.
  • Periods can be heavy and painful for a few months after IUD insertion.
  • You need to see a healthcare provider to get it inserted as well as to get an IUD removed. 
  • If an infection occurs when the IUD is fitted, it can cause pelvic inflammatory disease (this is a medical emergency, and the infection can spread to the entire pelvis if it’s not treated).

Similarities Between a Birth Control Implant and Intrauterine Device

Reversibility

Both implants and IUDs are long-acting reversible contraceptive methods, meaning you can get pregnant as soon as they are removed. However, you need to see a healthcare provider to get them inserted and removed. 

Effectiveness

Each contraceptive method is safe, effective, and convenient. The failure rate is very low, and the chances of pregnancy are 1% in the first year of use. 

Mechanism of Action

Another similarity is that hormonal implants and hormonal IUDs release the hormone progestin to prevent pregnancy. The hormone works by reducing or stopping ovulation (meaning it stops the ovaries from releasing eggs). It also thickens the cervical mucus and prevents sperm from entering the uterus. Lastly, it creates a hostile environment by thinning the uterine lining to make a fertilized egg less likely to attach.

Safety

Almost all women can safely use implants and IUDs, including teenagers, women who have never had a baby, and women who have had abortions. 

Sexually Transmitted Diseases

Both implants and IUDs do not protect against sexually transmitted diseases.

Differences Between Birth Control Implants and Intrauterine Devices

Placement

Birth control implants are placed in the upper arm. The insertion is quick, and a local anesthetic is used to make it painless. There are no stitches. You may have some mild bruising and soreness for a few days. You can’t see the implant, but you can feel it under your skin. 

IUDs are placed in the uterus (womb). A doctor or nurse will place a speculum in your vagina and insert the IUD using a special device. You might experience pain and cramping for a few minutes. Your doctor may advise taking pain medicine before the insertion, and they may use numbing medicine on your cervix to keep you comfortable. The IUD strings are 1-2 inches long and can hang into the upper part of your vagina, but you won’t notice them. 

How Soon Effective

Copper IUDs start working as soon as they’re inserted. Hormonal IUDs work right away if inserted in the first 7 days of your period. Otherwise, they take up to 7 days to start working to prevent pregnancy. Hormonal implants work right away if inserted within the first 5 days of your period. Otherwise, they take up to 7 days to protect you against getting pregnant. 

Duration of Effectiveness

Hormonal IUDs work for 3-7 years, depending on the brand. A copper IUD works for up to 10 years, whereas a birth control implant works for 3-5 years.

Cost Comparison

Family planning clinics provide implants, IUDs, and other forms of birth control at little or no cost. Your insurance may pay for some birth control methods. If you are paying out of pocket, you can expect to pay around $1,000 for a hormonal implant plus the cost of having it placed and removed. An IUD costs around $1,300. Keep in mind that this cost is spread over several years, so it might work out to be similar to other birth control methods like the pill or ring. 

Which is Better: Birth Control Pills or IUD / implant?

Birth control pills, Depo Provera (birth control shot), hormonal implants, and IUDs can all prevent unwanted pregnancies. The key differences between pills and implants/IUDs are as follows.

A birth control pill only prevents pregnancy if you take it correctly every day. Once an implant or IUD has been inserted, it is effective for 3-10 years without needing to do anything else.

Birth control pills cost $50 per month on average out-of-pocket. That’s a cost of $600 every year. However, generic birth control pills may cost less and out-of-pocket costs depend on health insurance plans. In comparison, implants and IUDs cost around $1,000 to $1,300 and last for several years. Additionally, IUDs and implants need to be inserted and removed by a healthcare provider and may incur additional costs. 

Ultimately the choice between a hormonal IUD, copper IUD, hormonal implant, or other methods of birth control will come down to your lifestyle (how soon you want to get pregnant in the future), your anatomy (fibroids, irregular uterine cavity), and your medical history (high blood pressure, liver disease, ectopic pregnancy). 

For example, if you are done with having children, it might make sense to have your tubes tied. In many women over the age of 35, doctors recommend IUDs because, unlike pills, they do not increase the risk of blood clots. Similarly, smokers may be advised against going on the pill due to a risk of vascular disease

On the other hand, while most women do well on IUDs, they may not be appropriate if you have uterine fibroids, an irregular uterine cavity, liver disease, a genital infection, or a history of pelvic inflammatory disease.

You should get professional medical advice before making a decision about birth control because some contraception methods may be better for you than others. 
 

References:

  1. https://www.plannedparenthood.org/learn/birth-control/birth-control-implant-nexplanon
  2. https://www.plannedparenthood.org/learn/birth-control/iud
  3. https://www.nhs.uk/conditions/contraception/contraceptive-implant/
  4. https://www.nhs.uk/conditions/contraception/iud-coil/