The Wellness Library

IUD vs. the Pill: What You Need to Know

by | Aug 11, 2021 | Hormones, Women's Health

Dr. Cassie takes the pulse of a patient sitting on a table.

Considering your contraceptive options and wondering about an IUD vs. the pill? We’re breaking down all you need to know about both, so you can make the best decision for yourself.

Let me start by saying that contraceptive methods are an extremely personal decision, and what works for you may not work for another. I always suggest that when it comes to making a decision about the use of contraceptives, you should outline the goals you wish to achieve with contraception, and outline what you may like or not like about each different option. Making an informed decision can be empowering and lead to a more pleasant experience surrounding your sexual health. 

And we can help. 🙂

There are many forms of birth control, but it’s really common to question an IUD vs. the pill. Is one better than the other? How do they each work? Let’s dive in.

The Birth Control Pill

Birth control pills come in two types: 

  1. Combination Pill: When commonly referring to “the pill,” most are referring to a combination pill that contains both estrogen (ethinyl estradiol) and progestin. 
  2. Progestin Only Pill or “The Mini Pill”: A pill that only contains progestin, a synthetic form of progesterone that does not truly mimic the same progesterone created by the ovaries. 

And with those two types of pills comes two types of dosing:

  • Monophasic: The same dose of estrogen and progestin is supplied in the pills throughout the month.
  • Multiphasic: The dosing of estrogen to progesterone is altered during the cycle. 

How do you use birth control pills?

Typically pill packs will contain 28 days of pills. Some will contain 21 days of hormone pills with 7 days of placebo pills (no hormones). Some will contain 24 days of hormone pills with 4 days of placebo pills (no hormones).

Other occasions, patients will be placed on continuous birth control in which 84 days of hormone pills will be provided with 7 days of placebo or no placebo pills at all. 

Regardless, it’s important to note this: Bleeding is initiated with placebo pills, BUT this is not a true menstrual period. It’s actually withdrawal bleeding from the removal of hormones. More on ovulation and why it matters here.

How do birth control pill options work?

Combination pill: Taking the combo pill option works by shutting down the brain-ovary communication. It signals to your brain that there are enough hormones available and that there is no need to signal for more hormones to be made. Having been supplied with estrogen and progestin, it suppresses GnRH release from the hypothalamus and the LH and FSH signaling from the pituitary, therefore suppressing signals for ovulation—and no egg is released. 

Progestin Only Pill: Although there is some hormonal suppression at play as described for a combination pill, the progestin only pill primarily works by making the endometrial lining less favorable to fertilized egg implantation, thickening cervical mucus which makes the environment extremely difficult for sperm to survive travel, and reducing egg motility through the fallopian tubes (note: progestin pills in most women will suppress ovulation altogether, but in the case that there is ovulation, it reduces the movement of it to travel).

These are daily dosed without placebo pills, and can suppress withdrawal bleeding altogether in some women.

How effective is the pill?

Whether the combo or progestin only pill, it is 99% effective at preventing pregnancy when used correctly.

Advantages to the pill

  • Prevent pregnancy. 
  • Decreased pain with bleeding.
  • Decreased blood loss.
  • In some it can reduce acne outbreaks. 
  • In some it can reduce occurrence of ovarian cysts (some experience increase of ovarian cysts).
  • It can help with menstrual migraines in some women. 
  • Ability to stop or control the menstrual cycle. 
  • Decrease ovarian or endometrial cancer. 

Disadvantages to the pill

  • You will need to take it daily. 
  • Impacts adrenal and thyroid function. 
  • It can lead to blood clots, strokes, or heart attacks.
  • Can lead to nutrient deficiencies.
  • Does not protect against STIs. 
  • Impacts gut and vaginal dysbiosis. 
  • Can cause low libido. 
  • It is associated with adverse mood changes. 

Disclaimer: This is not to deter the use of birth control, but rather provide information that will be helpful in making an  empowered and informed decision surrounding your sexual health. 

The IUD (Intrauterine Device)

What is an IUD?

The IUD is a small, T-shaped device that is inserted into the uterus by a medical practitioner. 

The IUD comes in two forms as well:

  1. Hormonal IUD: contains only progestin, a synthetic form of progesterone. These include Mirena, Skyla, Kyleena, and Lilleta IUDs. Can last up to 5 years depending on the brand. 
  2. Copper IUD: does not contain any hormones.This is the ParaGuard IUD. FDA approved to last for 10 years. 

How do IUD options work?

Hormonal IUDs: Through the slow release of progestin hormonal IUDs work by making the endometrial lining less favorable to fertilized egg implantation, thickening cervical mucus which makes the environment extremely difficult for sperm to survive travel, and reducing egg motility through the fallopian tubes.

This is very similar to how the mini pill works, but rather than taking a pill daily, the IUD is placed and left in place for a period of 3-5 years (time frame depends on brand). 

Copper IUD: This secondary option works by preventing sperm from being mobile and swimming; therefore, preventing egg fertilization.

How effective is an IUD?

IUDs are 99% effective at preventing pregnancy. 

I haven’t had much success with hormonal contraceptive options—now what?

When you’re considering an IUD vs. the pill, a personal favorite of mine for those who have the goal of preventing pregnancy in mind, but maybe haven’t had success with hormonal birth control options or want the opportunity to help balance hormones naturally is the ParaGuard (Copper IUD). The copper IUD provides the ease and convenience of skipping the pharmacy or remembering to take a pill daily, has a 99% success rate of preventing pregnancy, contains no hormones, and allows for ladies to start addressing hormone imbalances naturally. 

IUD vs. the pill final thoughts: Take it personally

Again making the decision to use contraceptives is a personal decision! There are so many different forms of birth control options that are offered that we only have been able to scratch the surface on the most commonly chosen options. Talk with your local licensed Naturopathic Doctor, to help stay informed and help support you in a decision that feels comfortable for your body and the goals you wish to achieve. 


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