IUD V. IMPLANT
With so many kinds of birth control out there these days, it’s important to have all the facts before deciding which you want to opt for. If you’re looking for a type of B.C that you don’t have to remember to take, both the IUD and the implant are options—but they work quite differently!
Read on to learn more about how they’re the same, how they vary, and the questions to ask to find out if either is right for you. IUD vs. Implant dun dun dun...
HOW ARE THEY ALIKE?
Ok, hold your horses. Let’s back up and first break down what each one is:
What’s an IUD?
The IUD, or intrauterine device, is a form of birth control that is inserted into the uterus to prevent pregnancy. In the U.S, all IUDs are T-shaped (and much smaller than you’d think!), though in the UK and other places around the globe, there are more models available. (2)
There are two types of IUDs: hormonal and non-hormonal, and both are body-safe. The hormonal IUD contains the synthetic hormone Levonorgestrel (aka progestin). The non-hormonal IUD contains copper wiring, which is what prevents against pregnancy (crazy, we know!). The copper—or non hormonal IUD—can also be used as effective emergency contraception if inserted up to five days after unprotected sex (1).
Even though there is only one kind of non-hormonal IUD available in the US (it’s called Paragard), there are a handful of different hormonal IUDs to choose from. The hormonal IUD lasts for 2-5 years and the copper one for 10.
For more info, check out our Ultimate Guide to IUDs!
Okay, so what is the implant?
The implant is a small piece of plastic which is the size and shape of a matchstick that a health care provider inserts into your upper arm (the underarm). It also releases the synthetic hormone Etonogestrel (aka progestin) to prevent pregnancy. The implant lasts up to 4 years (5) and Nexplanon is the only brand on the market. Find a ton of info about the Nexplanon implant right this way.
So nowww tell us, how are they alike? IUD vs. Implant:
They are both considered LARCs (Long Acting Reversible Contraceptives).
They are both small devices made of plastic that are put inside your body (the non hormonal IUD is copper and plastic ).
You need a physician to insert and remove them both.
The hormonal IUD and implant both use synthetic hormones to prevent against pregnancy. Neither of them contain synthetic estrogen.
They are both invisible to others, so you and your health care team are the only ones that need to know. Can’t tell or don’t want to tell your partner(s) or parent(s)? They won’t know. No pills to take, no alarms to set, no trips to the pharmacy involved.
There are risks/side effects involved for both. Any time you insert anything into your body, there will be potential risks and side effects. Read more below on specific things to think about and the need-to-knows.
You need to periodically check they are in the right place! While you don’t have to remember to do anything daily, it is certainly a good practice to periodically make sure your implant or IUD is in the right place. Remember to ask your health care provider to show you how to check after insertion! This is how you start taking control of your body and health as well as hopefully help prevent anything serious from happening. If you can’t find it during a routine check, don’t panic. You can always return to the clinic and have it checked out.
You need to periodically check in with your body and mind to ensure you are still feeling like this is the right choice for you. Because they both come with potential side effects, it is important to do self check-ins to make sure the side effects aren’t outweighing the benefits.
Neither IUDS nor the implant protect against STIs. Additional barrier methods like external condoms or internal condoms are needed for that!
HOW ARE THEY DIFFERENT?
IUD vs. Implant
They’re placed differently in the body: The implant goes in the arm and the IUD goes in the uterus.
The implant lasts 3 years while an IUD lasts between 2 and 10.
Only the copper IUD is recommended as emergency contraception (the implant can’t help you there!).
Only the copper IUD does not contain any hormones (one of the few options without any).
The copper IUD can increase bleeding during your periods, while the hormones in other IUDs and the implant often lessen period blood. These differences also depend on your body and how long you’ve used the method.
The insertion and removal process is quite different (uterus vs. arm)—see below for more details.
HOW ARE THEY INSERTED?
This is not something you can do at home, so you will have to go to a provider’s office. They’ll give you a pregnancy test to ensure you aren’t pregnant first and go through your health history to make sure the birth control method you are choosing is safe for your body. It’s important that you disclose all medications, supplements and herbs you are taking (even antibiotics!) You don’t need to disclose who you are or aren’t having sex with or how many partners you have (that’s your business!), but you should disclose if you drink, smoke, and have or had any STDs or STIs (PS- good time to get tested if it’s been a while!) Click here for a downloadable conversation guide to help you figure out the safest B.C option for you!
The T-shaped intrauterine device goes into your uterus, so a speculum will be used to “open the doors” if you will. Your cervix will be prepped and cleaned, and stabilized using a clipping instrument (how fun does this sound?!) The IUD is inserted via a tube, and then once the IUD is released, the tube comes out. (We give you the step-by-step breakdown here). It can be very uncomfortable (and triggering for some) so if you are able to bring a support person to your appointment, that might be nice. Many report cramping and pain afterwards lasting for hours or the rest of the day. (Pain killers, please!) If the pain is severe and continues to the next day, or you notice any really heavy bleeding, it’s best to call your health care provider. IUDs are effective straight away.
Fun fact: It’s sometimes easiest to insert the IUD when you have your period as the cervix is slightly open already.
The match-shaped implant goes in the inside of your upper arm, into the tissue just beneath the skin, via a syringe-like instrument. The implant insertion involves numbing the implant area, and there may be some bruising and achiness afterwards (8). Small scarring and bruising with insertion and removal are possible. You will need to use barrier methods like condoms for a week after getting the implant (3).
How do each of them work?
Both hormonal IUDs and implants release a small amount of a synthetic progestin which thickens your cervical mucus so sperm can’t reach the egg, thins the uterine wall to make implantation unlikely and in some cases, can stop ovulation all together. The synthetic hormones in each are similar, but not exactly the same. So, if one doesn’t work for you, the other may. This is important to note: no form of hormonal birth control has exactly the same cocktail of hormones- even if they contain the same kind of hormones. Experimentation and checking in with your body is key!
With a hormonal IUD, the hormones are more localized. Because the implant goes into the arm and delivers hormones to the bloodstream, you might feel more side effects with the implant than the IUD.
The copper IUD is a different story, because it has no hormones and relies on the magic of copper- which is toxic for sperm :croak:
If you are definitely deciding between the two, try asking yourself (and talking through with your practitioner...)
Do I like my current period? Would I like it to be heavier or lighter?
Have I used an implant or IUD before?
How do I feel about hormones in my body?
Do I want something in my arm or my uterus?
Could I be sensitive to copper?
Am I prone to vaginal infections?
Would I be OK potentially have a scar on my arm?
How old do I need to be to get an IUD or Implant?
If you’re under age, you may be able to access birth control without the consent or notification of your guardian. This changes by state, so check out this guide to see your options.
Can I use either of these if I have HIV/AIDS?
Yes! Any reduction in effectiveness is small and the benefits have been shown to outweigh the drawbacks (7). The IUD and implant can be safe options for seropositive people (7).
What are the risks for each?
Everyone’s body is different, so it is hard to predict who will experience side effects or which side effects you will experience. This is why it is so important that you pay attention to your individual body and the signals it may be giving you along the way.
That said, some of the more common side effects of the IUD are (6):
Changes to your period, like irregular bleeding and spotting
Hormonal acne, especially along the jawline.
Increased instances of BV (aka bacterial vaginosis)
More common side effects of the implant include (9):
While these are the most common, if you’re feeling constantly depressed, anxious, uncomfortable in your body, fatigued, dizzy, nauseous, or your sex drive has changed, it’s worth mentioning to your practitioner and seeing if there’s a connection to your birth control.
Are they safe during breast/chestfeeding?
Yes! Implants and IUDs are safe for breast/chestfeeders (4).
V. IMPORTANT INFO ALERT! If at any point you experience:
Extreme pain during intercourse
Severe abdominal or pelvic pain
Severe sudden headache
Severe leg pain
Get help immediately.
While it’s very, very rare, if you do become pregnant while on an IUD, there is a higher chance that the pregnancy will be ectopic (4), meaning it implants outside the uterus (remember, that uterus will be inhospitable while the IUD is in place!). This is dangerous and needs to be addressed immediately. If you suspect you’re pregnant while using any form of birth control, it’s important to speak to your doctor right away.
In short, they are both very effective. The implant and IUD are more effective than the pill or condom, and considered almost as effective as tubal sterilization (aka “getting your tubes tied”). Why? There’s no risk of user error. If you’re a person who just can’t remember to take pills, this might be a good option for you.
In one year of typical use, .05 people will get pregnant on the implant, .2 will become pregnant with the hormonal IUD, and .8 will become pregnant on the nonhormonal one (1). These are all less than 1 in a 100, but no method in 100% effective.
HOW ARE THEY REMOVED
Removal is generally quicker and less painful than insertion though it will still require that good ole speculum. An instrument is used to help the health care provider grasp the IUD strings and gently tug to remove it. A little bit of cramping is common, but is typically not as intense as insertion.
For the removal of the implant, the arm is again numbed. A tiny incision is made, and the implant is pulled out. This all happens in a couple of minutes. You may feel a pinch, but there shouldn’t be lots of pain. You will then have a dressing put on your arm which you should keep on for a few days to reduce bruising and in order to keep it clean and dry. You may experience tenderness, soreness and bruising.
V. important note: Even though these options both last years, you can always have it removed sooner! You are in control of your birth control (though you will need your health care provider’s help for these options)
IUD vs. Implant… hopefully you have a better sense now!
Written by: Catherine Work, C+S Team
Medically Reviewed by: Danielle LeBlanc, RN
1. Guttmacher Institute. July 26, 2018. “Contraceptive Use in the United States.” www.guttmacher.org/fact-sheet/contraceptive-use-united-states.
2. Guttmacher Institute. November 8, 2007. “Popularity Disparity: Attitudes About the IUD in Europe and the United States.” https://www.guttmacher.org/gpr/2007/11/popularity-disparity-attitudes-about-iud-europe-and-united-states
3. Mayo Clinic. December 22, 2018. “Contraceptive Implant.” www.mayoclinic.org/tests-procedures/contraceptive-implant/about/pac-20393619.
4. Espey, Eve, and Lisa Hofler. “Practice Bulletin No. 186 Summary: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.” Obstetrics & Gynecology, vol. 130, no. 5, 2017, pp. 1173–1175., doi:10.1097/00006250-201711000-00047.
5. Bedsider. March 2018. “Implant – Birth Control Method.” www.bedsider.org/methods/implant#alternatives.
6. Bedsider. 2019. “IUD – Birth Control Method.” www.bedsider.org/methods/iud#side_effects.
7. Jamshidi, Roxanne, and David Chelmow. “Practice Bulletin No. 117: Gynecologic Care for Women With Human Immunodeficiency Virus.” Obstetrics & Gynecology, vol. 116, no. 6, 2010, pp. 1492–1509., doi:10.1097/aog.0b013e3182054cae.
8. NWHN. March 29, 2018. “What Is the Birth Control Implant and How Is It Different from an IUD?” nwhn.org/birth-control-implant-different-iud/.
9. Stacey, Dawn (PhD, LMHC). Updated December 7, 2018. “Overview of the Nexplanon Birth Control Implant.” Accessed March 11, 2019. https://www.verywellhealth.com/nexplanon-birth-control-implant-faq-906864