The Short Answer
The pill and IUD are both highly effective, but they work differently and suit different lifestyles. The IUD is more effective in real-world use (99%+ vs 91%) because there is nothing to remember daily. The pill gives you more control - you can stop at any time, switch formulations easily, and use it to manage acne or period symptoms. Your best choice depends on how much daily effort you are willing to put in.
Key Points:
- IUDs are more effective in practice because they remove the human-error factor
- The pill offers more formulation flexibility (dozens of options if one does not work)
- Both are reversible, but the pill allows faster stopping without a clinic visit
- Cost over time favors the IUD (one-time cost vs monthly refills)
- Neither protects against STIs
Head-to-Head Comparison
| Factor | Birth Control Pill | IUD (Hormonal) | IUD (Copper) |
|---|---|---|---|
| Typical effectiveness | 91% | 99.8% | 99.2% |
| Daily action needed | Yes | No | No |
| Hormones | Estrogen + progestin (or progestin only) | Progestin only (local) | None |
| Duration | Daily | 3-8 years | 10-12 years |
| Period changes | Lighter, more regular | Lighter or absent | May be heavier |
| Insertion procedure | No | Yes | Yes |
| Fertility return | Immediate | After removal | After removal |
| STI protection | No | No | No |
| Typical monthly cost | $0-50/month | $0-1,300 one-time | $0-1,300 one-time |
When the Pill Might Be Better for You
- You want the flexibility to stop, switch, or adjust your method without a clinic visit.
- You want to manage acne, PMS, or painful periods.
- You are comfortable with a daily routine and rarely forget medications.
- You prefer not to have an insertion procedure.
- You want to try hormonal contraception before committing to a long-acting method.
When an IUD Might Be Better for You
- You want the highest possible effectiveness without relying on daily habits.
- You want protection that lasts years without refills or pharmacy trips.
- You are forgetful with daily medications or have an unpredictable schedule.
- You want lower ongoing costs over time.
- You want lighter or absent periods (hormonal IUD) or a completely hormone-free option (copper IUD).
Side Effects Compared
Pill side effects tend to be systemic (whole body) because the hormones circulate through the bloodstream. Common effects include nausea, breast tenderness, mood changes, headaches, and spotting. These usually improve within 2-3 months. There are dozens of formulations your provider can try.
Hormonal IUD side effects are mostly local because the progestin stays concentrated in the uterus. Cramping and spotting are common in the first 3-6 months. Systemic side effects like mood changes or acne are less common than with the pill.
Copper IUD side effects do not include hormonal effects at all. The trade-off is heavier periods and stronger cramps, especially in the first few months.
Full breakdown of side effects by method
What About Cost?
Without insurance coverage:
- Pill: $0-50 per month ($0-600 per year)
- IUD: $0-1,300 for insertion, but nothing after that for 3-12 years
Over 5 years, the IUD almost always costs less, even at full price.
Can You Try One and Switch?
Yes. You can switch from the pill to an IUD or vice versa at almost any point. Your provider can often insert an IUD during the same visit you stop the pill. Going from IUD to pill is as simple as starting the pill the day the IUD is removed.
Read our guide on switching methods
Frequently Asked Questions
Is the IUD more painful than taking a pill?
The IUD requires an insertion procedure that can be uncomfortable for a few minutes. After that, there is nothing to do for years. The pill is painless to take but requires daily commitment. The brief discomfort of insertion is a one-time event vs a daily task.
Can I use the pill if I have tried an IUD and it did not work out?
Absolutely. Many people try one and switch to the other. Having a negative experience with one method does not limit your options.
Which one is better for acne?
Combined pills (estrogen + progestin) are the better choice for acne. Some are specifically FDA-approved for acne treatment. Hormonal IUDs use progestin only and can occasionally worsen acne in some users. More on birth control and acne.