(Nexplanon) implant vs IUD: Which is best for your body?

Intrauterine devices (IUDs) and implants are both long-acting, reversible contraceptive (LARC) devices that are inserted into your body by a healthcare professional. It’s important to note that neither protects against sexually transmitted infections (STIs) [1], but they’re both highly effective at preventing pregnancy — over 99% effectiveness with typical use [2]. 

How do implants and IUDs work?

LARCs are effective at preventing pregnancy for three to 12 years depending on the type of device. They work with your body in a few different ways to make sure you don’t get pregnant. We’ll go over the implant first, then the two types of IUDs: hormonal and non-hormonal copper IUDs.

Nexplanon implant

The implant, also known by its brand name Nexplanon, is a tiny, thin rod about the size of a matchstick that sits under the skin of your upper arm [3]. This rod gradually releases the hormone progestin (a synthetic version of progesterone) into your body over time. This steady supply of progestin works to prevent pregnancy in two ways:

1. Prevents egg cells from leaving your ovaries, so there is no egg cell for sperm to fertilize in the first place
2. It thickens your cervical mucus, making it much more difficult for sperm cells to fertilize the egg cell [3]

Both of these processes work together to effectively prevent pregnancy for up to three years. When the three-year period is up, you can choose to get a new implant for another three years, or leave it out if you’re planning a pregnancy or just want to switch birth control methods [3].  

Hormonal IUD

The hormonal IUD is a T-shaped device that sits inside your uterus. It works similarly to the implant — the hormones it releases over time into your body thicken the cervical mucus and prevent ovulation (the process of eggs leaving your ovaries). This makes the hormonal IUD very effective at preventing pregnancy [5].

Non-hormonal copper IUD

The copper IUD has the same T shape as the hormonal IUD, and it also sits inside of your uterus. But instead of releasing hormones to prevent pregnancy, its active ingredient is copper. Copper prevents sperm cells from reaching and fertilizing egg cells. It also changes the uterine lining and prevents implantation of a fertilized egg cell. This is how the copper IUD effectively prevents pregnancy [6].

IUDs and implants: what are the options?

You can get IUDs and implants at any reproductive age — from when you get your period to menopause. They can also both be inserted at any time during your menstrual cycle (more on that later). There are a few different kinds of IUDs, all with different brand names and lengths of effectiveness:

• Mirena (hormonal IUD, effective for 8 years)
• Liletta (hormonal IUD, effective for 8 years)
• Kyleena (hormonal IUD, effective for 5 years)
• Skyla (hormonal IUD, effective for 3 years)
• Paragard (copper IUD, effective for 10 years) [5, 7]

The implant only has one current name brand — Nexplanon. It’s effective for up to five years [4].

IUD vs. implant insertion procedure

IUDs and implants are placed in different parts of the body, so the insertion procedures are quite different (although they both need to be performed by a healthcare provider).

IUD insertion

The IUD insertion process is pretty quick — the procedure will take about five to ten minutes, but the whole appointment may take up to 30 minutes. Before the procedure, your healthcare provider might want to test for STIs and pregnancy, as STIs need to be treated first, and the IUD can’t be fitted if you’re already pregnant [9].

It’s also a good idea to speak with your healthcare provider before the procedure about how you experience pain and what kinds of pain medications are available to you before, during, and/or post-procedure. Most people experience some sort of pain during and after the IUD insertion, so your doctor may be able to provide anesthesia or recommend an over-the-counter pain relief medication [5, 9].

Then, during the procedure, a smooth, tube shaped tool called a speculum will be inserted into your vagina to open it up, like a pap smear. The doctor will then insert the IUD through your cervix and up into your uterus. One or two small strings will come out of your uterus and into the top of your vagina — you won’t notice this, but it’s there so that the IUD can be removed or replaced in a few years [5].

Some people feel fine after getting an IUD inserted while others need to rest and recover for a while. You may experience some cramping and back pain similar to menstrual symptoms after the insertion, and you may also have some spotting. All of this should subside within a few days, but it’s a good idea to speak with your healthcare provider about any pain you’re experiencing [5].

IUDs can be inserted at any time, and you’re protected from pregnancy right away if you get Mirena, Liletta, or Paragard (the copper IUD). If you get Kyleena or Skyla, they’ll prevent pregnancy right away if they’re placed within the first seven days of your period. If they’re inserted at any other time during your cycle, you’ll need to use a backup contraception method like condoms or abstain from intercourse for the next seven days to make sure you don’t get pregnant [5].

Implant insertion

Inserting the implant is also a quick procedure that only takes a few minutes. Your healthcare provider will use local anaesthesia to numb the area on the inside of your upper arm, which is where the rod will be placed. Then, they’ll use a tool to insert the rod into the numbed area. It probably won’t hurt any more than getting a shot, but when the anesthesia has worn off, you may feel an ache where the rod was inserted. It should subside soon, and you may also have some slight bruising or swelling in the area for the next few days. Your healthcare provider will share more about what to expect and how to care for the area [4].

The implant can be inserted at any time as long as you’re not pregnant, but if it’s placed within five days of starting your period, you’ll be protected from pregnancy immediately, and you won’t need to use backup birth control. If it’s placed five days or more after your period starts, you’ll need to use a backup contraception method or abstain for seven days after the insertion [8].

IUD vs. implant removal

If you’re ready to remove your IUD or implant, the same provider that inserted it can remove it. If you’ve moved or want to try a different provider, most medical offices that insert IUDs can also remove them — just be sure to check with your provider(s) and your insurance for more information [5, 10].

There are a variety of reasons to get an IUD or implant removed — you may want to start trying for a pregnancy, you might not want to deal with hormonal side effects anymore, or it might be time to replace the device to maintain pregnancy prevention. Whatever the case may be, here’s what you need to know about getting these methods of birth control removed:

IUD removal

To remove the IUD, your healthcare professional will gently pull on the strings of the IUD in your vagina. The arms of the T shape of the device will fold in, and it will slip out. It’s usually less painful than getting the device inserted, but you may feel some cramping right as it comes out. You can always take over-the-counter pain medication before getting the IUD removed if you’re concerned about pain. You may also experience some light spotting, which will go away soon after [5].

You can get the IUD removed at any time during your cycle, but it’s possible to get pregnant right away once it’s removed. If that’s not your plan and you’re not getting a new IUD inserted to replace it, be sure to explore other types of birth control to stay protected from pregnancy [5].

Implant removal

If you want to get the implant removed, your doctor will use local anaesthetic to numb the area, just like they did during insertion. Once you’re numb, they’ll make a small cut in the skin and pull the implant out [10].

Most people don’t have side effects after removal, but you may feel some slight swelling or tenderness in the area over the next few days. Similarly to the IUD, you can get the implant removed at any time, and you’ll no longer be protected against pregnancy once it’s removed [4].

IUD vs. implant side effects

While the most common side effects of these contraceptives usually aren’t dangerous, and you may not experience any of them depending on your medical history and circumstances, they’re worth noting as you’re exploring your birth control choices. The IUD and the implant have slightly different potential side effects, and the hormonal IUD options have different side effects compared to the non-hormonal copper IUD. Let’s go through each:

Hormonal IUD side effects

Hormonal IUDs can actually have positive side effects for some, like less menstrual cramps and premenstrual syndrome (PMS) symptoms. They can also make your periods lighter, and some may stop getting periods altogether while the hormonal IUD is inserted (note that this will all come back if you get the IUD removed and don’t replace it with another IUD or alternative form of hormonal birth control) [5].

However, you may also experience some unpleasant side effects including irregular periods or spotting between periods. This usually goes away within three to six months though, once your body has gotten used to the new hormones in your body [5].

Copper IUD side effects

The non-hormonal copper IUD may actually make your menstrual period worse, with people often reporting more bleeding and cramps, especially in the first three-to-six-month adjustment period. After this, the symptoms usually get better over time. You may also experience spotting and irregular periods with the copper IUD [5].

Implant side effects

Similarly to the hormonal IUD, the most common negative side effect of the implant is spotting and irregular periods during the adjustment period. You may also experience headaches, breast pain, and nausea as your body works with the new hormones. For the implant, this adjustment period may take up to 12 months. But people have also reported lighter periods and less PMS on the implant — for many, periods can stop completely [10].

IUD vs. implant complications

While those side effects can be reasonably expected on any new hormonal medication, there are also some quite serious (but very, very rare) complications and disadvantages of the IUD and the implant alike. 

IUD complications

Speak with your healthcare provider about your existing conditions and medical history before deciding which birth control method to use, but it’s important to note that IUDs are not recommended if you have lupus, breast cancer, or a copper allergy (for Paragard IUD) [7].

Furthermore, there’s a very small chance that your IUD can move or slip out of your uterus. This is very rare, but if it happens, it won’t work the same way, and you can get pregnant. There’s also an extremely rare chance that the IUD can get stuck to the wall of your uterus. If this happens, your healthcare provider will need to remove and replace it [5]. 

During the insertion process, as with any medical procedure, there is a slight chance of infection that will need treatment from your doctor. Finally, while the chances of pregnancy with an IUD are extremely low, it’s more likely to be an ectopic pregnancy if you do get pregnant. An ectopic pregnancy is when a fertilized egg cell implants outside of the uterus — this needs immediate medical attention. Contact your doctor as soon as possible if you notice:

• Painful cramping or soreness in your lower belly
• Bleeding or pain during sex
• Fever, chills, or trouble breathing
• Abnormal discharge
• Heavy vaginal bleeding [5] 

Implant complications

Complications with the implant are also rare, but worth considering. You may experience arm pain that lasts for longer than a few days post-procedure, an infection from the insertion procedure that may require medication to address, or a scar in your arm from the implant [4]. 

Even more rarely, the implant may bend or break in your arm. If this happens, it needs to be removed and/or replaced [4]. Contact your provider if you experience any of the following symptoms after getting the implant:

• Bleeding, pus, discoloration, or pain at the injection site that doesn’t stop within a day or so
• Much heavier or longer menstrual bleeding than normal
• Yellowing of your eyes or skin
• The implant has moved in your arm [4]

Cost comparison: IUD vs. implant

One more important difference to take into account when deciding between the implant or the IUD is the cost and your type of healthcare system. The device, the cost of the insertion procedures, and the cost of removal are all considerations as you’re choosing your birth control.

According to Planned Parenthood, getting an IUD can cost up to $1800 in the U.S. The implant may be a bit more expensive — up to $2300 for insertion and up to $300 for removal. The good news is that most U.S. health insurance plans, including Medicaid and some government programs, may cover some or all of the cost. In the UK, birth control is typically covered by the NHS. Check with your insurance provider or the healthcare plan in your area to learn more [4, 5].

IUD vs. implant similarities

Let’s sum it all up with some key similarities to consider between the IUD and the implant:

• Both are external devices inserted into your body to prevent pregnancy
• They’re both effective for years
• You don’t need to think about them every day or every time you have sex
• They both need to be inserted and removed by a trained healthcare professional
• Neither protects against STIs

IUDs vs. implants differences

There are also some differences between the two to think about which one would be better suited for you:

• The IUD is inserted into your uterus, and the implant is inserted into your arm
• IUDs prevent pregnancy for a few more years on average than the implant does (depending on the IUD brand)
• The implant and some of the IUD brands are hormonal birth control options, while the Paragard copper IUD is non-hormonal
• The implant may be a bit more expensive than an IUD, depending on your healthcare coverage

Which one should you choose?

Ultimately, the decision between the implant vs. the IUD (or another form of birth control) is up to you, after informed conversations with your healthcare provider considering your medical history and current circumstances. They can help you make the best decision for your body and lifestyle, but here’s a handy, high-level comparison chart that may help you kick off the discussion:

*Keep in mind that costs and access can vary depending on where you live. 

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