Side-by-side comparison
Pill vs IUD
The IUD is far more effective in real life (over 99% vs about 93%) because there is nothing to remember. The pill needs no procedure and you can stop it yourself any day; the IUD needs a clinician to fit and remove it.
By the AltFTool health editorial teamLast reviewed Checked against WHO, CDC and NHS guidance
Key differences
| Feature | Combined pill | Hormonal IUD |
|---|---|---|
| Typical-use effectiveness | 93% | Over 99% |
| Perfect-use effectiveness | Over 99% | Over 99% |
| Hormones | Estrogen + progestogen | Progestogen |
| How long it lasts | One pill a day; protection depends on taking it consistently | 3 to 8 years, depending on the brand |
| Protects against STIs | No | No |
| Needs a clinician to start | Yes | Yes |
| Daily or every-time action | Yes | No |
| You can stop it yourself | Yes | No |
| Fertility after stopping | Quickly after stopping | Quickly after removal |
| While breastfeeding | Not in the first 6 weeks after birth (ask a clinician) | Yes |
| Effect on periods | Bleeding is usually lighter, more regular, and less painful, and some regimens let you skip bleeds. | Periods usually become lighter and less painful, and many people stop bleeding, though spotting is common in the first months. |
Read each guide
Combined pill
People who can remember a daily pill and want control over their periods, provided they do not have risk factors that rule out estrogen.
Hormonal IUD
People who want very effective, long-lasting contraception, especially those with heavy or painful periods or who cannot take estrogen.
FAQ
Which is more effective, combined pill or hormonal iud?
The IUD is far more effective in real life (over 99% vs about 93%) because there is nothing to remember. The pill needs no procedure and you can stop it yourself any day; the IUD needs a clinician to fit and remove it.
Does the combined pill or hormonal iud protect against STIs?
Neither does. Use condoms as well if you need protection from sexually transmitted infections.
Can I switch from the combined pill to the hormonal iud?
Usually yes. A clinician or pharmacist can tell you when to start the new method and whether you need extra protection (such as condoms) for a few days while switching.
More comparisons
Sources
Reviewed 1 November 2026. We link to the guidance itself so you can check it.