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An unwanted pregnancy can cause a lot of disruption in one’s flow of life. Unwanted pregnancy happens primarily due to a lack of knowledge and awareness about contraceptive measures.

The two most secure forms of contraception are Intra Uterine Devices (IUDs) and birth control pills. However, one must know the safest option, whose success rate is the highest, is aligned with one’s needs and health metrics and involves fewer side effects before choosing one.

Let’s look at the following comparison of pills vs IUD to make an informed decision.

It would help to understand how both these options work to prevent pregnancy. Let’s study these two processes independently.

• One has to take pills orally at a specific time every day. In some cases, one might have to take it for 21 days and refrain for 7 days; in other cases, one can take 28 days straight in a particular order.
  
• Birth control pills are a combination of steroid hormones, namely progesterone (synthetic progestin) and oestrogen that primarily avert pregnancy by preventing ovulation.
• Birth control pills also prevent sperm cells from entering the uterus by thickening the mucus layer at the opening.
• Pills also deter pregnancy by thinning the uterine tissue lining. It reduces the possibilities of the implantation of an egg and further fertilisation.

• An IUD is inserted by a professional health care provider, and an individual does not require doing anything for a long stretch of time, generally 5 – 10 years.
  
• For example, a copper IUDs primary function is to release a very low level of copper ion in the uterus that affects sperm motility and prevents fertilisation.
• A copper IUD would also fend off fertilisation by blocking the implantation of an egg.
• Hormonal IUD, on the other hand, works by slowly releasing hormones and preventing ovulation, thickening the mucus layer and thinning the uterine tissue lining.

The methods to prevent pregnancy, namely, IUD and birth control pills, come in various forms. Let's take a look at them to have a clear understanding.

Types of Birth Control Pills:

• Phasic and Monophasic Oral Pills: Phasic and monophasic pills are a combination of hormones that need to be taken every day for 21 days and discontinued for 7 days each month.
  
• Every Day Pills (ED Pills): Everyday pill or ED pill involves taking a specific type of pill for 21 days straight and another type of pill for the remaining 7 days in a 28-day cycle. The pills one takes for 21 days are active, and the rest are inactive or dummy pills in an ED pill pack.

Types of IUD:

• Copper IUD (Non-Hormonal IUD): Copper IUD contains primarily two elements: copper and plastic. The constant release of copper ions works as a spermicidal agent. It also prevents the implantation of the foetus in the uterus.
  
• Hormonal IUD: A hormonal IUD releases a hormone called progestin levonorgestrel. It thins the lining around the uterus and thickens the mucus near the cervix opening. It prevents pregnancy by stopping sperm from reaching an egg and by stopping ovulation too.

Effectiveness of Pills

• Completely User-Dependent: If taken in the right dosage, a birth control pill or combined pill can be 99% effective in preventing pregnancy. However, for most women, it becomes a challenge to maintain strict regularity, and each year 9 women out of 100 get pregnant while using the pills.
  
• Every Day Hassle: Using birth control pills can be very hectic. To keep the efficiency of birth control pills high, one has to:
  • Choose the right dosage depending on individual circumstances
  • Take it every day at a specific time
  • Make sure to start the intake at the right stage of her menstrual cycle
  • Use birth control apps to set reminders
• Short-term Effectiveness: Generally, it takes 7 days for a cycle of birth control pills to start having an effect. Until then, one must refrain from intercourse or use other pregnancy prevention methods. However, if one stops taking the pills, one can get pregnant within a month.
• Emergency Contraception: Using a regular birth control pill in a proper dosage is equally effective as an Emergency Contraceptive Pill (ECP). However, most clinical physicians don’t recommend such usage. One can take a regular pill within 120 hours of unprotected sex and another dose 12 hours after the first one to prevent pregnancy.

Effectiveness of IUD

• No User Involvement: When it comes to success rate, IUD is the most secure option, with a higher than 99% success rate. The success rate is due to the zero-user-involvement operative nature. It leaves no room for a mistake.
  
• One-Time Hassle: Most likely, when one is on her period, as the cervix stays more open that time, the physician will choose to insert the IUD. The short procedure involves the following steps:
  • Placing of a speculum to keep the vaginal wall open
  • Insertion of a tube where the IUD is put through the cervix into the uterus
  • Pushing the IUD out of the tube and placing it in the uterus
  • Pulling the tube and speculum out
• Long-Term Effectiveness: If one decides to use an IUD and gets it inserted, from that moment, she can forget about taking any measure for preventing pregnancy whatsoever for 5 to 10 years. Only in some cases, when an IUD gets expelled from the uterus, one needs to get it reinserted.
• Emergency Contraception: Both copper-bearing and levonorgestrel IUDs work perfectly as emergency contraception. If IUD is implemented within 120 hours of unprotected intercourse, it prevents unwanted pregnancy effectively.

However, according to the World Health Organisation, the most effective form of emergency contraception is a copper-bearing IUD.

Advantages of Pills

• Avoid Pregnancy: The primary advantage and benefit of using birth control pills is that one can avoid unwanted pregnancy or postpone it successfully until pregnancy is welcome.
• Cost Effective: Birth control pills or combined pills are cost-effective, as they are offered free with most health insurance. Other protective measures like condoms or diaphragms can cost much higher if used regularly.
• Ready for Pregnancy: After one stops taking the pill, in a few months, they can regain back their fertility and get their usual hormonal cycle back. In some cases, people have irregularities in their cycles, and some miss the cycles completely. However, even with irregular periods, one can get pregnant if they have stopped using the pills.
• Simple Process: It takes less than 5 seconds each day to take a pill. It also helps to prevent the disruption preparing for a condom can cause during intercourse.
• Effect on Period: Using birth control pills can also affect how one’s periods feel. For example, many women have severe cramps and heavy bleeding while menstruating. These pills can ease the cramps a little and even lower the bleeding.
• Other Effects: Studies show that birth control pills can lower the chances of uterine or ovarian cancer if it is regularly taken for five years or more.

Advantages of IUD:

• Long-Term Solution: If one decides to insert an IUD, depending on the type of IUD, one can get up to 10 (even 12) years; they don't have to think about getting pregnant.
• One-Time Cost: An IUD can also be covered by health insurance, but if not, it will ultimately cost less as it covers a longer time of effect.
• Ready for Pregnancy: Whenever a woman or a couple thinks it is the right time to get pregnant, they can ask a gynaecologist to remove the device, and the uterus will be instantly ready for pregnancy.
• Simple Process: The insertion of an IUD is a simple process; it involves 5 to 15 minutes of procedure. After it is done, the woman is recommended to wait for a few minutes to ensure she is feeling okay before leaving the doctor's chamber.
• Effect on Period: Copper IUD can increase cramps and bleeding in the initial phase but that generally subsides later. Hormonal IUDs affect one's periods similarly to pills.
• Other Effects: One can opt for an IUD a month after giving birth, and it does not affect one's breastfeeding in any way. One can opt for an IUD insertion after an abortion too. IUD is not associated with any type of cancer either.

Side Effects of Birth Control Pills

• Spotting: The pills change the hormone levels in the body and that affects one’s uterus lining causing spotting. This is a common side effect of birth control pills and generally goes away within 2-3 months of initial use.
• Vaginal Dryness: Pills containing oestrogen can flatten the natural high and low oestrogen trajectory and cause vaginal dryness. It can also indicate that the oestrogen level is low.
• Headaches: Many people who just started using pills for pregnancy prevention report having headaches in the first month. Generally, it goes away when the body is completely acclimated. However, each individual situation is different; one should consult a physician if it disrupts everyday life.
• Breast Tenderness: It can be a heavy feeling in one's breasts or a dull aching or burning sensation in the initial days of the first use of pills. It goes away in a few months of use.
• Nausea: Starting to use birth control pills, in many cases, involve feelings of nausea. However, It does not continue for more than 3 months. People facing this problem can have a little relief if they take their pill right before going to sleep.
• Mood Swing: The use of these pills can invigorate underlying mood-related issues. People who have suffered from mood disorders might see an increase in mood swings.
• Blood Clots: Birth control pills with oestrogen can form blood clots in one’s lungs and legs. And the blood-clot formation can create life-threatening situations.

Side Effects of IUD

• Uterine Infection: There is a very slim chance of uterine infection after an IUD insertion within 3 weeks of the procedure. However, a woman prone to STIs is at greater risk of having a uterine infection. Other than that, any pelvic infection due to the insertion, or a previous one can be treated without removing the device.
• Pain: Insertion of an IUD involves some cramping as one’s cervix is opened to fit the device. The initial cramps generally subside after some time. However, the duration of pain also depends on the type of the IUD. For example, hormonal IUDs would cause lesser cramps compared to copper-bearing IUDs.
• Expulsion: IUD expulsion can also cause sharp pain in the lower abdominal area. An IUD can fall out of someone's uterus partially or completely. The chances of expulsion increase during periods. One should check at regular intervals if their IUD is still in place by checking on the thread attached.
• Perforation: Organ perforation is one of the most severe side effects or risk factors of IUD. A perforated uterus due to miscalculated insertion or breakage of the device and its migration can cause pelvic inflammatory diseases (PID). In these cases, one has to contact professionals and get their IUD retracted.
• Moved IUD: It is very rare, but an IUD can move and cause problems. It can cause lower abdominal pain, make itself felt during intercourse, vaginal bleeding, fever due to infection, abnormal discharge, and more severe cramps.
• Ectopic Pregnancy: This is a very rare occurrence. When a sperm cell fertilises an egg reaching out further than the uterus and through the fallopian tube and the fertilised egg implants itself outside the uterine cavity.
• Risk of STIs: There is a slim chance of getting STIs during an IUD insertion procedure.

One should always consider the above-mentioned factors before considering either option for pregnancy prevention method.

One should compare the effectiveness, advantages, side effects and risk factors to make a decision that would suit her individual situation.

However, individuals must consult a gynaecologist or a professional healthcare provider of their choice for the right guidance.

Other than hormonal birth control methods and copper-bearing IUDs, there are several means of staying out of pregnancy. 2 of the most effective pregnancy prevention methods are:

• Surgical Method: It involves tubectomy, which is cutting off or tying up the woman's fallopian tubes so that sperms can never reach an egg, and vasectomy, where the man's tubes that carry sperms are sealed off.
• Behavioural Method: This method involves complete abstinence and contraceptive abstinence or outercourse. Complete abstinence means zero sexual activity, which leaves no room for unwanted pregnancy. Contraceptive abstinence means zero interaction between a vagina and a penis. It will stay 100% effective until one fails to continue the abstinence.