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The Pill vs. The Birth Control Implant: Which Is More Effective?

Kristin Hall

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 10/22/2020

Used properly, the birth control pill is one of the most effective ways to prevent pregnancy. Used by millions of women in the U.S. alone, it’s a safe, effective form of contraception that deserves its popularity.

However, the pill definitely isn’t the only way to keep yourself protected from pregnancy. From the IUD to the patch, injection and more, there are several different options available to reduce your risk of becoming pregnant from vaginal sex. 

Below, we’ve compared the pill and the birth control implant. We’ve listed the key advantages, disadvantages and unique features of each option to help you choose a form of contraception that best suits your needs. 

We’ve also listed the common side effects you might experience, whether you opt for the pill or the implant. 

The Birth Control Pill

The birth control pill (or “the pill,” as it’s more commonly known) is one of the most popular forms of contraception in the world.

Currently, there are two types of birth control pill available. The first is the combination pill. This type of birth control pill uses two hormones — a synthetic version of estrogen known as ethinyl estradiol, as well as a progestin hormone.

This type of birth control pill works by preventing your body from ovulating, meaning you won’t release eggs. It also affects your cervical mucus, creating a thicker barrier that prevents sperm from coming into contact with an egg. 

The second type of birth control in use today is the progestin-only pill, or “mini-pill.” This type of birth control pill only contains a small dose of a progestin hormone, without any ethinyl estradiol or other hormones.

While the progestin-only pill can stop you from ovulating, this isn’t guaranteed. Instead, this type of birth control pill prevents pregnancy by affecting your cervical mucus, making it less likely for sperm to enter into your uterus and come into contact with an egg.

Our guide to combined and progestin-only birth control pills goes into more detail on the major differences between each type of birth control, as well as the main reasons you might want to use one type of pill over the other. 

From an effectiveness standpoint, both types of birth control pill work very well as a way to stop pregnancy.

Used according to the instructions, the combined birth control pill and progestin-only pill have a 99 percent effectiveness rate. This means that if you take the pill as recommended at the same time every day, you have a one percent risk of becoming pregnant every year.

Of course, it’s far from uncommon to miss a dose, take a pill late or make other mistakes while using the pill. Because of this, the average “real life” effectiveness rate of the pill is about 91percent. 

If you’re worried about becoming pregnant, the best way to keep yourself protected is to take your pill at the same time every day without missing any doses.

Advantages of the Pill

Compared to other forms of birth control, the pill offers several key advantages. 

First, it’s very effective when used correctly. If you take your pill on time without missing any doses, you’ll be protected from pregnancy as high as 99 percent of the time. 

Second, the pill has several benefits for your period. If you normally have a heavy period, there’s a good chance you’ll experience lighter bleeding after you start taking the pill. Many women also get a shorter period after they start using hormonal birth control. 

The pill can often make cramps, aches and other forms of premenstrual discomfort less severe, making it worth considering if you get discomfort before or during your period. 

Some birth control pills also let you skip your period. If you choose an extended cycle pill, such as Seasonale®, Quasense®, Seasonique® or LoSeasonique®, you’ll be able to skip two out of every three periods, giving you one period about every three months.

Most birth control pills come with a cycle calendar, making it easy to track where you are in your cycle. If you follow the instructions provided with your birth control pill, it’s normally easy to keep yourself continually protected without any missed doses.

Third, the birth control pill can improve your skin. Combined birth control pills such as Estrostep®, Yaz® and Ortho Tri-Cyclen® are linked to reductions in acne breakouts and are all approved by the FDA as treatments for hormonal acne. 

These pills work by suppressing the production of hormones that contribute to acne. Our guide to birth control and acne goes into more detail on how these medications can help you prevent acne while protecting yourself from becoming pregnant.

It’s important to note that not all birth control pills prevent acne — you’ll usually only experience an improvement in your skin if you use a combined estrogen and progestin birth control pill. 

Finally, the pill may reduce your risk of developing certain diseases and health conditions, such as endometrial and ovarian cancers, ovarian cysts and several vaginal infections.

Disadvantages of the Pill

While the pill is safe and effective, it’s not completely free of side effects. There are also several practical disadvantages to the pill that can make it less effective.

Most side effects of the pill are relatively minor. Common side effects include breast tenderness, nausea and fluid retention. It’s also quite common to experience spotting — bleeding in between your periods — after you start using the birth control pill.

These side effects are most common during the first one to three months of using the pill. Most of the time, they’ll resolve on their own as your body becomes used to the hormones in the birth control pill. 

Our guide to birth control side effects goes into more detail on how and why these side effects happen, as well as your risk of experiencing them.

While uncommon, it’s also possible to experience some more serious side effects after you start using the pill. 

Of these, the most serious is a mild increase in your risk of developing blood clots. If you have existing cardiovascular issues, or if you’re a smoker aged 35 or up, you could develop a higher risk of blood clots and other cardiovascular side effects after starting the pill.

These side effects can also occur with other forms of hormonal birth control. Our guide to birth control and smoking goes into more detail on how these cardiovascular issues can happen, as well as alternative birth control options if you’re at risk. 

Since you need to take the pill every day for it to be effective, it’s possible to become pregnant while using the pill if you miss a dose or take a pill late.

If you’re prone to forgetting to take medication, you work in a job with irregular shifts or if you travel frequently and find it difficult to stick to a daily medication schedule, the pill might not be the best form of birth control for you.

It’s also important to know that the pill doesn’t provide any protection from sexually transmitted infections or HIV. To keep yourself fully protected, it’s best to use a barrier-based form of birth control such as condoms. 

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The Birth Control Implant

The birth control implant is a tiny, rod-shaped implant that’s inserted into your arm. The implant is about the same size as a matchstick, meaning you won’t notice it physically after it’s inserted into your body. 

After insertion, the birth control implant works by slowly releasing a small dose of etonogestrel, a progestin hormone, into your body.

In the U.S., the birth control implant is sold under the brand name Nexplanon®. Internationally, it’s available under a variety of different brand names. 

Etonogestrel stops you from becoming pregnant in two ways, similar to the progestin-only birth control pill. 

First, it prevents you from ovulating, meaning any sperm that enters into your vagina cannot come into contact with an egg. 

Etonogestrel also affects your cervical mucus, preventing sperm from entering your cervix even if an egg is released. 

Unlike the pill, which needs to be taken every day, the implant starts working as soon as it’s in your body. The implant can last for up to five years, meaning you’ll be protected from becoming pregnant without having to worry about taking a daily pill.

The birth control implant has one of the highest effectiveness rates of any form of contraception. After it’s inserted, the implant is more than 99 percent effective at stopping you from becoming pregnant from vaginal sex. 

Since it’s impossible to forget a dose with the implant, there’s no “real life” effectiveness rate to worry about. Once the implant is in your body, your risk of becoming pregnant from vaginal sex is less than one percent every year. 

Normally, the implant will protect you from pregnancy for approximately five years. However, if you decide you want to get pregnant, your healthcare provider can remove the implant. You’ll be able to get pregnant as soon as the implant is removed without any delays or lasting effects. 

Advantages of the Implant

The biggest advantage of the birth control implant is that it’s extremely effective. After it’s placed in your arm, the birth control implant has one of the highest effectiveness rates of any hormonal contraceptive, helping you avoid unexpected or unwanted pregnancies. 

Because the implant is inserted into your body, it’s also impossible to make a mistake and miss a dose. This means your average risk of becoming pregnant is far lower with the implant than it is with a typical birth control pill under “real life” usage conditions.

If you’re looking for a simple, zero-effort form of birth control, the implant is one of the best options for you. Inserting the implant is a quick process that will only take your healthcare provider a few minutes. 

Beyond its effectiveness as a form of contraception, the birth control implant also has several other benefits.

Like the pill, the implant can make your period lighter, shorter and less painful. About one third of women who use the implant completely stop getting their period after one year, making it a good form of birth control if you frequently get heavy, painful or uncomfortable periods.

Because the implant only contains a progestin hormone, it’s less likely to contribute to certain side effects than the combined birth control pill.

Finally, because the implant is placed under your skin, it’s a completely hidden, private form of birth control. Once it’s inserted into your body, there’s no need for you to swallow a pill daily or visit the pharmacy to renew your prescription. 

Disadvantages of the Implant

No form of contraception is perfect, and the birth control implant is no exception. Like all other forms of hormonal birth control, the implant can cause several side effects. Most of these side effects are minor and resolve on their own after a few months.

The most common side effect of the implant is spotting, or irregular bleeding in between your periods. Spotting is most common during the first few months of using the implant, and usually resolves on its own over the course of the first year.

Most of the time, spotting from the birth control implant is light. However, a small percentage of women who use the implant experience changes in their bleeding patterns. 

Other potential side effects of the implant include breast tenderness and pain, mild weight gain due to fluid retention, nausea and headaches. A small percentage of women develop infections and skin irritation as a result of using the implant. 

While these side effects can seem alarming, it’s important to keep them in perspective. Overall, the implant is a safe and effective form of birth control, with side effects uncommon and usually temporary in nature. 

Because the implant only contains a progestin hormone, it doesn’t have any effect on acne or other skin conditions.

Finally, just like the pill, the birth control implant doesn’t provide any protection against sexually transmitted infections or HIV. To keep yourself protected, you and your partner will need to use condoms.

The Pill or the Implant: Which is More Effective? 

Both the pill and the implant are highly effective forms of birth control, with a 99 percent effectiveness rate when used correctly.

However, in real life conditions, the implant is usually a more effective form of birth control than the pill. Once it’s inserted into your arm, it’s impossible to forget a dose, take a pill late or make other common birth control mistakes with the implant.

Because of this, the implant is a great choice if you’re worried about forgetting to take the birth control pill, or if you just don’t like the idea of taking a pill every day to keep yourself protected from becoming pregnant.

On the other hand, the pill also offers its own range of advantages. If you prefer oral medication to an implant or need to treat hormonal acne, the birth control pill is a great way to keep yourself protected from pregnancy.

As always, there’s no “best” form of birth control for everyone. Both the implant and the pill offer their own advantages and disadvantages, making the best form of birth control the one you feel most comfortable using. If you want to know more about all the options of contraception available, the best thing to do is talk to your healthcare provider.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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