Purpose: This study aimed to assess the effect of playing different pick-and-roll (PnR) defensive tactical options during small-sided games (SSGs) on external and internal loads in female basketball players. Methods: Twelve female basketball players (age 28 [2] y; stature 175 [6] cm; body mass 65 [7] kg; playing experience 18 [4] y) belonging to a team competing in the Lithuanian second division were recruited for this study. Across 3 experimental sessions and in a randomized order, players performed 3 SSGs sharing the same features but using 3 defensive strategies on the middle PnR action: Switch, Trap, and Drop. External load was measured using PlayerLoad (PL); the number of accelerations, decelerations, and changes of direction, classified based on their intensities as low (<2.5 m·s−2), medium (2.5–3.5 m·s−2), and high (>3.5 m·s−2); and jumps categorized as low (<40 cm) and high (≥40 cm). Internal load was measured via rating of perceived exertion (RPE). Results: Higher PL values in SSGs including Trap defense were found compared with Drop (P < .001, ES = 0.69, moderate) and Switch (P = .001, ES = 0.60, moderate). Additionally, a higher number of accelerations was registered in Trap defense compared with Drop defense (P = .027, ES = 0.99, moderate). Trap defense also led to higher RPE compared with Switch (P = .003, ES = 1.49, large) and Drop (P = .004, ES = 1.42, large) defense. Conclusions: Different defensive strategies on the middle PnR can influence the external and internal loads during SSGs, and female basketball coaches should consider the high demand of the Trap defense when designing SSGs.