The Latest on Long-Acting Reversible Contraception - Which One Would Be Right for You?

Why choose long term contraception over something like a birth control pill?

·       Studies show that users of a long term reversible contraception (LARC) are more likely to continue the contraception and have fewer unintended pregnancies. 

·       This also translated to fewer abortions. This includes for teens, so a lower teen pregnancy rate.

Long Acting Reversible Contraception Overview

There are 2 classes of LARC: IUDs (Intrauterine Device) and the implant that is injected into the arm called Nexplanon.  It is about the size of a match stick. There are currently 5 IUD’s being used in the U.S., each of which can be used for varying periods of time:

Why so many options? They range in size and cost.

What are the downsides to a LARC?

Procedure

It will require a procedure to place it.  It is usually not very painful for most people.  You can ask your provider to give a little numbing injection. 

Cost

Also, there will be an initial cost.  Most insurance companies cover LARCs 100%, but without insurance you will need to pay up to $300.  If you use the device for its full lifespan, it will be cheaper than taking pills, but it is all up-front costs.

Side Effects

Side effects are another downside.  The most common side effect of the copper IUD is heavier and more painful periods.  This usually decreases over time.  The other IUDS can cause almost constant light bleeding, headaches, nausea, mood swings, breast tenderness and ovarian cyst formation.  These are all rare and also decrease over time.  The most common side effects of the Nexplanon are irregular bleeding and heavier periods.  Many, however, have no periods.  There are also reports of weight gain and increased acne with the Nexplanon. 

How does the IUD work and what are the risks?

The copper IUD prevents the sperm from migrating up to the fallopian tubes to fertilize the egg. The others change the cervical mucous to make the uterus impenetrable to sperm.  The risks are that your body can expel it.  This happens less than 10% of the time in the first year.  Uterine perforation, or poking a hole in the uterus during insertion is a really rare occurrence at about 0.1%.  There is also a risk of a difficult removal if the strings of the IUD curl up into the cervix or uterus.

Which LARC is the most effective?

They all are over 99% effective, but the Nexplanon is the most effective. Here is how it compares to other methods:

Other benefits:

·       The Mirena is used for heavy periods.  In fact, most women will have decreased bleeding and many will have no periods while it is in place.  It also has been used to prevent or reverse early endometrial cancer.

·       The Copper IUD can be used for emergency contraception up to 5 days after unprotected intercourse.

Other interesting facts:

·       All LARCS can be placed immediately after delivery and can be used during breast feeding.

·       All LARCs are >99% effective for 2 years after their FDA approval date. 

·       Return to fertility after the removal of a LARC is almost immediate.

More information:

Your provider can help you choose which IUD would fit you best if you are unsure.

For more information about birth control options, visit: https://www.plannedparenthood.org/learn/birth-control

By Codi Dawn Wiener, MD

Dr. Codi Wiener joined IHWSH as a physician-advisory almost as soon as she'd heard about us, so compelled because her "passion in life is women's health." She is an attending at the Texas Children's Hospital, a fellow of the American College of Obstetrics and Gynecology, with specialized training in minimally invasive and robotic surgical approaches to gynecological disease.