August 31, 2022

What to know about long-acting reversible birth control

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Of many birth control options, IUDs and implants are very reliable, with the least hassle. 

Are you certain you don’t want to become pregnant in the next year?

It’s important to understand how different forms of birth control work, and which type is the best choice for you.

Long-acting reversible contraception (LARC) methods are the most effective birth control option.

To compare the number of pregnancies occurring in people using a LARC method vs. the birth control pill and condoms: Over the course of one year, of 100 LARC users, fewer than one will get pregnant. Of 100 birth control pill users, 9 will become pregnant; and among the same number relying on condoms, 18 will become pregnant.

Dr. Ivana Thompson, an obstetrician/gynecologist with Vanderbilt Women’s Health, explains these long-acting reversible contraception methods, which include intrauterine devices (IUDs) and subdermal (beneath the skin) implants that are inserted into the arm. 

The “reversible” in the term “long-acting reversible contraceptives” means you can have the implant or IUD removed if you want to get pregnant.

The benefits of long-term birth control

Most patients can use IUDs or subdermal implants safely. These “get it and forget it” methods mean there’s no need to remember to take a daily pill, or insert a contraceptive ring before sex. Once an IUD or an implant is removed, the ability to get pregnant is restored. These long-acting contraceptive methods are recommended as a tool not only for preventing a first pregnancy but also for spacing out pregnancies in a way that’s best for the individual and for families.

It is important to note that neither an IUD or an implant will prevent sexually transmitted infections. Condoms are the best way, aside from abstaining from sex, to avoid sexually transmitted diseases.

Important facts to consider about birth control options, and what to know about IUDs and implants:

All about intrauterine devices (IUDs)

How do IUDs work?
An IUD is a T-shaped device that a health-care provider inserts into the uterus, through the vagina. There are two types of IUDs: those that release a hormone; and non-hormonal devices wrapped in a copper coil. 

IUDs that rely on hormones release progestin, which thickens cervical mucus to prevent pregnancy. IUDs stop or decrease menstrual bleeding. Hormone-based IUDs can stay in place for three to eight years.

Copper IUDs do not contain any hormone. The copper limits sperm mobility, so sperm cannot reach an egg to fertilize it. With a copper IUD you still ovulate and get your period. They can stay in place for up to 12 years. 

Safety

Today’s IUDs are safe. They do not increase the risk for infection or cause infertility. Compared with the earliest IUDs on the market a generation ago, today’s IUDs have an improved design that reduces the risk of infections. Serious complications are very rare, Thompson said. 

IUD effectiveness

“One of the benefits of using an IUD is that they are over 99% effective at preventing pregnancy,” Thompson said. 

What it’s like to use an IUD

Having an IUD inserted feels similar to having a menstrual cramp. An IUD is inserted by your health-care provider in an office visit. (It can also be inserted immediately after giving birth, vaginally or by C-section. Ask your obstetrician or midwife about this option before you go into labor. IUDs are safe for mothers who are breastfeeding their babies.) If you decide to get an IUD, talk with your doctor first about taking an over-the-counter pain medicine. Most patients feel no long-term side effects from IUDs. 

When the IUD is at the end of its effective life, it can be removed quickly and easily during an office visit. Once the IUD is removed, there is no residual contraceptive effect; fertility is restored.

All about subdermal implants

The most common subdermal (under the skin) implant used today is marketed under the brand name Nexplanon. It’s a single small (4 cm) rod containing hormones, placed under the skin in an arm. 

How does the birth control implant work?
The implant works by releasing progestin, which prevents ovulation. The implant is the most effective contraception available — “a smidge more effective than the IUD,” Thompson said. 

This implant works for up to three years. 

Two advantages of an implant over other birth control methods, Thompson said, are that, like an IUD, “once it’s in place and it’s working, a person doesn’t have to be reminded to do something every day, week or month,” unlike needing to take a daily pill or insert a sponge before sex.

Also, Thompson pointed out, the subdermal implant is the only type of birth control that must be placed that does not require a pelvic exam.

What it’s like to get an implant
Your health-care provider will numb your arm and insert the implant during a clinic visit.
With an implant, there are no regular periods, Thompson said, though unpredictable spotting or bleeding is fairly common.

A backup method of birth control is recommended during sex in the first week after insertion, but after that the implant is fully effective. The implant is removed by a provider. Pregnancy is possible immediately after removal. 

Insurance may cover costs for long-acting reversible contraceptives.

Most insurance plans now cover long-acting reversible contraceptives, including having them put in and taken out, with no out-of-pocket cost to the patient. Ask your insurance company what it covers.

Birth control types that are not considered long-acting

Other popular options include birth control pills, the contraceptive ring (the pill and the ring require a prescription); contraceptive sponges (available over the counter); and diaphragms, which need to be fitted by a health care provider. These are not considered to be “long acting” methods. They’re less reliable than long-acting methods, because you must remember to use them (insert the ring, take the daily pill, etc.) 

Why choose a LARC birth control method?

Long-acting reversible contraception is not just for parents who are done having children. They are the best choice for many people, including teenagers, because they are safe, effective and reversible.

However, again, they do not protect against sexually transmitted diseases. Only abstinence or using condoms accomplishes that.

Care for all stages of life

Vanderbilt Women’s Health provides the best in women’s health care at locations across Middle Tennessee.

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