The news about long acting reversible contraception.
In light of the recent news about women’s reproductive rights, Dr. Fliedner is interested in educating his patients on the latest medical research and helping them to navigate the many options for birth control. We’ve discussed tubal ligation and short-acting hormonal birth control methods. This third and final article in the birth control series presents three types of long-acting reversible contraception (LARC) methods: injection, implant, and intrauterine devices (IUDs).
As we have discussed in our former birth control blogs, birth control is not a one-size-fits-all. There are countless choices for women today, but a LARC may just be the right option for you. They are an excellent option for a woman who may want to become pregnant in the future but also desires long-term, highly effective pregnancy prevention. The effects of IUDs, implants, and shots are reversible whenever you decide to become pregnant. You simply stop the injections or visit your health care provider to remove the IUD or implant.
Understanding long acting reversible contraception
The name really says it all. Long-acting reversible contraception, or LARC, is a reversible birth control that provides long-lasting pregnancy prevention.
While not currently the leading choice among women, LARC use has been rising in recent years in the U.S. due to educational efforts such as the Contraceptive CHOICE Project, which we will discuss below.
Long-acting reversible contraceptives are the most effective method of birth control because they can prevent unwanted pregnancy up to 20 times better than birth control pills, patches, and vaginal rings, according to Planned Parenthood.
So, with all the potential benefits, why is long acting reversible contraception not a more popular choice? Studies have shown several reasons women choose birth control methods other than LARC methods. These include the following:
- Lack of education: Women are more familiar with quick solutions, such as “the pill” or condoms, and they don’t have access to facilities offering LARC.
- Fear: According to the National Library of Medicine, women express fears about pain, expulsion, a foreign body inside them, and the potential for physical harm.
- Cost of entry: LARC methods need to be inserted by a doctor, and they have a more significant upfront cost than paying as you go, as with the birth control pill, for example. However, under the Affordable Care Act, all insurance plans in the health insurance marketplace must cover all FDA-approved contraceptive methods prescribed by a woman’s doctor, including LARC.
- Misconceptions about safety among providers: In a 2012 study, researchers from the Centers for Disease Control and Prevention showed that nearly a third of healthcare providers had misconceptions about the safety of IUDs. Such concerns are misplaced. According to the American College of Obstetricians and Gynecologists, LARC methods “are the most effective reversible contraceptive methods.”
- Control factor: Women want to be in control of their reproductive health. If they suddenly want to get pregnant, they can stop taking the pill. With an IUD, they would need to visit the doctor to remove it.
The Contraceptive CHOICE Project
In 2010, the Contraceptive CHOICE Project was a study performed at Washington University in St. Louis with the intent of introducing and promoting the use of long-acting reversible contraception by removing financial and knowledge barriers. In the study, 9,256 women aged 14–45 years were offered their choice of both short- and long-acting contraceptive methods without charge.
The results of the tests were fascinating. The continuation rates for participants who chose LARC were higher than for those who chose short-acting methods. The CHOICE project also identified a significant reduction in unintended pregnancies and in the abortion rate of study participants compared with a similar population from the same geographic area (American College of Obstetricians and Gynecologists).
Long acting reversible contraception
The birth control shot (sometimes called Depo-Provera®, the Depo shot, or DMPA) is a hassle-free option for women who don’t want to be tied to the daily responsibility for birth control.
Injections work by suppressing ovulation and by thickening cervical mucus, which keeps the sperm from reaching the egg. Every 12 weeks, you go to your doctor for an injection, and you’re good to go for another 3 months.
How effective is the birth control shot?
In a perfect world, the birth control shot’s effectiveness is more than 99%, meaning less than 1 out of every 100 women who take the shot will get pregnant each year. Statistics, however, reveal that the shot is about 94% effective because women forget to get their shots on time. So, in reality, about 6 out of every 100 shot users will get pregnant each year.
The better you are at remembering to schedule your shot on time, the better the results. We recommend that women download a birth control app of their choice to notify them of upcoming appointments.
If effectiveness is the most important thing to you when picking a birth control method, we recommend that you look closer at IUDs and the implant. These two are the most effective kinds of birth control.
Intrauterine device (IUD)
The longest-lasting, no-hassle birth control options are IUDs. An IUD is a small T-shaped device that is inserted into the uterus by a healthcare provider. It works by preventing sperm from fertilizing an egg.
There are two types of IUDs:
- Hormonal IUD. This plastic IUD releases the hormone progestin. This hormonal type of IUD also thins the uterine lining, making it more difficult for a fertilized egg to implant. One type, Mirena, is approved for use for up to five years, while another, Skyla, is approved for use for up to three years.
- Copper IUD. The copper IUD, Paraguard, is often referred to as the non-hormonal IUD option. It is approved for use for up to 10 years.
While both types of IUDs can remain in place for years, they are also easily removed by a healthcare practitioner if a woman decides she would like to become pregnant.
Pros of the IUD
- It’s so tiny you can’t feel it. The flexible, T-shaped appliance is only about an inch long. During an office visit, Dr. Fliedner can insert it into your uterus, where it remains for three to 12 years, depending on the type of IUD you have. Whenever you’re ready to start a family, make an appointment with us, and in five minutes, Dr. Fliedner can remove the IUD.
- It is almost as effective as abstinence. The only way to 100% guarantee that you won’t get pregnant is to abstain from sexual activity. With the IUD’s 99% efficacy rate, your risk of getting pregnant is extremely low.
- It’s ready when you are. With an IUD, you can have spontaneous sex without having to preplan and prepare. Your IUD offers reliable contraception for years at a time.
- The IUD is low maintenance. The IUD stays in place for years without requiring checkups or maintenance. It’s perfect for the busy woman who doesn’t have time to remember to take the pill.
- The IUD is available with or without hormones. This is great news for women with a history of cancer in their family and want birth control without the hormones. While some IUDs contain slow-release hormones that prevent ovulation, the copper-wrapped IUD contains no hormones but is just as effective.
- The IUD is a reversible treatment. Once your OB/GYN removes the IUD from your uterus, your body is ready to get pregnant. You can discuss with him the steps to improve your pregnancy rate.
Cons of the IUD
- Your OB/GYN specialist must insert it. The IUD is not a DIY process, and getting an IUD involves a little planning. You can’t just run down to the drugstore and purchase one. You will need to make an appointment with your OB/GYN specialist to put it in place. The good news is that it is a simple in-office procedure that only takes a few minutes, similar to getting a Pap smear.
- You may experience some cramping right after insertion. Over-the-counter painkillers should be sufficient to offer you relief. If your pain continues or increases, you need to see your OB/GYN to discuss perhaps removing the IUD and choosing another form of birth control.
- The IUD can slip out of place. Although it rarely happens, IUDs can “get lost” in your uterus or slip into your vagina partially or completely. You can regularly check your IUD’s position by feeling for the short strings that hang into your vagina.
- Side effects can occur with an IUD. Although most women have no reaction to IUDs, if you experience pain, cramping, or spotting, contact your OB/GYN right away. Also, contact your doctor if you notice other changes, such as chills, heavy bleeding, or unusual vaginal discharge.
A contraceptive implant is a hormonal long-term birth control option for women. It is a flexible plastic rod about the size of a matchstick that your OB/GYN specialist inserts under the skin of the inside of your upper arm.
In the United States, it’s sold under the brand Nexplanon, formerly Implanon. Once inserted, the implant releases progestin into the system over the next three to four years.
The introduction of progestin suppresses ovulation, thickens the cervical mucus, and creates changes in the uterine lining that make pregnancy nearly impossible. According to the Centers for Disease Control and Prevention (CDC), the efficacy rate is 99.9%!
As with the IUD, the implant can be removed at any time if a woman decides she wants to get pregnant. Much like the IUD, the implant shares the same pros and cons.
Pros of the implant
- It is effective. It’s one of the most effective birth control methods on the market today.
- It is long-lasting and maintenance-free. Once inserted, the implant lasts three years before needing to be replaced.
- It is convenient. No need for any pre-sex preparation or reminders.
- It is cost-effective in the long run. It can be costly upfront, but there are no costs beyond that for three years. Many insurances cover Nexplanon. Go to the Nexplanon site to read about health insurance coverage.
- It can improve your periods. It can improve cramps, make periods lighter, or stop them entirely for some.
- It is estrogen-free. It’s safe for people who can’t use birth control that contains estrogen.
- It is reversible. Your OB/GYN can remove it anytime, and your fertility will return as soon as it’s removed.
Cons of the implant
- Your OB/GYN must insert it. The implant requires that you make an appointment with your OB/GYN specialist to insert it under the skin, but it is a simple in-office process and the implant is noticeable.
- You may experience some cramping right after insertion. Over-the-counter painkillers should be sufficient to offer you relief. If your pain continues or increases, you need to see your OB/GYN to discuss perhaps removing the implant and choosing another form of birth control.
- You may experience irregular bleeding with an implant. Some women may experience irregular bleeding, especially during the first six-to-12 months. This may occur in the form of spotting in between periods or having longer, heavier periods. Some women have irregular bleeding the whole time the implant is in. On the other hand, some women get no periods at all, at least for a while. You need to be okay with irregular periods if you are thinking about the implant.
Who can use LARC?
LARC methods are a safe and effective birth control choice for women of all ages, women who have never given birth, and women who have just given birth. The American College of Obstetricians and Gynecologists recommends starting LARC immediately after childbirth.
Long acting reversible contraception offers women a safe, long-lasting choice for preventing pregnancy, with little thought to maintenance. It’s an option that most women should consider a viable choice.
Keep in mind that long acting reversible contraception, like other contraception options, does not protect against sexually transmitted diseases (STDs). Be sure to use a condom to reduce your risk of infection.
Trust Dr. Fliedner With Your Reproductive Health
To explore what birth control option is right for you, book a consultation with Dr. Fliedner at our practice in Flower Mound or Lewisville. With over 30 years of experience counseling women about their reproductive health, Dr. Fliedner is the perfect one to help you navigate the numerous contraception methods.
To review the other articles in this birth control series, click the links below.