Long- Acting Reversible Contraceptives: LARCs
"The thinking women's contraceptive"
Not all contraceptives are created equal. The most commonly used methods in the U.S. are only 92% effective. The most commonly used contraceptives world-wide are >99% effective. The latter are long-term, easily reversible methods of birth control; several options are currently available.
These are considered top-tier options for women because they are as effective as a permanent method, but easily reversible. LARCs are particularly useful to women who do not want to become pregnant in the near future (college students, new mothers, breast cancer survivor, etc...) These methods work extremely well, (>99 %), mostly because you do not have to remember anything on a regular basis.
Things to consider when choosing your birth control:
- How soon do I want to get pregnant? (If, ever...)
- How well does each contraceptive work?
- Is the efficacy affected by my weight?
- How involved do I need to be for my contraceptive to be successful?
- How long does it work for?
- Is there a delay to fertility when I stop using it?
- Since they all have side effects,what side effects can I live with?
- How much does it cost, per month/per year...?
- Does insurance cover the cost of the method and the associated medical care?
Just as no boyfriend is perfect, no method of birth control is perfect. In the office consult, we will go over all of your options, with props, their advantages and disadvantages. After careful consideration, only you can really decide the best method for you at this stage in your life.
The Progestin Implant (Nexplanon)
Nexplanon is a single-rod progesterone implant, (etonorgestrel), the size of a matchstick: 4 cm x 2mm. The implant is inserted by your gynecologist under the skin in the upper inner arm. It is highly effective for up to three years, and can be removed sooner if you want to become pregnant or are unhappy with this method. The pregnancy rate is less than 1% in the first year of use.
The insertion is done in a 5 minute, completely painless procedure, using 2-3 cc of lidocaine. There is no scar, and no one can see the implant. Most patients forget it is there, (unless they feel it between the biceps and triceps muscle), but are thrilled not to have worry about pregnancy. The implant protects you from pregnancy within 24 hours of insertion.
In addition to providing top-tier contraception, the implant has also been shown to help painful cramps and the pain of endometriosis. The most bothersome side effect is irregular bleeding. A lucky 25 - 30% of patients lose their period altogether(hooray!), while the other 70 -75% can have unpredictable bleeding patterns. This is normal, and nothing to worry about: you are not pregnant, it is not a medical problem.
Of those who get unpredictable bleeding, they have similar or fewer number of bleeding or spotting days per 3 months as prior to the implant, it will not be more bleeding days/year, nor will the episodes be heavier than you are used to. As long as you can accept unpredictable menses, the implant is an easy decision; it is extremely effective and completely painless! Once the implant is removed however, you can become pregnant quickly if you wish.
An IUD (intrauterine device) is one of the safest and most effective contraceptive methods available. It is a small piece of plastic, shaped like a “T” that is used to prevent pregnancy. It is inserted into the uterus by your provider and, depending on your choice, can last for 3 to 10 + years.
It is considered a top-tier contraceptive because it is so effective. IUDs work primarily by preventing fertilization, not by interrupting an implanted pregnancy.
For every 100 women using an IUD, fewer than 1 per year will get pregnant. It is safe for most women of reproductive age, including teens and those never pregnant. Each type has a string on the end that allows a woman to check that the IUD is in place.
There are currently 2 Types of IUDs in the US: Hormonal and Non-Hormonal
1. Copper T IUD (Paragard)This is the most commonly used IUD in the world, and is approved for up to 10 years (Although studies show it effective for longer.) Because it contains no hormones, it can be used by those wishing to avoid estrogen and progesterone–based contraception. (For example, breast cancer survivors…)
2. Levonorgestrel-20 IUD (Mirena) This IUD contains the hormone levonorgestrel, a progestin, making it safe for women who cannot use estrogen-based contraceptives for medical reasons (i.e. migraines with aura, clotting disorder, lupus, etc.) It is currently approved for 5 years.
3. Levonorgestrel-14 IUD (Skyla): "the baby sister of Mirena": This IUD also contains the hormone levonorgestrel, in a lower dose than Mirena, so is currently approved for 3 years. It is smaller than the other 2, and is easier to place in a small uterus. The T shape of LNg-14 is 28 by 30 mm compared to LNg20: 32 by 32 mm, and has a smaller inserter diameter (3.8 mm versus 4.75 mm.)
4. Levonorgestrel-17.5 IUD (Kyleena): smaller like Skyla, lasts as long as Mirena (5 years.)
5. Liletta-19 IUD: similar to Mirena.
What are the possible side effects from using an IUD?
Initial discomfort with placement varies with each patient: her cervix, uterus and her pain threshold. The smaller IUD (Skyla) is typically more comfortable for those who have never been pregnant. We use premedications to minimize discomfort, but despite all our efforts, inserting the device inside one’s uterus is briefly painful for many women. Most patients find the first few minutes uncomfortable, but note dramatic improvement over the next half hour, to no pain within 24 hours. Ibuprofen helps during the first day.
Rarely, inserting the IUD may cause infection of the uterus or fallopian tube, typically soon following the insertion. (<1/100, noted in first 3 weeks after placement.)
Even less commonly (<1/1,000), the IUD may be placed through the uterine wall, called perforation. This can be seen with inexperienced providers, placement after a pregnancy, or in the setting of a uterine abnormality.
Lastly, an IUD may fall out or move out of place, called expulsion(about 5 %.) String checks once a month following your menses will help you confirm this is not your case.
Some women using the copper IUD see changes in their menses: increased cramping as well as heavier flow. The progestin-IUDs on the other hand decrease menstrual bleeding and cramping, and therefore are often the choice of patients with severe menstrual cramping or excess flow. The first few months of these IUDs are usually associated with frequent spotting, that turns to light or no menses.
Do IUDs or the Implant protect you against AIDs & STDs? No.
IUDs will not protect you against HIV, the virus that causes AIDS, or against STDs. All women at risk of STDs should use a latex condom consistently, in addition to an IUD to prevent STDs. If you or your partner is allergic to latex, use polyurethane condoms.
Process of Obtaining an IUD or an Implant
- Once you have chosen a LARC method, IUD or Implant, our staff will precertify you with your insurance company, to ensure you will not be responsible for the cost of device (around $750-$850) and insertion. When this is done, the insurance company will send us the device in your name.
- Upon receipt of your IUD or implant, a staff member will call you and schedule an appointment for placement. This process generally takes 2-3 weeks.
- The best time to place is during day 5-7 of your menstrual cycle, but any time is acceptable, as long as it is not possible that you are pregnant. (If you are sexually active in the few weeks prior to your appointment, please use condoms reliably.)
Important: We want to minimize insertion pain
For IUD placement, please take 600 mg of Ibuprofen about one hour prior to appointment.
For the implant, no premedication is needed. You can bring a friend or your Mom if you like.
Feel free to bring your I-phone with headphones to listen to music if that helps you relax.