Should You Be Using a Long Acting Reversible Contraceptive (LARC)?

A good contraceptive choice for sexually active women in their reproductive years is a long acting reversible contraceptive. Traditionally, women have used birth control pills, patches, vaginal rings or monthly injections of the progesterone hormone Depo-Provera.

Long acting birth control methods give women options that do not require taking a pill daily or using hormones weekly, monthly or every 3 months. The long acting birth control methods have a better continuation rate and lower pregnancy rate than short acting birth control methods, especially in the women younger than 20 years of age.

The intrauterine device (IUD) and the implantable rod, known as Nexplanon, are long acting contraceptives available in the United States. The IUDs function by making the environment in the uterus incompatible with pregnancy. The progesterone secreting IUD also changes the cervical mucous which decreases the transport of sperm into the uterus.

There are 2 types of IUDs: hormone-containing and copper. Mirena and Skyla are hormone-containing and Paragard is a copper IUD. Mirena and Skyla continuously secrete a hormone called progesterone for the duration of the IUD in the uterus. The Mirena is functional for 5 years and the Skyla for 3 years. The amount of monthly bleeding is decreased with progesterone IUDs. In many cases, women experience no bleeding at all. The Paragard IUD may cause heavier bleeding in some women.

Current evidence demonstrates the safety of modern IUDs and suggests that the relative risk of pelvic infection is slightly increased in the first 20 days after insertion due to bacterial contamination. There is a 0-2% rate of infection with the insertion process and then returns to baseline. The risk of pelvic infection is not increased once the IUD has been placed.  The progesterone IUD may decrease the risk of pelvic infection by thickening the cervical mucous. Patients are still cautioned about STD risks in general as IUDs do not protect against them. The IUD does not increase infertility and can be placed in women that have never been pregnant, as well as women that have had pregnancies. Many times medications are used prior to insertion for pain control and ease of insertion. Expulsion of the IUD is only 3-5%.

The contraceptive implant, Nexplanon, can cause some changes in menstrual bleeding patterns. The most common bleeding pattern is infrequent bleeding in 33% of 90 day cycles, followed by no bleeding in 16.9% of cycles and frequent bleeding in 6.1% of cycles. There is also a reduction of painful periods and pelvic pain. There is no documentation of weight gain with use of Nexplanon as there is with Depo-Provera injections.

The new federal laws regarding insurance coverage allows for coverage of birth control for most women; therefore, allowing women to access these LARCs while lessening the worry of cost.

If you want to consider a long acting reversible contraceptive, please make an appointment with one of the providers in the clinic and discuss your options.