With so many birth control options out there for women to use, it can be hard to know which one might work best for you. However, we know that the category of long-acting reversible contraceptives (also known as LARCs) work the best in preventing pregnancy out of the methods that are not permanent. This is why LARCs are often recommended for women who want to prevent pregnancy reliably, but still have the option to have a baby in the future.

What exactly is a LARC?

Both intrauterine devices (IUDs) and the contraceptive implant (known as Nexplanon) fall into the category of LARCs. They can last from 3 years (Nexplanon and some IUDs) all the way to 10 years (such as the copper IUD). Therefore, they are considered long-acting, and yet all are removable and thus reversible. IUDs are small T-shaped devices placed in the uterus, and the contraceptive implant is a rod the size of a matchstick that is inserted under the skin of a woman’s arm.

How do they work?

The copper IUD works by preventing sperm from fertilizing an egg by making it difficult for the sperm to migrate and stay alive. Hormonal IUDs (these contain a form of the hormone progesterone) do this as well, but mostly prevent pregnancy by thickening cervical mucus. This makes it harder for sperm to get into the uterus. Contraceptive implants primarily work by releasing a low daily dose of a hormone similar to progesterone, and this keeps a woman from ovulating (or releasing an egg), which then prevents pregnancy.

Do they cause an abortion?

No! None of these methods will cause an implanted pregnancy to abort.

Tell me the good things about LARCs…

The best thing is how well they work! Both IUDs and contraceptive implants fail less than 1 percent of the time. For a visual reference, you can go here to see just how much better they are at preventing pregnancy than birth control pills, condoms, and other commonly used forms of birth control. In addition, LARCs are great because once they are placed there is nothing you have to do daily to “use” them, so you aren’t at risk of forgetting to take a pill, for example. Many women who use hormonal IUDs and the contraceptive implant report lighter or no periods, which can be a very enjoyable side effect. Lastly, once a LARC is removed a woman’s fertility comes right back, which means she can get right to trying to conceive if that is what she desires.

…and the not so good.

It is true that the placement of a LARC does require a procedure, and though they are all done in the office and are very brief, sometimes they can be uncomfortable. The copper IUD can lead to heavier periods for some women, which is not always desirable. Irregular spotting can be common in some women with the contraceptive implant and hormonal IUD. While not dangerous, it can be annoying (but for many is very light and gets better with time!).

What does it feel like to get one placed?

Many women report cramping with the placement of an IUD, but this tends to be less intense in women who’ve had babies before. The contraceptive implant is placed in a woman’s arm, and numbing medicine is used to make the insertion more comfortable. Taking ibuprofen prior to the placement of a LARC can help decrease pain afterwards, which is often brief and very manageable.

Are they expensive?

Up until the Affordable Care Act was passed, these devices were rather costly and could run upwards of $1,000 for some women. With the implementation of the ACA however, many are covered completely or close to it and so cost is no longer an issue, but it is important to check with your provider first so you can know what to expect.

Who can I go to for a LARC?

Most OB/GYNs will place LARCs, and if they are not trained they can refer you to a partner who is. Many Family Medicine physicians and Nurse Practitioners who care for women, as well as Certified Nurse Midwives, are also comfortable inserting these devices. If you aren’t sure who in your area is able to insert one, checking with Planned Parenthood can help guide you.

Are you sure I can get pregnant after having my LARC removed?

Yes! Rumors have often circulated that LARCs hurt your fertility, but that is not true at all.

Takeaways

  • Long-acting reversible contraceptives (or LARCs) are the most effective types of birth control that are also reversible.
  • LARCs include IUDs and the contraceptive implant.
  • Less than 1 in 100 women who use LARCs will get pregnant.
  • You can get pregnant immediately after removal of a LARC.

References

  1. The American College of Obstetricians/Gynecologists. Practice Bulletin #186: Long-acting reversible contraception: Implants and intrauterine devices. November 2017.
  2. The Centers for Disease Control. S. selected practice recommendations for contraceptive use, 2016.

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