Clinically speaking: questions and answers on long-acting reversible contraception

Clinically speaking: questions and answers on long-acting reversible contraception

Medically reviewed by Mary Jane Minkin, MD

If you’re looking for a safe, effective, and hassle-free way to prevent pregnancy, long-acting reversible contraception (LARC) may be a good option for you.

We reached out to Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine and a member of HealthyWomen’s Women’s Health Advisory Council, to find out what questions you should ask your healthcare provider (HCP) if you are planning on using LARC.

What is long-acting reversible contraception (LARC)?

As the name suggests, long-acting reversible contraception it is effective birth control that lasts a long time and can be easily reversed.

Most oral contraceptives would be nearly 100% effective if we weren’t human, and we could remember to take things at exactly the same times every day and never forget a thing. But unfortunately, with real world usage the numbers are more like 91% or 92%.

This is where the concept of long-acting reversible contraception comes into play. Eliminate the possibility of human error.

What are the different types of LARC?

The intrauterine device (IUD) was one of the first LARC methods. IUDs are small devices that are inserted into the uterus. They are approved to last anywhere from 3 to 10 years, depending on the brand. Hormonal IUDs, such as Mirena, Skyla, Liletta, and Kyleena, contain progestin, a man-made version of the hormone progesterone. ParaGard, which is made of copper, is currently the only hormone-free form of LARC.

Many women like hormonal IUDs because they can help control bleeding, meaning you may not get a period or your periods will be very light. And you can become fertile pretty quickly after you remove them. One downside is that they can only be inserted by a healthcare professional, and insertion and removal can cause pain.

Then there’s the contraceptive implant, Nexplanon, which is a progestin-releasing stick that’s inserted into your arm. It lasts three years. The implant is a good option for people who want long-lasting hormonal birth control but want to avoid estrogen. The most common concern people have about implantation is that many people get breakthrough bleeding with it. And it must be inserted and removed by a healthcare professional.

How effective are these LARC methods?

They are very effective on 99%.

Who can use LARC contraceptive methods and who can’t?

Most women can safely use LARC methods, although all forms of hormonal birth control have some circumstances in which they shouldn’t be used. For example, women who have unexplained bleeding should avoid LARCs until they can figure out what’s causing the bleeding. A healthcare professional can offer specific guidance on safety issues.

It is also important to note that LARCs do not protect against sexually transmitted infections (STIs). Condoms are the only form of birth control that also prevents STDs.

What are some common misconceptions about LARC methods?

I think the biggest misconception about LARC is that these methods can negatively affect a woman’s fertility in the long run. And it’s not like that. By definition, LARC is reversible.

Another misconception is that you have to keep them on for as long as they’re active, but that’s not true. You can remove LARC at any time.

What questions should women ask themselves to make an informed decision about birth control? What factors do you consider when making recommendations?

Whether a woman is starting birth control for the first time or contemplating transitioning many years later with the same shape, I always want to help guide her to what will make her happy, what will best meet her individual needs.

Are you just trying to prevent pregnancy or do you also want to control bleeding? Do you want to start a family sooner rather than later? Other factors to consider include ease and effectiveness.

With so many safe and effective options available, women can choose the one that best meets their specific needs.

This resource was created with support from Organon and Co. and Sebela Women’s Health, Inc.

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