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Long-acting reversible contraception (LARC) methods include the intrauterine device (IUD) and the birth control implant. Both methods are highly effective in preventing pregnancy, last for several years, and are easy to use. Both are reversible—if you want to become pregnant or if you want to stop using them, you can have them removed at any time.
How effective are LARC methods?
The IUD and the implant are the most effective forms of reversible birth control available. During the first year of typical use, fewer than 1 in 100 women using an IUD or an implant will become pregnant. This rate is in the same range as that for sterilization.
Over the long term, LARC methods are 20 times more effective than birth control pills, the patch, or the ring.
The IUD is a small, T-shaped, plastic device that is inserted into and left inside the uterus. There are two types of IUDs:
1. The hormonal IUD releases progestin. One hormonal IUD is approved for use for up to 5 years. Another is approved for use for up to 3 years.
2. The copper IUD does not contain hormones. It is approved for use for up to 10 years.
Both types of IUDs work mainly by preventing fertilization of the egg by the sperm. The hormonal IUD also thickens cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg, and keeps the lining of the uterus thin, which makes it less likely that a fertilized egg will attach to it.
The IUD has the following benefits:
A health care provider must insert and remove the IUD. He or she will review your medical history and will perform a pelvic exam. To insert the IUD, the health care provider puts the IUD in a slender plastic tube. He or she places the tube into the vagina and guides it through the cervix into the uterus. The tube is withdrawn, leaving the IUD in place.
Insertion of the IUD may cause some discomfort. Taking over-the-counter pain relief medication before the procedure may help. The IUD has a string made of thin plastic threads. After insertion, the strings are trimmed so that 1–2 inches extend past the cervix into your vagina. The strings should not bother you.
With the copper IUD, menstrual pain and bleeding may increase. Bleeding between periods may occur. Both effects are common in the first few months of use. Pain and heavy bleeding usually decrease within 1 year of use. Both hormonal IUDs may cause spotting and irregular bleeding in the first 3–6 months of use. The amount of menstrual bleeding and the length of the menstrual period usually decrease over time. Menstrual pain also usually decreases. A few women also may have side effects related to the hormones in these IUDs. These side effects may include headaches, nausea, depression, and breast tenderness.
Serious complications from use of an IUD are rare. However, some women do have problems. These problems usually happen during or soon after insertion:
The birth control implant is a single flexible rod about the size of a matchstick that is inserted under the skin in the upper arm. It releases progestin into the body. It protects against pregnancy for up to 3 years.
The progestin in the implant prevents pregnancy mainly by stopping ovulation. In addition, the progestin in the implant thickens cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg. Progestin also keeps the lining of the uterus thin, making it less likely that a fertilized egg will attach to it.
The implant has the following benefits:
The implant is inserted into your arm by a health care provider. A small area on your upper arm is numbed with a local anesthetic. No incision is made. Your health care provider places the implant under the skin with a special inserter. The procedure takes only a few minutes.
To remove the implant, your health care provider again numbs the area. One small incision is made. The implant then is removed.
The most common side effect of the implant is unpredictable bleeding. For some women, these bleeding patterns improve over time. Some women have less menstrual pain while using the implant. In some women, bleeding stops completely. Other common side effects include mood changes, headaches, acne, and depression. Some women have reported weight gain while using the implant, but it is not clear whether it is related to the implant.
Possible risks include problems with insertion or removal of the implant. These problems occur in less than 2% of women. Although rare, if a woman becomes pregnant while the implant is inserted, there is a slightly increased risk that it will be an ectopic pregnancy.
Birth Control Implant: A small, single rod that is inserted under the skin in the upper arm by a health care provider. It releases a hormone and protects against pregnancy for up to 3 years.
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.
Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.
Emergency Contraception: Methods that are used to prevent pregnancy after a woman has had sex without birth control,
Fertilization: Joining of the egg and sperm.
Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.
Ovulation: The release of an egg from one of the ovaries.
Pelvic Exam: A physical examination of a woman’s reproductive organs.
Pelvic Inflammatory Disease (PID): An infection of the uterus, fallopian tubes, and nearby pelvic structures.
Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.
Sperm: A cell produced in the male testes that can fertilize a female egg.
Sterilization: A permanent method of birth control.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.
Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.