I find myself talking to many patients every day about contraceptive options. Contraception has been quite a hot topic in the news lately, mostly related to insurance coverage mandates. It is and has always been something important to discuss, as roughly half of all pregnancies are unintended in the United States. Pregnancy is a "natural" state, but should be planned to minimize risk to both mother and fetus.
There are so many options for contraception, including hormonal, non-hormonal, short-acting, long-acting, pharmaceutical, natural - each with its own pros/cons and efficacies.
Today, though, I'd like to focus in on long-acting reversible contraceptives (LARCs). LARCs include the intrauterine devices (IUDs) and contraceptive implant. These are highly-effective long-term birth control options that have been gaining popularity over the past few years.
LARCs can be used by women of any age. For many years, health providers discouraged use of IUDs in women who have never had children, but this is no longer the case. We are now frequently using the contraceptive implant as well as IUDs in young women or women who have never been pregnant. There really are very few women who cannot use LARCs.
One of the best features of LARCs is their effectiveness. Pregnancy occurs less than 1 in 100 users. That's over 99% effective. LARCs have been found to be just as effective as tubal ligation, but are immediately reversible. In fact, many women who may otherwise have undergone tubal ligation are now choosing to use this most effective birth control and avoiding surgery.
The IUD is a small T-shaped device that is placed into the uterus during a simple office procedure. There are 2 different types of IUDs. One is non-hormonal. It is made of copper and lasts for up to 10 years. The other contains progestin, a hormone that acts locally within the uterus to thin the uterine lining. One advantage of this type of IUD is that over time, a woman's menstrual periods become very light or go away completely because the lining gets so thin. Many women choose the hormonal IUD for this reason. Because it keeps the uterine lining from becoming thick, it also decreases the risk of uterine cancer. One hormonal IUD lasts for 3 years, the other lasts for 5 years.
The IUDs are thought to work mostly by inhibiting the sperm from reaching the egg. The hormonal IUD also thickens the cervical mucus, making it difficult for sperm to even enter the uterus. In the case of the hormonal IUD, the thin lining of the uterus is also likely less receptive to implantation of a fertilized egg. Fertility normally returns immediately after removal of the device.
Placing the IUD involves placing a speculum in the vagina and cleaning the cervix with Betadine. A small clamp is placed on the cervix to hold it steady. The uterus is then "sounded" - a thin rod is placed through the cervix until it touches the top of the uterus to measure the length of the uterine cavity. This is important because the IUD applicator is then set to that length to be sure the IUD is placed right at the top of the uterus. The arms of the IUD are drawn into the applicator, and it is then advanced into the uterus. Once inside, the arms are released, the IUD is advanced to the top, and the applicator is removed. The strings on the end of the IUD are then trimmed to about 1" outside the cervix. The clamp and speculum are removed, and it's done! The entire procedure takes only about 2 minutes. Most women experience a cramping sensation during the procedure, but it is temporary, and can be lessened by taking ibuprofen before the office visit.
As with any medication or procedure, there can be side effects or risks. With the hormonal IUD, it is common to have unpredictable bleeding for up to 6 months after insertion. The nonhormonal IUD can result in slighly heavier periods for up to 6 months. There is a chance the IUD can be expelled from the uterus. During placement, the uterus can be perforated, resulting in a chance of the IUD being placed into the abdominal cavity. This happens only about 1 per 1,000 insertions. If this occurs, it can only be removed surgically, usually with an outpatient procedure. It is rare to have any long-term complications. Although pregnancy is very rare with an IUD, there is a chance that if pregnancy does occur, it will implant within the fallopian tube, resulting in an ectopic pregnancy, which may require surgery.
All of this sounds scary, but is exceedingly rare. The IUD is an excellent form of contraception, and it's no coincidence that most of the female OB/GYNs I know use an IUD. It is easy to use, extremely effective, and readily reversible.
The implant is a small plastic tube containing a progestin that is placed just under the skin of the upper inner arm. With this device, the progestin hormone acts systemically, meaning through your whole body. It acts mainly by stopping ovulation. It, like the hormonal IUD, also thickens the cervical mucus and thins the uterine lining, making fertilization and implantation less likely.
Placing the implant is also a simple office procedure. The inside of the upper arm is injected with a local anesthetic. The arm is cleaned with Betadine, then using a sterile applicator, the implant is injected under the skin. After placement, you can feel the implant under the skin, but it is difficult to see. A bandage is placed over the site.
The most common side effect of the implant is unpredictable bleeding. For many women, this improves over time. Complications can include bleeding or bruising during insertion, and difficulty with removal.
The benefits of long-acting reversible contraception greatly outweigh risks for most patients. Their ease of use and efficacy make them a good choice for almost anyone. It's important to note that these forms of birth control do not protect you against sexually-transmitted disease.
Women should discuss pregnancy prevention with their health care providers and determine the best method to allow a planned low-risk pregnancy when the time is right.
Check out these links for more information:
Mirena IUD official website
Skyla IUD official website
Paragard IUD official website
Nexplanon insert official website
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