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Contraceptive Choices: IUDs and Implants (LARC)

Decoding LARCs: Understanding IUDs and Implants for Hassle-Free Contraception | DoctorOnCall

What Are LARCs?

You may not be familiar with the phrase "long-acting reversible contraception" (LARC), but you may have heard of the types of contraception that fall under this category: intrauterine device (IUD) and implants.[1]

LARC methods revolutionise family planning with their effectiveness and hassle-free approach, providing effective contraception while requiring minimal effort to use or maintain.[1] After removal, fertility quickly returns.[1]

Follow us on this journey to decode LARCs by offering insights into their effectiveness, duration, and ease of use. This way, you can navigate the world of long-lasting contraception with confidence and clarity!

What Are IUDs?

An intrauterine device (IUD/IUCD) is a small, T-shaped device inserted into the uterus to prevent pregnancy.[2] This device works by altering the environment in the uterus, making it inhospitable for sperm and eggs to meet.[2] 

IUDs are one of the most reliable forms of birth control available, with over 99% effectiveness.[2] They are convenient and low-maintenance, offering long-term protection without requiring daily attention. Once inserted, an IUD can provide contraception for several years.[2]

Types of Intrauterine Devices (IUDs)

1. Copper IUD

  • How It Works: The Copper IUD releases copper ions into the uterus, which are toxic to sperm.[2] This disrupts their movement and ability to fertilise an egg.[2]
  • Copper IUD Benefits: 
  1. Protects against the risks of pregnancy[3]
  2. May potentially offer some protection against endometrial cancer (cancer of the lining of the uterus) and cervical cancer[3]
  3. Decreases the risk of ectopic pregnancy[3]
  • Getting a Copper IUD: A trained healthcare provider inserts the IUD in a short clinic visit, which takes about 10 minutes.[4] You may feel some discomfort, but a local anaesthetic is available. In some cases, sedation can be used.[4] 
  • Effectiveness and Duration: Once inserted, the copper IUD provides continuous contraception for up to 10 years.[4] It is immediately effective, providing long-lasting protection against pregnancy.[4] 
  • Side Effects: Changes in your menstrual cycle may occur, particularly during the initial 3 to 6 months, leading to symptoms like prolonged and heavy bleeding, irregular periods, and increased discomfort or pain during menstruation.[3]

2. Hormonal IUD 

  • How It Works: The hormonal IUD releases a small amount of progestin hormone into the uterus.[3] This thickens cervical mucus, making it difficult for sperm to reach an egg, and it also thins the uterine lining.[3]
  • Hormonal IUD Benefits: 
  1. Offers protection against pregnancy and reduces the risk of iron-deficiency anaemia[3]
  2. May potentially provide some safeguard against endometrial and cervical cancer[3]
  3. Alleviates menstrual cramps, reduces heavy monthly bleeding, and eases symptoms of endometriosis, including pelvic pain and irregular bleeding[3]
  4. Decreases the risk of ectopic pregnancy[3]
  • Getting a Hormonal IUD: A skilled healthcare provider inserts the hormonal IUD into the uterus during a brief office visit, typically lasting about 15 minutes.[5] While some discomfort may be experienced, the option of a local anaesthetic is available. In certain cases, sedation can also be administered.[5]
  • Effectiveness and Duration: The hormonal IUD provides effective contraception for up to 3 to 5 years, depending on the specific type. It begins working immediately upon insertion.[3]
  • Side Effects: You may experience alterations in your menstrual cycle, such as lighter bleeding, irregular periods, or even a temporary absence of monthly bleeding.[3]Additionally, acne, headaches, breast tenderness, and other mild side effects may occur.[3]

What are Implants?

Implants work by continuously releasing a progestin hormone into the woman's body.[6] This hormone is similar to the natural hormone progesterone. It primarily operates by:

  • Inhibiting the ovaries from releasing eggs (ovulation)[6]
  • Thickening cervical mucus to hinder sperm from reaching an egg[6]

Benefits of Implants

Implants provide a variety of notable advantages, including:

  • Protection against pregnancy[3]
  • May offer some protection against iron deficiency anaemia[3]
  • Reduces the risk of ectopic pregnancy[3]

Getting an Implant

A contraceptive implant is a small, flexible rod that's inserted under the skin of your upper arm. The procedure is quick and straightforward, feeling similar to receiving an injection.[7]To ensure your comfort, a local anaesthetic is used to numb the area.[7]

One of the advantages of the contraceptive implant is its reversibility.[7] It can be removed at any time by a trained doctor or nurse.[7]Removal is a simple and brief procedure, also utilizing a local anaesthetic for your comfort.[7]

Effectiveness & Duration of Implant

The contraceptive implant is highly effective, ensuring more than 99% protection against pregnancy.[7] Once it's in place, you can put thoughts of contraception aside for an extended period of up to three years.[7] This makes it an ideal choice for women who cannot use oestrogen-based contraceptives and those who struggle to maintain a daily pill regimen consistently.[7]

Side Effects of Implants

While implants are highly effective at preventing pregnancy, they can sometimes come with side effects. These may include changes in your period, like lighter or longer bleeding, or irregular bleeding patterns.[3] You might also experience symptoms like headaches, abdominal discomfort, acne, or changes in weight.[3] Some people may also notice breast tenderness, dizziness, shifts in mood, or occasional nausea.[3] 

If you have any concerns regarding these potential side effects, it's advisable to consult your healthcare provider for tailored guidance and support.

Who Can Use LARCs?

IUDs and implants are suitable for most women. They can be used safely and effectively by:[3]

  • Women who have or have not had children[3]
  • Married or unmarried women[3]
  • Women of various age groups, including adolescents and those over 40[3]
  • Women who have recently had an abortion, miscarriage, or ectopic pregnancy[3]
  • Breastfeeding women[3]
  • Women with current or previous anaemia[3]
  • Women living with HIV, with or without antiretroviral therapy[3]

Who Shouldn’t Use LARCs?

While IUDs and implants are generally safe, there are situations in which they might not be recommended. Women in the following circumstances should consult a healthcare provider before opting for LARCs:[8]

  • Current pelvic inflammatory disease (PID) or purulent cervicitis[8]
  • Known or suspected pregnancy[8]
  • Unexplained vaginal bleeding[8]
  • Uterine fibroids[8]
  • Uterine cancer[8]
  • Specific known uterine anomalies[8]
  • Allergies to any component of the IUD or implant[8]

A healthcare provider can offer personalised advice based on individual health history and circumstances.

Do IUDs and Implants Protect Against STIs?

IUDs and implants do not protect against sexually transmitted infections(STIs).[6] For protection against both pregnancy and STIs, it's advisable to use condoms in addition to LARCs.[6]

Cost and Availability of LARCs

While some initial costs may be associated with purchasing and inserting LARCs, they tend to be cost-effective over time. In many countries, these methods are available at family planning clinics, healthcare providers' offices, and hospitals. Additionally, some LARCs may be covered by health insurance or available through government-subsidised programs, making them accessible to a wide range of women.

Take a Leap Forward!

LARCs offer women the power to make informed choices about their reproductive health with highly effective, low-maintenance contraceptive solutions. Reach out to a healthcare provider today for personalised advice tailored to your contraceptive well-being!

References

  1. ACOG. “Long-Acting Reversible Contraception: Implants and Intrauterine Devices.” ACOG, https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices. Accessed 20 October 2023.
  2. UNFPA. Hormonal Intrauterine Device (IUD) 1 Intrauterine device (IUD) 2 Implantable Contraceptives 3 Injectable Contraceptives 4, https://www.unfpa.org/sites/default/files/resource-pdf/larcs-unfpa-2021.pdf. Accessed 20 October 2023.
  3. WHO. “FAMILY PLANNING.” Family Planning, https://fphandbook.org/sites/default/files/WHO-JHU-FPHandbook-2022Ed-v221115a.pdf. Accessed 20 October 2023.
  4. FPNSW. “Copper IUD.” Family Planning NSW, https://www.fpnsw.org.au/factsheets/individuals/contraception/copper-iud. Accessed 20 October 2023.
  5. Sexual Health Victoria. “Mirena IUD | Hormonal IUD Mirena | IUD Mirena insertion | IUD Mirena cost | Mirena IUD Melbourne.” Sexual Health Victoria, 21 August 2023, https://shvic.org.au/for-you/contraception/iud-intrauterine-device/hormonal-iud-contraception-mirena#how-do-i-use-the-hormonal-iud. Accessed 20 October 2023.
  6. ACOG. “Long-Acting Reversible Contraception (LARC): Intrauterine Device (IUD) and Implant.” ACOG, https://www.acog.org/womens-health/faqs/long-acting-reversible-contraception-iud-and-implant. Accessed 20 October 2023.
  7. NHS. “Contraceptive implant.” NHS, https://www.nhs.uk/conditions/contraception/contraceptive-implant/. Accessed 7 November 2023
  8. LINDA PRINE, MD, AND MEERA SHAH, MD, MS. “Long-Acting Reversible Contraception: Difficult Insertions and Removals.” 1 September 2018, https://www.aafp.org/pubs/afp/issues/2018/0901/p304.html. Accessed 20 October 2023.

Disclaimer

The information provided in this article is intended for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. 

The images used in this article are for illustration purposes only. The author and publisher do not accept any responsibility for any liability, loss, or risk, personal or otherwise, incurred as a consequence, directly or indirectly, from the use or application of any information contained in this article.

Written By Dr Shobika Nair, Doctor of Medicine, I.M. Sechenov First Moscow State Medical University, Russia on

Reviewed By DoctorOnCall Panel Doctor