Contraceptives have existed for thousands of years. In ancient Greece and Rome, the use of a plant called silphium (found only in a small region of Libya) was so popular as a method of birth control that over-cultivation resulted in its extinction. In ancient Egypt, a concoction of crocodile dung (ew!) and sour milk was developed, which was then placed into the vagina to prevent pregnancy. You really do not want to get pregnant to come up with that! As evidenced by these examples, the desire to control one’s reproductive life led to some interesting birth control methods. Luckily these days, we have a lot of options to choose from that do not involve dung or plant matter. Additionally, we can also use these options to treat many other conditions associated with the menstrual cycle.
For many years in modern America, the options available for pregnancy prevention were withdrawal (“pull out and pray”), barrier methods (think condoms, diaphragm, caps), or “the pill.” These options tend to be easily accessible and can be the right option for many people. On the other hand, I take care of many patients who find it difficult to adhere to these methods or they simply forget to take the pill daily. When a daily birth control pill requires strict adherence, there are increased risks of bothersome bleeding patterns and even unexpected pregnancies if not taken as prescribed. And the data bears this out: did you know that almost half of all pregnancies in the United States are unplanned?
Luckily, a category of contraceptives known as Long-Acting Reversible Contraceptives (LARC) devices exists. It sounds complicated but is actually really straightforward. Here’s the breakdown: “Long-Acting” because these devices last for several years (think 3 to 12 years depending on the method); “Reversible” because once removed, the effects are rapidly reversed, and fertility returns very quickly; and “Contraceptive” because they provide birth control. Some LARC devices provide additional benefits such as decreased bleeding, prevention of some gynecologic cancers, and improvement of painful periods – pretty wonderful, right?
Intrigued? Read on! Here is a brief summary of the types of LARC devices available in the United States. Pregnancy rates for all LARC devices are <1%. Compare this to pregnancy rates using condoms, which are approximately 12% in one year. It’s important to keep in mind that these methods do not prevent the transmission of sexually transmitted infections, so remember to use a condom in addition to a LARC device.
Intrauterine devices (IUDs) are growing in popularity. These are small, T-shaped devices that are placed into the uterine cavity using a small straw-like device. There are hormonal and non-hormonal IUDs. The hormonal IUDs act by releasing a small amount of the hormone progesterone over the course of several years. This causes thinning of the uterine lining (endometrium) and prevents pregnancy by thickening cervical mucus to keep sperm from getting into the uterus. The Mirena® IUD was recently approved to last for 6 years, Liletta® lasts 6 years, Kyleena® lasts 5 years, and Skyla® lasts 3 years.
The non-hormonal IUD (Paragard®, copper IUD) functions by releasing microscopic copper ions into the uterine environment to make sperm incapable of swimming correctly. Pretty cool, huh? This IUD lasts 10-12 years.
The etonogestrel arm implant (Nexplanon®) is a hormonal matchstick-sized plastic rod that gets implanted underneath the skin above the triceps muscle in the arm. This device must be inserted by a trained clinician. Lasting 3-4 years, this implant works to prevent pregnancy by actually stopping the egg from being released (ovulation) and thickening cervical mucus.
Wondering which one is a good choice for you? I recommend the copper IUD for pregnancy prevention and emergency contraception only, as it has no hormones. The hormonal IUDs and the implant are used to treat medical conditions associated with the menstrual cycle in addition to pregnancy prevention. These conditions include painful periods, endometriosis, anemia due to heavy periods, uterine pre-cancer, polycystic ovarian syndrome, and improvement of menses in people who do not want them (this applies to all people: non-binary/transgender/cisgender).
If you want to control your reproductive life and potentially improve various aspects of the menstrual cycle for a long time, then a LARC device may be the right choice for you. These are safe and effective, and they have high user satisfaction rates. Placement of IUDs and implants can be done in the office by your reproductive health clinician; they can also be placed under sedation. If you want to learn more, do not hesitate to call your friendly neighborhood Atrius Health OB/GYN or your primary care provider. Feel free to use the term “LARC.” Look at it this way: it is much better than asking your clinician for a cup of crocodile dung.