The name says it all. Long-acting reversible contraception, or LARC, is reversible birth control that provides long-lasting (think years) pregnancy prevention. While not currently the leading choice among women, LARC use has been on the rise in recent years. In women aged 15-44, LARC use has grown from 1.5% in 2002 to 7.2% in 2011–2013. The rising popularity of LARC can likely be attributed to its high rate of effectiveness (more than 99 percent) and ease of use.
LARC methods, which include intrauterine devices (IUDs) and implants, are highly reliable—research has shown LARC to be 20 times more effective than birth control pills, the patch, or the vaginal ring. One important reason why is the LARC removes the “user error” factor that can make other methods less effective. No need to remember to take a pill daily, or have a diaphragm on hand ready to go. Once LARC is in place, it does its job for years with no input from the user at all, acting as a “set it and forget it” method.
But there’s one thing that shouldn’t be forgotten—protecting against sexually transmitted infections (STIs). While LARC is a highly effective way to prevent pregnancy, LARC methods don’t prevent STIs. For this reason, many choose to use (and health professionals recommend) condoms in addition to a LARC method. Dual use of condoms and LARC thus offers couples dual prevention.
ASHA’s Fred Wyand (a.k.a. Fredo) discusses dual use of LARC and condoms in the latest episode of ASHA Sex+Health podcast. Fred explains the facts about LARC and the added benefit of dual use of LARC and condoms to prevent STIs.
There are two LARC methods: the intrauterine device (IUD) and the birth control implant. The intrauterine device (IUD) was once a popular choice in the U.S., but following problems linked to the poorly designed Dalkon Shield model in the 1970s, usage dropped due to concerns about safety. The current newly designed models share none of the earlier safety concerns, but some misconceptions about this issue persist.
The birth control implant has been available in the United States since the 1990s. The earliest model, Norplant, included multiple rods implanted under the skin and offered pregnancy prevention for up to five years. Almost immediately after its approval, however, it became a target for misuse, as legislation was introduced in several states mandating its use in specific groups of women, including those receiving public assistance. Use of implants became an issue in the courts, as women facing charges including child and abuse and neglect were offered the option of accepting implants as condition of a reduced sentence.
Understanding and acknowledging this history of coercive use of LARC and safety concerns is important, to avoid problems of the past. But so too is understanding the potential value of LARC methods today. The current concern with LARC is making sure women are well informed about these methods, including benefits and side effects, and making LARC an accessible and affordable option to all women.
IUD: An IUD is a small T-shaped device that is inserted into the uterus by a healthcare provider. It works by preventing sperm from fertilizing an egg. The hormonal type of IUD also thins the uterine lining, making it more difficult for a fertilized egg to implant.
There are two types of IUDs:
- Hormonal IUD: This plastic IUD releases the hormone progestin. One type, Mirena, is approved for use for up to 5 years, while another, Skyla, is approved for use for up to 3 years.
- Copper IUD: The copper IUD, Paraguard, is hormone-free. It is approved for use for up to 10 years.
While both types of IUDs can remain in place for years, they can also easily be removed if a woman decides she would like to become pregnant. Most women have no issues with the IUD, but problems can include spotting between periods, a heavier flow (with Paraguard), and back pains. Rare but serious problems can occur as well, and usually happen shortly after the IUD is inserted. These complications include the IUD falling out of the uterus, or piercing the uterine wall. Learn more about IUDs and hear stories from real women who use this method at Bedsider.
Implant: The birth control implant is a single small, thin rod that is inserted under the skin of a women’s upper arm by a healthcare provider. The rod releases the hormone progestin into the body, which both helps prevent ovulation and thickens cervical mucus, helping prevent sperm from reaching an egg. The implant prevents pregnancy for up to 3 years.
As with the IUD, the implant can be removed at any time if a woman decides to get pregnant. The most common side effect is irregular bleeding—including spotting between periods and heavier periods. This typically improves over time. Learn more about implants and hear stories of women using this method at Bedsider.
So with all the potential benefits, why is LARC not a more popular choice? One reason is the large upfront cost. Both methods must be inserted, and removed, by a physician and costs cannot be spread out over time as with other methods. However, under the Affordable Care Act, all insurance plans in the health insurance marketplace must cover all FDA-approved contraceptive methods prescribed by a woman’s doctor, including LARC.
Another factor involves misconceptions about safety, even on the part of providers. In a 2012 study, researchers from the Centers for Disease Control and Prevention showed that nearly a third of healthcare providers had misconceptions about the safety of IUDs for women who have never had children. Such concerns are misplaced—the American College of Obstetricians and Gynecologists recommends that LARC methods be offered as first-line birth control methods and encouraged as options for most women, including adolescents and women who have never had children.
LARC offers women a safe, long-lasting choice for preventing pregnancy—one that requires no real thought or effort over years. It’s an option that most women should consider a viable choice.