Questions and Concerns about Long-Acting Reversible Contraception

A contraceptive implant in the upper arm

Long acting reversible contraception—or LARC—methods are safe, reliable, and prevent pregnancy for years. For many people they are a great choice, since they don’t require much thought after they’re inserted. There’s nothing to remember every day and no interruptions before sex.

They aren’t the best choice for everyone, of course, as people have personal preferences for what fits in to their lifestyle and health profile. But some people may avoid LARC methods due to misconceptions about their safety or impact on health and future fertility. While the history of coercion and misuse of LARC methods is a legitimate cause for concern and no one should be pushed into choosing a contraceptive method that isn’t right for them, it is also important to have accurate information about these methods. The best choice is an informed one.

Below we address some of the common myths and misperceptions about LARC methods, so you can decide whether a LARC is a good choice for you.

Does it hurt to have a LARC inserted?

This is a common question—and fear—about LARC methods. Does it hurt to have an IUD inserted? How bad is it? The answer is—it depends on the person. Many people describe feeling a “pinch” followed by cramping, some compare it to the discomfort of a Pap test, and others find the process quick and manageable. Watch the video above to see what real people experienced with an IUD. You can also read through a step-by-step guide on getting an IUD and check out the story of one woman who had a hard time with her IUD insertion, but in the end  found that it was worth the effort.

One suggestion to reduce possible discomfort is to schedule the insertion around times when your cervix is naturally a bit more open—during ovulation and during your period.  If you’re interested in getting an IUD but concerned about pain, talk to your healthcare provider beforehand about your concerns, so they can help with pain management.

And what about the implant? Pain doesn’t seem to be a common complaint among implant users, as the arm is numbed with an anesthetic before insertion. There can be some pain and bruising, though, and you may have a very small scar after removal. You can hear more from people who have used this method at Bedsider.

Woman holding on to her abdomen

How will a LARC affect my period?

Another common concern is that a LARC will cause problems with your menstrual cycle, like excessive bleeding and spotting between cycles. While it’s true you may see some changes in your cycle, it will depend on the type of LARC you’re using.

For example, the hormonal IUD is more likely to make your periods lighter and less frequent—they might even stop completely. You may also have less cramping. The copper IUD, on the other hand, might cause increased bleeding, especially in the first 3-6 months. But for many people, this gets better over time. With either type of IUD, it’s not uncommon to have occasional spotting between periods, but again this may lessen over time.

Spotting and irregular bleeding are also common side effects of the implant, at least for the first year. Some people have heavier bleeding while others may not have a period at all for a while. There’s no one standard, but expect some irregularities with your cycle.  You can learn more about spotting and irregular bleeding here.

A woman speaking with her doctor

Will it affect my future fertility?

There are some persistent misconceptions about the safety of the IUD—that it will cause problems like pelvic inflammatory diseases (PID), infertility (the inability to have a baby), or even cancer. This may stem from problems with a specific IUD used in the 1970s—the Dalkon Shield—which was associated with a higher risk of PID and tubal infertility. That product was taken off the market and these risks don’t apply to the IUDs available today. Studies of people around the world who use IUDs have shown that overall, IUD users are no more likely to suffer from PID than those who use other forms of contraception. Once an IUD is removed, your fertility returns to normal.

So the IUD is a safe and effective option, but still may not be right for everyone. While the IUD does not cancer, it is not recommended for anyone who has a gynecological cancer, like cervical or uterine cancer. The hormonal IUD is also not recommended for anyone who has had breast cancer. The copper IUD should not be used if you have a copper allergy or a history of Wilson’s Disease, a rare disease that causes copper to accumulate in some organs.


What about side effects?

Person holding their hands on their stomach

When choosing any form of contraception, it is important to think about possible side effects. Not everyone will experience side effects, of course, but knowing what to expect is important—including how long some side effects might last.

For example, some people using a hormonal IUD will have irregular bleeding, including spotting between periods or heavier bleeding during a period. However, this is more common during the first several months of use. After some months, bleeding may become lighter, menstrual cramps may decrease, and periods may disappear entirely.

With the copper IUD, which doesn’t reply on hormones, bleeding may actually increase and periods may be heavier in the first months of use. Cramping may also be worse. Again, these symptoms are more typical in the first few months of use and may get better over

With the implant, irregular bleeding—including spotting and longer, heavier periods—is also possible. While this may get better after the first 6-12 months, it also may continue for the entire time someone uses the implant. On the other end of the spectrum, some people may have no periods for a time. 

Check out Bedsider to learn more about possible side effects, as well as more about real people’s experiences with LARC methods.