By Stuart Shalit, DO, Obstetrician and Gynecologist, Virtua OB/GYN

What’s long-acting reversible birth control?

Having some control over pregnancy isn't exactly a novel idea. The practice of contraception has an interesting history dating back thousands of years. Thanks to decades of advanced scientific and medical research, women and men are fortunate to have more birth control choices than ever—each with different benefits and risks.

Long-acting reversible contraception (LARC) is a form of birth control that garners the most questions.

LARCs include the copper or progestin IUDs (intrauterine devices) and the implant (under the skin), which are all methods of contraception that women can use for an extended length of time. Unlike the pill, which a woman must remember to take at the same time every day, a LARC is inserted (or implanted) once and is highly effective for three, five, or up to 10 years without any daily effort. A LARC is more error-proof, more effective, and often better tolerated than the hormonal birth control pill.

How does an IUD work?

Function: The progestin-containing IUDs (ex. Mirena or Skyla) prevent pregnancy by:

• Thickening cervical mucous so sperm can't penetrate it
• Slowing down the sperm's movement in the fallopian tube so the egg and sperm are less likely to meet
• Thinning the uterine lining to prevent implantation
• Suppressing ovulation

The copper IUD (Paragard) contains no hormones but interferes with sperm movement and egg fertilization and works to prevent implantation.

Insertion: An IUD is a small T-shaped device with tiny threads at the bottom. In a two- to three-minute in-office procedure, the doctor inserts a sterile IUD into the uterus and trims the connected threads hanging out of the cervix. The process can cause cramping, but taking ibuprofen before the procedure helps minimize discomfort. To remove the IUD, the OB/GYN grasps the threads and pulls the IUD out through the cervix.

Side effects: The most common side effect of the progestin IUD is irregular bleeding for the first three to six months while the body is getting used to the hormone. Although it's not usually heavy, it may be persistent, annoying, or last for a prolonged time. Some users of the progestin IUD may not menstruate at all. In rare cases, women complain of bloating, weight gain, headaches, or acne.

The copper IUD doesn't regulate your period because it doesn't contain hormones. So, the most common side effect is a slightly heavier period.

In very rare cases, an IUD moves outside the uterine cavity and into the uterine muscle or penetrates through the uterine muscle into the pelvic cavity. It's even rarer for it to fall out entirely.

How does the insert work?

Function: The progestin insert (Nexplanon) is a four-centimeter rod that prevents pregnancy using the same strategy as the progestin IUD. It lasts up to three years and provides more than 99% protection against pregnancy.

Insertion: In this in-office procedure, the doctor numbs the area inside the upper arm with lidocaine and inserts the sterile rod just under the skin. Removal requires a small incision.

Side effects: Patients often complain of an unfavorable change in their bleeding patterns or the same side effects described earlier for progestin-containing IUDs (headache, bloating or weight gain, acne, depression). Because side effects are more common with the insert, some providers recommend the IUD for most women interested in a LARC.

How do I know if a LARC is right for me?

A LARC is a fantastic choice for teens. The World Health Organization has recommended LARC as first-line contraception in adolescents because it's safe with few side effects and provides long-term control for an age group that's especially vulnerable to unplanned pregnancies.

For other reasons, a LARC is also an excellent option for perimenopausal women. Many women in their late 30s to 50s are interested in alternatives to sterilization (like tubal ligation) that are low maintenance, near permanent, and cause minimal side effects. Furthermore, hormonal fluctuations are common at this age and can produce irregular or heavy menstrual cycles, for which the progestin-containing IUD is particularly effective. A LARC can be prescribed specifically for cycle control to women in their 40s who experience heavy or painful periods, even if they have had a tubal ligation.

Peri- and post-menopausal women who need endometrial protection also can use progestin-containing IUDs in conjunction with hormone replacement therapy (estrogen patch, gel, or spray). The progestin IUD is also an option for women with abnormal endometrial cells who require prolonged progestin treatment.

For further information, it's always best to contact your doctor. Your gynecologist is there to answer questions, help you make the right choices, and ensure you're making the best possible decision for your health. 

Schedule an appointment with a Virtua OB/GYN

• Call a Virtua women's health navigator at 844-896-6367 to find a provider who meets your needs. 
• Find a Virtua OB/GYN practice near you and schedule an appointment. Virtua OB/GYNs, nurse practitioners, and midwives offer flexible appointment schedules at locations throughout Burlington, Camden, and Gloucester Counties.