LARCs may be your answer to birth control worries

Many women interested in long-term birth control have turned to LARCs.

LARCs, or long-acting reversible contraceptives, include IUDs and progestin arm implants. Patients like that they offer higher effectiveness in preventing pregnancy than other methods, and that they are convenient. They don’t require a lot of maintenance, such as having to remember to take a pill every day, said Obstetrician/Gynecologist Lindsay LaCorte, DO, MPH, who practices at Cape Cod Hospital OB/GYN in Hyannis.

“For many women, this is a relief to have one less thing to worry about,” she said.

LARCs also have fewer side effects and are safer than other hormonal methods, even if you have other medical problems.

According to the Guttmacher Institute, a non-profit international policy and research organization, LARCs started their rise in popularity in the early 2000s. In 2002, 2.4 percent of American women aged 15-44 who used contraceptives chose LARCs, with 2 percent using an IUD and 0.4 percent an implant. By 2018, use had risen to 17.3 percent, with 13.7 percent using an IUD and 3.6 percent an implant.

IUDs

IUDs, or intrauterine devices, are small plastic T-shaped devices placed inside the uterus. They have thin strings that trail through the cervix into the vagina for removal. IUDs work by preventing sperm from fertilizing eggs, and do this by releasing either copper or a form of the hormone progestin, according to the American College of Obstetricians and Gynecologists (ACOG).

Copper IUDs, called Copper Ts, disrupt sperm’s ability to swim, and:

• Can work for up to 10 years, according to ACOG.
• Contain no hormones.
• Are a great choice for women who choose to avoid hormonal treatment and want to have natural menstrual cycles.
• Have a failure rate of 0.8 percent, according to the Centers for Disease Control and Prevention (CDC).

Hormonal IUDs block sperm from entering the uterus by thickening mucus in the cervix, and:

• Are effective for 3-8 years, depending upon hormone dosage, according to PICCK (Partners in Contraceptive Choice and Knowledge, a program funded by the state Executive Office of Health and Human Services). Of the four types available, two contain 52 mg and last 6-8 years, one contains 19.5 mg and lasts 5 years and one contains 13.5 mg and lasts 3 years.
• Two of the devices are specifically designed for women who haven’t had children, Dr. LaCorte said. The smaller size makes it easier and less painful to place.
• Mirena, one of the two higher-dose hormonal IUDs, is also approved for management of heavy menstrual periods, Dr. LaCorte said.
• Have a failure rate of 0.1-0.4 percent, according to the CDC.

Using an IUD often causes changes in menstrual bleeding, according to ACOG. Period discomfort and bleeding may increase with a copper IUD. Longer and heavier periods may happen initially after using a hormonal IUD, but eventually periods usually become shorter and lighter.

Risks include the uterus expelling the IUD, and the chance of the IUD accidentally injuring the uterine wall during placement, according to an August article on the JAMA Network. IUDs don’t cause ectopic pregnancies, but if a woman gets pregnant while using an IUD, she would have a higher risk of it being an ectopic pregnancy, Dr. LaCorte said.

Any sexually transmitted infections (STDs) should be treated prior to placement of an IUD, as that can raise the risk of pelvic inflammatory disease.

Contraceptive Implants

Implants are small plastic rods containing a form of progestin that are inserted under the skin of the upper arm. The progestin works by preventing ovulation, as well as blocking sperm from entering uterus by thickening mucus in the cervix, according to ACOG. Contraceptive implants:

• Can work for 3-5 years, according to PICCK.
• May reduce period pain.
• May reduce symptoms of endometriosis and polycystic ovary syndrome and lower risk of uterine and ovarian cancer.
• Have a failure rate of 0.1 percent, according to the CDC.

Similar to IUDs, implants can alter periods. Periods may occur more often or less often – even cease. About 22 percent of implant users have their periods stop, according to PICCK.

“This can be hard to predict. I usually review with the patient how they responded to hormonal treatments in the past to determine what their reaction might be. But we often have to use trial and error to find the right method,” said Dr. LaCorte.

Other side effects can include dizziness, headache, acne, weight gain, digestive upset and breast or back pain, according to PICCK. Risks include improper insertion of the implant, and a rare higher risk of ectopic pregnancy if an implant user gets pregnant, according to ACOG.

Choosing a Method

IUDs and implants are two of many contraceptive methods from which women may choose. Dr. LaCorte said she asks patients three questions to help them decide what’s right for them:

• How long do you want to prevent pregnancy?
• Do you need protection against STDs?
• Do you have medical issues that might interfere?

The answer for some patients may be combining two forms of birth control, she said. For example, an IUD to prevent pregnancy and condoms to prevent STDs may suit some patients.

Health history helps determine choice. Women over 35 who smoke, or have had breast cancer or blood clots, may not be candidates for standard birth control pills that contain estrogen, according to the CDC. Because IUDs don’t use estrogen, there’s little worry of increasing the chance of DVTs (deep vein thrombosis – blood clots in legs or arms), Dr. LaCorte said.

“All of the LARCs have lower side effects of weight gain and effects on mood compared with the other methods,” she said.

Women with uterine, cervical, breast or endometrial cancer, or lupus with positive or unknown antibodies may not be candidates for hormonal IUDs or contraceptive implants, according to PICCK.

Women who get an implant or IUD should continue to have annual gynecological exams, Dr. LaCorte said. If they feel any changes in their IUD strings or the area of their implant, they should report those to their doctor right away, she added.