Long-Acting Reversible Contraception (LARCs)

Two drawn hands reach out to each other. The one on the left has two IUDs, with the words "hormonal" and "copper" written over them. The hand on the right as a birtin control implant in its palm. The hands are light pink against a darker pink background. Illustration by Rosie Ranauro

The following text uses the word “pussy” as defined by Pussypedia.

by Elisa Caref

What is going on?

There are two main categories of birth control: user-dependent birth control, like the pill, patch, or condoms, and long-acting reversible contraception (LARCs). Most experts consider three forms of contraception to fall in the LARC category: intrauterine devices (IUDs) and the implant.

(The NuvaRing is sometimes considered a LARC, sometimes user-dependent.1 The NuvaRing is a hormone-releasing flexible plastic ring that the user inserts into their own vaginas, just below the cervix every month. Hormonal injections have also been considered LARCS. They are birth control shots, like Depo-Provera, that can last for several months at a time are still generally considered less effective than other LARCs because they still depend on the user returning to the doctor to continue receiving the shots.2 In fact, 30-40% of injection users stop getting the shots within the first year.)1,3

Anyway, back to the tried-and-true LARCs, what they are, and how they work.

IUDs get inserted into your uterus. There are now several kinds of IUD on the market.4 The copper IUD (Paraguard) is non-hormonal. The copper itself prevents fertilization of the egg in the uterus.2 This is because copper causes an inflammatory response that is slightly toxic to sperm, and in the unlikely event that sperm do fertilize eggs, viable embryos won’t usually develop.5

The other IUDs are hormonal. They give you a dose of a hormone called levonorgestrel once a day right into your uterus which causes cervical mucus to be thick and prevent sperm from being able to get through it. They also sometimes prevent you from ovulating.2

  • The Mirena (20-mcg LNG-IUD) gives you 20-mcg.4
  • The Liletta (18.6-mcg LNG-IUD) gives you 18.6-mcg.4
  • The Kyleena (19.5-mcg LNG-IUD) has 19.5-mcg but gives you 17.5 mcg.4
  • The Skyla (14-mcg LNG-IUD) gives you 14-mcg.6

Contraception implants like the Implanon are silicone tubes with hormones (levonorgestrel) that get surgically implanted into your arm.7 They release levonorgestrel into your body to prevent your body from ovulating so you can’t get pregnant.2

LARCs are probably the most effective form of birth control. One long-term study found a rate of pregnancy within the first year of use for a group that used IUDs and implants to be less than .3% while for the group that used pills, patches, and rings to be 4.8%.1

Many accidental pregnancies occur because most other forms of birth control depend largely on the user to remember to take it. LARCs just stays put in the body for years.1 The implants can generally last 3-5 years, while the hormonal IUDs last for 3 years (Skyla), 4 years (Liletta), and 5 years (Kyleena and Mirena).4 Copper IUDs are safe and effective for up to 10 years.2

How common is this?

Despite that LARCs have been around for decades, people with pussies* have only started to use them in greater numbers very recently. By 2012, it was reported that 11.6% of cisgender women in the US who use birth control use LARCs—an increase from 8.5% in 2009.8 LARCs are not as common as other birth control methods because patients and their doctors are less informed about them, and they are less often available in doctors’ offices.2

How can I take care of my body?

One study looked at people with pussies* over the age of 21 and how long they keep using the birth control they use. After three years of use, nearly 70% of the people who used IUDs and over 50% of people who used the implant continued using them. (This could be influenced by the fact that you have to go to the doctor to get them out but they also might just like them, we can’t know!) Of the people who used non-LARC methods, only about 30% kept using them after three years.3

LARCs are long-lasting and effective, but they do have reported side effects and some people may be worried about their placement methods. The implant is placed in (and removed from) the arm through minor surgery with local anesthesia.7 All IUDs are placed directly in the uterus by doctors. A small percentage (5%) of pussies* expel IUDs within the first three months of use, which can increase the risk of pregnancy.2 Copper IUDs are more likely to be expelled by the body than the hormonal ones.8

All three LARC methods have varying potential side effects once implanted. In one study around 30% of users got their LARCs removed within three years of placement. Among people who had their LARCs removed, changes in menstrual flow and cramping are among the most reported reasons for discontinuing, in addition to simply not liking how it made them feel.3

The hormonal IUDs cause some people with pussies* to completely stop having their period after 3-6 months, while the copper IUD tends to cause heavier bleeding and cramps during menstruation, and occasionally in between cycles as well.3

LARCs do not affect one’s ability to get pregnant after they stop using the method! They also tend to be less of a hassle than oral contraception or the Nuvaring, because it only takes one doctor’s visit to put them in, and then there are no monthly prescriptions to buy.2

 

Author’s Dedication: To my mother – although she was hoping I would have a baby at age 30, she respected my decision to go out on a LARC and still be child-free at 31. She raised me with an openness of talking about sex, sexuality, and pussies*, which I am more and more grateful for every day, and clearly impacted my ability to write this article.

Sources

  1. Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, et al. “Effectiveness of Long-Acting Reversible Contraception.” The New England Journal of Medicine. 366(21). (2012): 1998-2007. <https://www.nejm.org/doi/full/10.1056/nejmoa1110855>. *This study has a conflict of interest that raised our eyebrows––not enough to toss it out but enough for us to want to leave a note to let you know that one of the authors miiiiight have reasons to report positive findings on LARC effectiveness. Still, other studies we found support these findings.
  2. Fleming CF. “Long-acting reversible contraceptives.” The Obstetrician & Gynaecologist. 11(83). (2009): 83–88. <https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1576/toag.11.2.083.27480>.
  3. Diedrich JT, Zhao Q, Madden T, Secura GM, Peipert JF. “Three-year Continuation of Reversible Contraception.” American Journal of Obstetrics and Gynecology. 213(5). (2015): 662.e1–662.e8. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292132/pdf/nihms844720.pdf>.
  4. Espey, E, Hofler, L. “Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No. 186.” American College of Obstetricians and Gynecologists. Obstetrics & Gynecology. 130. (2017): e251–69. <https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins—-Gynecology/Public/pb186.pdf>.
  5. Ortiz ME, Croxatto HB, Bardin CW. “Mechanisms of action of intrauterine devices.” Obstetrical & Gynecological Survey. 51(12). (1996): Suppl. S42-51. <https://www.ncbi.nlm.nih.gov/pubmed/8972502/>.
  6. Hardeman J, Weiss, B. “Intrauterine Devices: An Update.” American Family Physician. 89(6). (2014): 445-450. <https://www.aafp.org/afp/2014/0315/p445.html>.
  7. Sivin, I. “Risks and Benefits, Advantages and Disadvantages of Levonorgestrel-Releasing Contraceptive Implants.” Drug Safety. 26(5). (2003): 303-335. <https://www.ncbi.nlm.nih.gov/pubmed/12650633>.
  8. Phillips SJ, Hoffer LG, Modest AM, Harvey LFB, Wu LH, et. al. “Continuation of copper and levonorgestrel intrauterine devices: a retrospective cohort study.” American Journal of Obstetrics and Gynecology. 217(57). (2017): e1-6. <https://www.ncbi.nlm.nih.gov/pubmed/28315664>.

This article was previously published in Pussypedia and is reposted with permission.