Benefits of long-acting reversible contraceptives

When my patients ask about choosing reliable, safe forms of birth control, I absolutely recommend long-acting reversible contraceptives (LARC). In particular, I recommend an intrauterine device (IUD).

An IUD is a small, T-shaped device that’s easily inserted into your uterus by your gynecologist or other healthcare provider during an office appointment. Once it’s placed, you can’t feel it.

They’re a convenient way to prevent unwanted pregnancy. You don’t have to think about birth control. You don’t have to worry about missing a pill or going to a pharmacy. Depending on which of the two types of IUD you choose—with hormones or without—they can prevent unwanted pregnancy for up to 10 years. If you decide you want to get pregnant, they can be removed at any time.

Some of my patients are unaware of the availability or the safety of these devices. The risks associated with them are extremely low. The biggest risk of placement that my patients worry about is uterine perforation – or the device going through the uterus. This is rare and happens 1% of the time.

Your healthcare provider can help you decide which type of IUD is better for you.

The copper IUD is hormone free. It prevents pregnancy by changing the intrauterine environment to prevent sperm from reaching the egg. I recommend this type for my patients who prefer not to add hormones. The copper IUD lasts up to 10 years, at which point it can be replaced.

For patients who experience bad cramping and heavy bleeding during their periods, I recommend the type of IUD that contains the hormone progesterone. It acts by thickening the cervical mucous to prevent sperm transport into the uterus, and also helps decrease the amount of bleeding each month. Two common brand names are Mirena, which lasts for five years, and Skyla, which contains less progesterone and lasts for three years.

Inserting the IUD is a simple office procedure. I prepare my patients by letting them know they’ll experience some cramping, which is usually relieved with ibuprofen. You might plan to rest a little bit afterwards, but any activity is fine if you feel up to it.

If you’re planning to use an IUD after having a baby, be aware that placement can occur in the delivery room after the placenta is delivered. When placement is made immediately following childbirth, the risk of expulsion by the uterus is raised to between 10% and 27%, while the normal risk is between 2% and 10%.

The remarkably low risk of pregnancy after an IUD is placed is just 2% over a 10-year period, which is the same as tubal ligation (sterilization). If you do become pregnant after placement, it’s important to contact your physician as soon as possible.

Another long-acting, reversible and effective birth control option is an arm implant. During an office visit, it’s placed under the skin in your upper arm via a small incision. It remains effective for three years. The biggest complaint I’ve had from patients is unscheduled bleeding. Some patients have their normal periods, some don’t have a period and some have unscheduled spotting throughout the life of the device. There’re ways to address the bleeding if it happens.

Another effective method to prevent unwanted pregnancy is a birth control shot. While each person reacts differently to hormones, the side effect my patients complain about the most with the injection is weight gain. On average, a patient could gain up to 11 pounds in three years while receiving the injection. Although the reason for weight gain is unclear, the thought is that the hormones cause an increase in hunger.

Being responsible for birth control means using the best options available for you. You should also check with your insurance provider, as coverage can vary. For example, the out-of-pocket cost for IUDs can range from about $0 up to $1,300.

I think IUDs are a great option. In fact, they’re what I use.

Kamilah Dixon-Shambley is a board certified obstetrician and gynecologist with The Ohio State University Wexner Medical Center.