IS LONG ACTING REVERSIBLE CONTRACEPTION FOR ME?
Long acting reversible contraception (LARC) is nothing new. Modern IUDs date back to Poland in 1909, when Dr. Richard Richter fashioned a device from silkworm guts. Researchers around the world have tweaked the design, sometimes in disastrous ways. But the newest wave of IUDs and birth control implants has gained the confidence of many OB-GYNs. In 2009, the American Congress of Obstetricians and Gynecologists (ACOG) named LARCs the number one birth control method for the majority of women. They’re the top choice for reversible birth control worldwide, but have been slower to catch on with Americans.
A Troubled History
The first FDA-approved IUDs hit the U.S. market in 1968. The earliest designs were plastic with a monofilament nylon string for removal. Soon researchers added copper, a natural spermicide. Next they learned that a micro-dose of the hormone progestin could ease cramps and decrease bleeding. Trouble started when manufacturers started adding a multifilament string to the Dalkon Shield, then the market leader. “It had nothing to do with the method itself,” says Eric Marlowe Garrison, bestselling author and sex counselor in Williamsburg, Va. “It had to do with the fibers that would descend though the cervix. The problem with those threads was that they were hollow. They were tubes that bacteria could travel through.” Sales stopped abruptly in 1974 after thousands of women developed infections and six died. Manufacturers pulled all but one brand of IUD from the U.S. market.
The development of birth control implants suffered similar, though less lethal, setbacks. In 1990, the FDA approved Norplant — six small, hormone-filled rods implanted in a woman’s upper arm. But the implants proved difficult to remove and were quickly associated with attempts to prevent female criminals and addicts from breeding. Norplant disappeared from the U.S. market in 2002.
New Generation LARCs
Starting in 1988, a new, safer generation of IUDs trickled into the market. ParaGard is a hormone-free copper IUD which can stay in place for up to 10 years. Mirena is a plastic, hormonal IUD good for five to seven years. Smaller versions of Mirena include Skyla, Liletta and Kyleena. Dr. Mache Seibel, a member of the Harvard Medical faculty and author of “The Estrogen Fix,” says she appreciates the “one and done” nature of LARCs. “You get it inserted and then you don’t really have to worry about it. And it’s quite effective.”
Implants also enjoyed a renaissance. Unlike Norplant, Nexplanon and Implanon are single rods. It only takes a couple of minutes to insert them under the skin of the upper arm. The progestin immediately starts preventing pregnancy by halting ovulation and thinning the uterine lining, making it harder for eggs to attach.
Pros and Cons
LARC benefits are obvious – not having to think about birth control. So why are there so many online videos and blog posts by angry women getting their implants and IUDs removed? The two biggest drawbacks are fear and discomfort around insertion, along with the side effects that some women experience.
A tubular inserter propels the IUD past the cervix and into the uterus, where it opens into a T shape. While a brief procedure, any woman can imagine this does not sound like fun. Cramps may follow, lasting anywhere from two weeks to six months, accompanied by erratic bleeding. A small number of women develop pelvic inflammatory disease, and 1 in 1,000 IUDs perforate the uterine wall during insertion, according to ACOG.
Unpredictable bleeding is the most common side effect of implants. Some women also gain weight or experience mood swings.
Who should use LARCs?
Birth control pills, the most popular reversible contraception method in the U.S., work best when taken at the same time every day, Garrison says. LARCs are “very forgiving for people who have trouble remembering things.” Garrison recommends LARCs for women who change time zones a lot, such as pilots or flight attendants. Also, women doing missionary, military or Peace Corps work will find LARCs easier than refilling prescriptions. LARCs don’t prevent sexually transmitted infections, so they’re best for people in long-term, monogamous relationships.
Doctors often recommend LARCs for teenagers who might forget to take pills and probably want to avoid babies for a while. But Seibel also recommends IUDs as part of hormone therapy for women who are past their reproductive years. There are handy online algorithms that can help determine your best birth control method.