Dr. Varshali Mali, MBBS, DNB - Obstetrician and Gynecologist

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Long-acting reversible contraception methods (LARC)
Long-acting reversible contraception methods (LARC)

How to avoid pregnancy by Long-Acting Reversible Contraception methods (LARC)

Methods | Effectiveness | Pros & Cons

By

MBBS, DNB (OBGY)

Gynecologist & Pregnancy Doctor

Long-acting reversible contraception methods (LARC)
Long-acting reversible contraception methods (LARC) provides effective and reliable protection against pregnancy for an extended period. These contraception methods can be easily reversed in case if you want to get pregnant and have a baby. Once the method is reversed, the return of fertility is rapid. Out of all available contraception methods, these are the most often used family planning methods. The main reason why they are so popular is that these contraception methods don't depend on you remembering to take or use it before, during or after the sex. You don't need to take any ongoing efforts to prevent pregnancy. These methods offer the great freedom and peace of mind when it comes to family planning.
IUD (Copper T) is one of the most regularly used LARC contraception methods, but there are other "fit-and-forget" LARC methods. These methods include intrauterine system (IUS / hormonal coil), contraceptive injections, and implant. LARC methods are more than 99% effective to prevent pregnancy. This means only 1 woman out of 100 using this method will get pregnant. These methods are very cost effective considering the duration for which they offer protection.
This article contains details about all four long-acting contraception methods (LARC) and how to avoid pregnancy effectively using these methods.
Long-acting and reversible contraception methods (LARC) - Intrauterine Devices (IUD) / Non-hormonal coil

Intrauterine devices (IUD) / Non-hormonal coil contraception method

Intrauterine Devices (IUD) long-acting contraception method type
Type
Long & reversible contraception methods (LARC)
Effectiveness of intrauterine devices (IUD) long-acting contraception method
Effectiveness
99%
Intrauterine Devices (IUD) long-acting contraception method frequency of use
Frequency of use
5 to 10 Years
STD protection status by Intrauterine Devices (IUD) long-acting contraception method

Protection against STDs

No
Long-acting and reversible contraception methods (LARC) - Intrauterine Devices (IUD) / Non-hormonal coil
Intrauterine devices or simply an IUD is a small piece of flexible plastic and copper wrapped around it and looks like a letter T with two threads at one end. IUD is also known as an intrauterine contraceptive device (IUCD or ICD), contraceptive coil, or copper T. There are different types of IUD (copper T) mainly categorized based on the amount of copper and surface area exposed. IUD is the most used contraception methods for family planning. This long-acting and reversible contraception (LARC) method is popular due to its effectiveness to avoid pregnancy, the peace of mind and privacy it offers. The major advantage is that you do not need any on-going effort or attention to avoid pregnancy. That's the reason, sometimes it is also referred as "fit and forget" contraception method. Once removed, even after long-term use, fertility returns to normal condition rapidly.
Copper T is inserted into the uterus or womb with the two threads hanging through the cervix into the top of the vagina. It releases copper ions and changes the fluid inside the womb and fallopian tubes to make it hard for sperms to survive there. Although IUD decreases the absolute number of sperm cells that reach the egg, in some cases few sperms may reach the egg and fertilization may happen. To avoid pregnancy in such cases, IUD stops the egg from attaching to the wall of the uterus and prevent pregnancy.
Copper T is one of the most effective contraception methods with more than 99% effectiveness. It means only 1 out of 100 women using IUD has a chance of getting pregnant. They are so effective because you need not take any efforts to remember to use it and practice to use it correctly. One limitation of Copper T is that it does not offer protection against sexually transmitted diseases. You need to use condoms to prevent STDs. You also need to consult the doctor to insert the IUD.
IUD / Copper T is perfectly safe for most of the women but there are some conditions that may cause side effects or complications. Using IUD might not be safe if you have certain STDs, cervical or uterus cancer which is not treated if you have a pelvic infection or you are allergic to copper. Consult the doctor to find out if IUD is safe for you. It is very rare to get pregnant while using IUD, but if you get pregnant, make sure to get copper T removed as soon as you find out about your pregnancy. If you get pregnant with IUD in place, there is an increased risk of ectopic pregnancy and other serious health problems. That's the reason why you need to consult the doctor in case if you get pregnant while using IUD.
Advantages
IUD / copper T contraception method is very effective and long-term solution to avoid pregnancy. Once fitted, you need not think about how to avoid pregnancy. It offers great peace of mind and privacy. No one needs to know about it and no extra efforts to remember to use it or make effort to make it perfect. It is one of the most effective "fit and forget" contraception methods. Copper T can be easily removed, and it won't affect your fertility or make it harder to get pregnant. Your fertility comes to normal condition very rapidly. It is hormone free contraception methods without any hormone-related side effects. It is very cost-effective compared to other contraception methods considering the duration for which it offers protection to prevent pregnancy. IUD can also be used as emergency contraception. If copper T is inserted within 120 hours of having unprotected sex, it is over 99% effective to prevent pregnancy.
Disadvantages
Few women may experience some side effects after inserting copper T. Few of the IUD side effect includes pain, cramping or a backache for few days, spotting between periods, irregular and heavy periods. These side effects generally go away in a few months. You can also take some pain medicines to help you with few side effects. Talk to your doctor about what problem you are facing. The doctor will explain all contraception methods available and evaluate if IUD is the best suitable contraception method based on your need. The doctor will also guide you about family planning and how to avoid pregnancy effectively. Another limitation of copper T is, it does not protect against sexually transmitted diseases. You need to use condoms to protect yourself against STDs.
Long-acting and reversible contraception methods (LARC) - Hormonal IUD / Intrauterine system (IUS)

Hormonal IUD / Intrauterine system (IUS)

Hormonal IUD or Intrauterine system (IUS) long-acting contraception method type
Type
Long & reversible contraception methods (LARC)
Effectiveness of hormonal IUD or intrauterine system (IUS) long-acting contraception method
Effectiveness
99%
Hormonal IUD or Intrauterine system (IUS) long-acting contraception method frequency of use
Frequency of use
3 to 5 Years
STD protection status by hormonal IUD or intrauterine system (IUS) long-acting contraception method

Protection against STDs

No
Long-acting and reversible contraception methods (LARC) - Hormonal IUD / Intrauterine system (IUS)
Hormonal IUD also referred to as intrauterine system (IUS) are a small flexible plastic device that has a shape of letter T. It has a container filled with progestogen hormone which is slowly released inside a womb. The two threads attached at one end, pass out through the neck of the womb or cervix and lie in your vagina. These threads help to check if it is still at the place and used to easily remove it when needed. These threads or none of the part of IUS hangs out of the body and your partner will not feel its presence during sex.
The intrauterine system is like IUD, but instead of releasing copper ions, it releases the progestogen hormone to prevent the pregnancy. These progestogen hormones are similar to those naturally released by the ovaries. These hormones thicken the mucus at the entrance to the womb, making it difficult for sperm to pass and reach an egg. In case if few sperms still reach the egg, these hormones also prevent the growth of the egg by making the lining of womb thin. In some women, IUS sometimes also stops releasing the egg (ovulation).
IUS is one of the very effective contraception methods to prevent pregnancy. It is more than 99% effective and has a very low failure rate of just 1 in 2000 cases. Most of the advantages are similar to IUD which makes IUS also one of the preferred long-acting and reversible contraception methods (LARC). The IUS may also make your periods much lighter, shorter and usually less painful. It may even stop the periods completely after the first year of use.
Fitting IUS is not that complicated procedure and takes very less time. It can be fitted at any time during your menstrual cycle if you are not pregnant. A general examination of the vagina is done by the doctor to see position, size of the womb and any signs of infections. If everything is fine, the procedure will not take more than 20 to 30 minutes. After fitting the IUS, if you feel unwell, have a pain in your lower stomach, have a high fever or smelly discharge from your vagina, you may have an infection. Visit the doctor immediately for further investigation or for removing IUS. Most of the women can use IUS. But women with breast cancer, cervical cancer, liver diseases, arterial disease or history of serious heart disease or stroke, untreated STI or pelvic infections may not be able to use IUS. Consult your doctor to see if IUS is a best suited for you, and if not, select from other suitable contraception methods based on your body and your family planning requirement.
Advantages
This is one of the long-acting and reversible contraception methods (LARC) which lasts from 3 to 5 years. This method does is not affected by any other medicines. Along with offering the same benefits as that of IUD, this method also helps to make your periods lighter, shorter and less painful. It may even stop the periods completely. It is safe to use an IUS even if you're breastfeeding.
Disadvantages
The IUS procedure may cause some discomfort. Your periods might become irregular or stop completely, which may not be suitable for a few women. Some women may experience headaches, acne, breast tenderness or mood swing after having the IUS fitted. IUS does not protect from sexually transmitted decreases and you need to use a condom to protect yourself from them. Some women may experience irregular vaginal bleeding and spotting in the first six months. This is one of the contraception methods which causes hormonal changes and may not be suitable for you. Consult the doctor before taking a decision and to know how to avoid pregnancy effectively.
Long-acting and reversible contraception methods (LARC) - Contraceptive implant

Contraceptive implants

Contraceptive implant long-acting contraception method type
Type
Long & reversible contraception methods (LARC)
Effectiveness of contraceptive implant long-acting contraception method
Effectiveness
99%
Contraceptive implant long-acting contraception method frequency of use
Frequency of use
4 years
STD protection status by Contraceptive implant long-acting contraception method

Protection against STDs

No
Long-acting and reversible contraception methods (LARC) - Contraceptive implant
NOTE : The contraceptive implant is mostly not available in India. If you are thinking about using the implant as contraception methods, please check with the doctor about its availability.
The contraceptive implant is a small flexible plastic rod. It is of the size of a matchstick, about 40 mm long and 2 mm wide. The contraceptive implant is placed just below the skin of your upper arm. It is invisible from outside and easy to hide.
This is one of the hormonal contraception methods and contains a progestogen hormone. Progestogen hormone is like what is naturally released by a woman during her period. The progestogen hormone contained in the contraceptive implant is slowly released into your bloodstream to avoid pregnancy. These hormones prevent pregnancy in two ways. First, this hormone thickens the mucus on your cervix and stops sperms from reaching to your egg. As sperms can't meet the egg, pregnancy can't happen. Second, it makes the lining of your uterus or womb thinner. So even in case if sperms meet the egg, it cannot get attached to the uterus and keep growing.
The contraceptive implant is one of the very effective long-acting and reversible contraception methods (LARC). It is more than 99% effective. In one year, only 1 out of 100 women using contraceptive implant will get pregnant. Some medicines like those used to treat HIV, epilepsy, and tuberculosis (TB), may make contraceptive implants less effective. Always tell the doctor about the implant if you are prescribed any of these medicines. It is very important to have the implant changed at a right time. So, keep a reminder about when is the due date to change the implant.
You can insert the implant any time during your menstrual cycle. The implant starts working immediately after you inserted it. If you have just given a birth to a baby and inserted implant within first 21 days, it starts working immediately. If you have inserted the contraceptive implant after 21 days, you need to use some other contraception methods for the next 7 days to avoid pregnancy. The contraceptive implant is safe for most of the women. It might not suitable contraception methods if you are pregnant, if you want your periods to be regular if you have some medical conditions like breast cancer, liver disease, cirrhosis or liver tumors, diabetes with complications, heart disease or on medication for HIV, epilepsy, and tuberculosis (TB).
Advantages
The contraceptive implant is one of the very effective long-acting and reversible contraception methods (LARC). You don't need any ongoing attention to avoid pregnancy. Just fit it and forget it for the next 3 years. It may make your periods lighter, shorter and less painful. If you are thinking about how to avoid pregnancy even if you are breastfeeding, the contraceptive implant might be a suitable contraception method. The implant is very easy to remove, and fertility returns to normal condition very rapidly. It is one of the best options for women who cannot use estrogen-based contraception methods. The contraceptive implant may give some protection against cancer of the womb.
Disadvantages
The contraceptive implant needs a small medical procedure to fit and remove it. The procedure may cause some tenderness, bruising and swelling when first put in. You will be able to feel it in your arm and sometime may feel discomforting. The major disadvantage of the contraceptive implant is its effect on period. Periods may become irregular, last longer than expected and may stop completely. You may experience other side effects like headaches, acne, nausea, breast tenderness, changes in mood and loss of sex drive. All this should get settled in first three months. If your initial discomfort does not go away, consult your doctor for diagnosis and to understand what is wrong. The doctor will able to tell you if the implant is suitable for you if not, the doctor will advise on how to avoid pregnancy using other contraception methods.
Long-acting and reversible contraception methods (LARC) - Contraceptive injection / shots

Contraceptive injection / shots

Contraceptive injection / shots long-acting contraception method type
Type
Long & reversible contraception methods (LARC)
Effectiveness of contraceptive injection / shots long-acting contraception method
Effectiveness
99%
Contraceptive injection / shots long-acting contraception method frequency of use
Frequency of use
3 months
STD protection status by Contraceptive injection / shots long-acting contraception method

Protection against STDs

No
Long-acting and reversible contraception methods (LARC) - Contraceptive injection / shots
The contraceptive injection is a shot that contains the hormone progestogen. The Depot-medroxy progesterone acetate (DMPA) is the commonest type of injectable contraceptive. It is marketed as Depo-Provera in India. So, the contraceptive injections are also referred to as Depo-Provera, the Depo shot or DMPA. The contraceptive injection contains a hormone progestogen which is similar to one of the hormones produced naturally by a woman's ovaries.
The contraceptive injection works in the same way as that of implants. Hormone progestogen is released into your bloodstream steadily. It avoids pregnancy by preventing the ovaries from releasing an egg each month (ovulation). When the egg is not produced, you can't get pregnant. It also makes cervical mucus thicker which make it very difficult for sperms to pass and meet eggs. Thus, it prevents pregnancy as egg and sperms can't meet.
Contraceptive injection is one of the very effective long-acting and reversible contraception methods (LARC). When used perfectly, it is effective more than 99% to prevent pregnancy. It means only 1 out of 100 women using contraception injection will get pregnant. Sometimes women may forget to take the shots, so in real life, it is considered as 94% effective. You need to get shots after every 12-13 weeks, about once in 3 months or 4 times in a year. Once you take the contraceptive injection, it cannot be reversed, and you cannot plan for getting pregnant for the next 3 months or want to avoid the side effects. The shot must be given by a doctor, so make an appointment considering the frequency of these shots. If you miss your contraception injection timing, you may not be protected from pregnancy. If you get your shot as late as 15 weeks after your first shot and you have unprotected sex, you might get pregnant. Take the pregnancy test before taking next shot.
Contraceptive injection is safe for most of the women. This is one of the contraception methods which you can use even if you are breastfeeding or recently have given birth to the baby. Contraception injection might not be a safe option if you have breast cancer, irregular and unexplained bleeding, atrial disease, heart disease or stroke or risk factors for osteoporosis (thinning of the bones). If you don't want your periods to change, if you are planning for a baby within the next one year, contraceptive inject is not a good choice. This is one of the contraception methods which causes hormonal changes and may not be suitable for you. Consult the doctor before taking a decision and to know how to avoid pregnancy effectively.
Advantages
This long-acting and reversible contraception methods (LARC) is very effective to prevent pregnancy. It is super private (taken in a doctor's clinic), safe and convenient way to avoid pregnancy. It does not interrupt the sex and protects you 24x7. The contraceptive injection can make your period less often. The periods may stop completely usually after a year of using the shots. This is not a permanent contraception method and very easy to stop. If you are thinking about how to avoid pregnancy even if you are breastfeeding, a contraceptive injection might be a suitable contraception method.
Disadvantages
The contraception injection may make period irregular, heavier or stop completely. This might be discomforting for a few women. Once taken, it cannot be reversed so any side effect might continue for some time. Depo-Provera type of injection may affect your bones especially for women at risk of osteoporosis. If you are planning for a baby in the coming one year, this is not a good choice. It takes about 9-10 months for fertility to return to normal condition. You also need to make sure to take the shot every 3 months. This contraception method does not protect from sexually transmitted diseases and you need to use condoms to get protection from STDs. There might be a few side effects like nausea, weight gain, headaches, breast tenderness, or depression. Talk to the doctor in case if you experience any of these and discuss other contraception methods and the suitability.
Getting pregnant and having a baby is exciting and the best thing that can happen to a woman. Many times, the unplanned pregnancy is undesirable and can bring stress, disturbance in your plans and overall unhappiness about pregnancy. Unintended pregnancy has a major impact on numerous social, economic, and cultural aspects of life. Through a good selection from all contraception methods and appropriate family planning, you can avoid all this and decide when you want to get pregnant.
Long-acting reversible contraception methods (LARC) are the most effective contraception methods out there. LARC lasts for many years and you don't have to remember to use it. Its "fit-and-forget" contraception methods and does not need any attention before, during and after sex. The great part of these contraception methods is that they are long-acting but not permanent. All the LARC methods are becoming popular, but IUD or copper T is the most commonly used contraception method in India. This is also a very cost-effective solution in the long run and a great choice for family planning. The cost of other contraception methods over the years is substantially high compared to the cost of IUD and the medical procedure required to fit it.
LARC offers a great protection, peace of mind, and most importantly does not need your attention at all. So, if you are a sexually active woman and worried about how to avoid pregnancy, LARC is a great long-acting solution. Remember that having a baby is very exciting and a life-changing event. Do not allow this to happen as an accident. Plan for it to avoid stress, disturbance in your plans and overall unhappiness about pregnancy. You can learn to avoid pregnancy naturally, use barrier contraception methods, use hormonal contraception methods, or use these long-acting methods. It is also understood that selecting the best one from all available contraception methods might go tough. If you are in doubt, consult the doctor who will help you to choose a contraception method that is best suitable for you. The more you know about these contraception methods and family planning, the more in control you can be of your sexual health. If you do not want the pregnancy, use appropriate contraception methods to avoid pregnancy. Let the pregnancy bring happiness than a stress and worry about what to do next.
Dr. Varshali Mali (MBBS, DNB). Gynecologist & Pregnancy Doctor

About Author

Dr. Varshali Mali is an Obstetrician and Gynecologist. She did her MBBS from Dr. D. Y. Patil Medical College, Pune, and DNB (Obstetrics & Gynecology) from Jehangir Hospital, Pune. She has a number of years of experience working as a gynecologist, pregnancy doctor, and lecturer. Currently, through her clinic located at Life Republic township near Marunji, she provides gynecology and pregnancy care solutions to the women around Hinjewadi, Wakad and nearby area in Pune. In her patient community, she is known for her welcome nature, smiley face, supportive attitude, intelligence and in-depth knowledge about gynecology and pregnancy. Mother of two daughters, she believes that motherhood is the best gift one can get. As her contribution, she puts her best efforts to make the pregnancy journey most enjoyable for her patients.

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