Not Ready for Baby #2? How Long-Acting Reversible Contraceptives Can Simplify Your Life
OB/GYN Dr. Kameelah Phillips breaks down long-acting reversible contraceptives
If your life is anything like that of my patients in New York, it’s packed. Between work, endless toddler birthday parties, and the constant ping of group chats, there’s barely a moment to breathe.
The last thing any of us needs to think about on a daily basis is the most effective form of contraception. While there is no such thing as the “right” method for everyone, finding a method that you can use consistently and correctly can feel overwhelming, but remember, you have options.
If you’re looking for something that’s highly effective, low-maintenance, and fits into your life without daily planning, long-acting reversible contraceptives (LARCs) might be the contraceptive category worth considering.
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What are LARCs?
LARC stands for long-acting reversible contraceptives (LARCs). LARC is one of my favorite “set it and forget it” options for long-term and highly effective birth control. LARCs are over 99% effective and fully reversible. These include the arm implant, Nexplanon, and IUDs (intrauterine devices). Each option is a safe and highly effective method of birth control that can last for years.
These methods are popular for a reason: once they’re in place, they work for years. This means no more setting your timer to take your pill, remembering to run to the pharmacy, or even remembering to pack your birth control every time you leave for vacation. This is a huge win for women looking to simplify their birth control regimen with a highly effective option. And if your plans change? No problem, your LARC can be removed anytime by a healthcare provider.
When I talk to patients about birth control, many are eager to have a first baby or another child one day, just not right now. This is why reversibility is such an important part of our conversation. Once a patient is ready to try to start getting pregnant, their health care provider can remove the LARC, and fertility can be restored quickly.
Long-acting reversible contraceptives also come in different hormonal options. When discussing birth control options with my patients, I like to break down the different birth control methods into three categories: non-hormonal, combined hormonal birth control (including estrogen and progestin), and progestin-only.
This helps me counsel them about a method that may best match their lifestyle, health, and reproductive goals. We talk through each option and how they work to help them choose a method that is right for you.
IUDs: Hormonal and Non-Hormonal Options
If you’re open to a uterine option, an IUD or intrauterine device could be a great long-term fit. The IUD is a tiny, T-shaped device placed in the uterus by a trained healthcare provider. IUDs can prevent pregnancy for anywhere from 3 to 10 years, depending on the type of IUD you choose.
Hormonal IUDs
Hormonal IUDs are a type of long-acting reversible contraception that is inserted into the uterus. It contains a synthetic version of the natural hormone progesterone. It works by thickening the cervical mucus to block sperm, thinning the uterine lining to make implantation less likely, and sometimes, it can suppress ovulation.
A healthcare provider must insert the IUD. Once it is inserted, and depending on the type of IUD you choose, it will provide continuous pregnancy protection for 3 to 8 years and is over 99% effective.
In the U.S., there are four types of hormonal IUDs. They differ in how much hormone they release and how long they last before needing to be removed.
Possible side effects: One of the most common complaints I receive from patients is bleeding or spotting outside of their period. This can be an inconvenience for the first few months. I also counsel them that they may have no period at all. While this may seem like a bonus, some women may be concerned that they are pregnant if they do not see regular bleeding. The third precaution I warn my patients about is the possibility of developing an an ovarian cyst, which may cause intermittent discomfort.
Copper IUDs
If you’re looking for a hormone-free option, the copper IUD might be a good fit for you. This type of IUD is wrapped in a small amount of copper, creating an environment that is toxic to sperm, preventing them from reaching an egg.
Like hormonal IUDs, the copper IUD is inserted by a healthcare provider into the uterus. It can stay in place for up to 10 years and is over 99% effective at preventing pregnancy. Since it is hormone-free, the Copper IUD may be a preferred option for women who do not want or cannot tolerate hormonal birth control.
Possible side effects: This option is the opposite of the hormonal IUD. I always counsel patients that their periods may be heavier, crampier, or even longer. They should be prepared for this.
Arm Implant: Nexplanon
Nexplanon is a soft, flexible implant about the size of a matchstick that’s inserted by a healthcare professional and rests just under the skin of your upper arm. In a quick office procedure, a healthcare provider inserts the Nexplanon, which remains effective for up to three years…unless your reproductive plans change before this time, in which case you can have it removed.
Nexplanon works to prevent pregnancy in three ways. It releases a steady, low dose of the hormone progestin. Progestin stops ovulation (the release of an egg from the ovary), thickens the cervical mucus to make it harder for sperm to reach the egg, and changes the lining of the uterus to make it less welcoming for a fertilized egg to implant. This means over 99% effectiveness, right up there with the pill but without the daily commitment.
When your family plans change, a health care provider can remove the device at any time in a simple office procedure. Once Nexplanon is removed, your body will quickly return to ovulating again. In fact, some people can get pregnant as soon as a week after having it removed.
Possible side effects: My counseling around Nexplanon is similar to the hormonal IUD when it comes to periods, because patients may experience a change in their normal menstrual bleeding pattern. They should be prepared for this, and typically, it will resolve with time. They may also have some arm tenderness after placement. This should resolve within a few days.
If you’re looking for birth control that’s safe, reliable, and easy to manage, long-acting reversible contraceptives could be a great fit.
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Dr. Kameelah Phillips is a board-certified OB/GYN, an Organon health partner and a Black female gynecology specialist based in New York City. She is affiliated with Morristown Medical Center, New York-Presbyterian Queens, and Lenox Hill Hospital. Dr. Phillips provides comprehensive care in gynecology, obstetrics, menopause management, and lactation support, with a special focus on serving minority and LGBTQ+ communities.
