The options for Long-Acting Reversible Contraceptives (LARCs)

When thinking of contraception, many people still think of condoms or the pill (including the minipill) rather than Long-Acting Reversible Contraceptives, also referred to as LARCs. The Pill and condoms are very popular, useful methods, but as many of you know, they have their drawbacks. They are short-acting. One of the most important features of contraception is what doctors call “compliance”. Compliance is the ability of an individual to remember to use the contraceptive as required, to get the lowest failure rate (failure being an unplanned pregnancy). The problem with condoms for contraceptive purposes are; they aren’t always put on in the first place, they can break, or they can come off during sex.  

The commonest problem with the pill is remembering to take it every day. Most studies show a pregnancy per rate per annum for couples using condoms of 5% per annum.  

With the pill it is 1-2% per annum, assuming it’s taken correctly. This is where long-acting reversible contraceptives (a.k.a. LARCs) can be very good options for women requiring contraception.  

1. IUDs: Intra-uterine contraceptive devices.  

This tried and true method first came into widespread use through the 1950s and 1960s. Traditional IUD’s rely on causing a gentle irritation to the lining of the uterus (the endometrium) thus promoting menstruation to occur with each cycle even if an egg fertilises. IUD’s can usually be inserted in the consulting rooms, but you can choose to have this done under a light general anaesthetic if you would prefer, we can discuss this during your private appointment. 

Copper-based IUD:

Currently available in Australia in this group is the copper-IUD. The copper IUD can stay in the uterus for up to five years. It is reversible at any stage, has a low failure rate (approximately 0.5 -1.0% per annum) and does not interfere with the natural hormonal regulation of the menstrual cycle.  

Compliance is excellent, as once inserted you don’t have to think about it again for another five years unless you’d prefer it to be removed. The main drawback of copper IUD’s is your period is usually heavier, may last a little longer, and possibly be more painful at times.

Hormonal – based IUD (Mirena and Kyleena):  

Progesterone containing IUD’s were invented in Finland in 1991 and have become extremely popular both as a method of contraception and for an effective treatment of heavy menstrual bleeding, separate to contraception. They don’t need changing for five years, are reversible at any time, have a low failure rate (0.2-0.5%) per annum, and again have perfect compliance.  

Best of all they uniformly make periods extremely light and are usually much less painful for women who normally experience period pain. Being progesterone based, a small group of women (around 5-10% ask to have them removed if they experience side effects. These can include a change in mood, libido, acne, or irregular annoying spotting. Most women not only find them satisfactory, they continue to have them changed every five years until menopause.

There are two brands of progesterone IUDs: Mirena and the newer Kyleena.  

2. Contraceptive implant: (Implanon)  

The etonogestrel implant has been available in Australia since the mid-1990s. It is a thin soft cylindrical rod-shaped implant which is inserted under the skin in the inner upper arm. Insertion is easy and when correctly placed you will not notice the device at all. It’s easy to insert and lasts for three years before needing changing, is reversible and has the lowest failure rate of all contraceptives (around 1 in 1000 per annum). This method is also quite effective at relieving pre-menstrual migraine.  

A drawback of using contraceptive implants is around 10-20% of women experience a persisting alteration to their menstrual pattern with more days of bleeding per month, or irregular periods. The remaining 80% are unchanged or experience very light periods.  

3. Contraceptive injections: (Depo – Provera)  

First invented in 1967, this is the oldest long-acting hormone-based contraceptive available. It is a small intramuscular injection administered every three months. It is very effective with a failure rate somewhere between 1 in 500 and 1 in 1000. It is a stronger progesterone than later methods including the various pills, Mirena and Implanon.  

Because of this, progesterone related side effects (think pre-menstrual symptoms) can occur more commonly. Perhaps mostly because of this, it is less popular now than the above-mentioned methods, but still has a role to play in selected patients.  

How do I decide which method is right for me?  

Talk with your GP, who will then discuss your gynaecological history, examine you and discuss which options may suit best. If you are still unsure or your doctor feels you need further assessment, request a referral to see me for an appointment. We will discuss all the options for you to choose from, allowing us to arrange the right contraceptive for you.  

Good family planning has made an enormous difference to the quality and options for a woman’s lifestyle in the last 60 years or more. Getting it right for you, is so important and you can find the option that suits you best. 

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Author: Dr Peter England, Obstetrician and Gynaecologist.
Read more about Dr Peter England

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