By Dr. Tara Singh, MD
INDIA New England Health Columnist
CAMBRIDGE, MA–In the last 20 to 30 years, there has been an explosion in contraceptive options available for women: everything from pills, to a patch, to a vaginal ring or Long – Acting Reversible Contraception (LARC) options.
LARC options have the advantages of great success rates, minimal side effects, and empowering women to take control of fertility planning. They are completely reversible, and have been shown to be 20 times more effective than birth control pills. There is no associated increased risk of sexually transmitted infections with these options.
Women can use LARC options for birth control even before they have children. LARC options include the intrauterine device (IUD), of which there are four options available, the implant and the progesterone injection.
The IUD – this small T-shaped device is inserted in the office by a trained healthcare provider, and can remain in situ for three to ten years, depending on the chosen IUD. There are two main types of IUDs: copper- containing and progesterone – containing.
The chance of pregnancy with either type of IUD is approximately 1/1000. Women who use the copper IUD report monthly menses. It has been noted with this IUD that menses may be prolonged (up to seven days) and heavier. This IUD has also been associated with increased menstrual cramping, especially in women who already experience strong menstrual cramps.
Women who use the progesterone IUD report generally having lighter menses, and up to 60 % of women will safely be amenorrheic at one year. The effect of these IUDs on menstruation is completely reversible with removal of the IUD. The IUD works to prevent fertilization, thicken the cervical mucous, and thin the lining of the uterus in the case of the progesterone-containing IUDs.
The implant – this small, single, progesterone – containing rod is inserted into the upper arm of the non-dominant hand in the office by a trained healthcare provider. The implant can be used for three years, with the chance of pregnancy being 1/1000. It works by preventing ovulation, thickening the cervical mucous and thinning the lining of the uterus. Up to 20 % of women will be amenorrheic at one year of use. A large percentage of women will report irregular spotting with this option that may be controlled with hormones.
The progesterone shot – this shot is administered every 12 weeks by a healthcare provider. The chance of pregnancy is 1/100 with perfect use. It acts to prevent ovulation and thin the lining of the uterus. It has been associated with irregular bleeding and also with amenorrhea. The shot can stimulate the appetite. With careful control of eating habits, weight gain is generally not a concern.
LARC options are appealing to many women in the USA as seen by the dramatic increase in usage from 1.5 % in 2002 to greater than 12 % in 2014. Many advantages exist including that they are patient independent, can be removed at any time without affecting pregnancy rates, do not interfere with intercourse or other daily activities, and others cannot tell that the woman is using contraception.
The cost can be covered by insurance, the Affordable Care Act, Planned Parenthood and Title X funding. Discussion with your healthcare provider about which option is best for you is the next step!
(Dr. Tara Singh is a physician at Cambridge Health Alliance.)