LARC (Long-Acting Reversible Contraception)

What is long-acting reversible contraception (LARC)?

Long-acting reversible conception (LARC) is birth control that provides long-term pregnancy prevention. LARCs provide protection for three to 10 years or more, depending on the birth control brand. LARCs come in two forms, a device your provider inserts into your uterus and a device your provider implants into your arm. Your provider can remove the device if you decide you’d like to become pregnant.

Unlike condoms, LARCs don’t protect you from sexually transmitted infections (STIs).

Which contraceptives are LARCs?

There are two types of LARCs, intrauterine devices (IUDs) and implants.

IUDs

An IUD is a small, plastic T-shaped device that your provider inserts in your uterus. There are copper IUDs and hormonal IUDs. Various brands are FDA-approved to prevent pregnancy.

• Copper IUDs: Paragard® is the only FDA-approved copper IUD. It prevents pregnancy for 10 years.
• Hormonal IUDs: There are five FDA-approved hormonal IUDs: Mirena® (seven years), Liletta® (six years), Kyleena® (five years) and Skyla® (three years).

Implants

An implant is a matchstick-sized plastic rod that your provider places in the inner part of your upper arm.

Nexplanon® is the only FDA-approved implant currently used. It prevents pregnancy for three years. Nexplanon is the updated version of an earlier implant called Implanon.

How effective are LARCs at preventing pregnancy?

LARCs prevent pregnancy 99% of the time. Some providers advise that you can wear them past the date they’re authorized to prevent pregnancy and still be protected from becoming pregnant.

Ask your provider how long you can safely wear your IUD or implant without risking pregnancy.

How commonly are LARCs used?

LARCs are the second most popular form of reversible birth control in the U.S., following birth control pills.

Increasingly, more people are turning to LARCs as their primary birth control method. In the U.S., IUD use increased from 2% to 14% between 2002 and 2014 among people who are designated female at birth (DFAB) and using contraception.

Who should use LARCs?

You should use an IUD or implant if you’re looking for the most effective pregnancy prevention available. Unlike other forms of birth control, like pills, patches and injectables, LARCs don’t require ongoing maintenance. If you know you’re likely to forget to take your pill or schedule an appointment with your provider to get your birth control shot — LARCs may be the best option for you.

Who shouldn’t use LARCs?

You shouldn’t get an IUD or implant if:

• You’re pregnant.
• You have unexplained vaginal bleeding.
• You have cervical cancer or uterine cancer.
• You have a sexually transmitted infection (STI).
• You have a high risk for contracting an STI.

In some instances, you may need to avoid a particular type of LARC. You shouldn’t use the copper IUD if you have a copper allergy or Wilson’s disease. Avoid hormonal IUDs or implants if you have:

• Severe liver disease.
• Breast cancer (or if you have a high risk for breast cancer).

Speak with your provider if you’re thinking of getting an implant and have a history of blood clots or if you have a high risk for developing blood clots.

How does LARC birth control work?

LARCs cause changes in your uterus that create a toxic environment for sperm. They prevent sperm from traveling from your uterus to your fallopian tubes, where they could potentially fertilize an egg. Contraceptive implants also interrupt your menstrual cycle.

• Copper IUDs: Trigger an immune response in your uterus that causes inflammation. The inflammation makes it difficult for sperm to survive. Copper IUDs also thin your uterus lining. Even if an egg is fertilized and becomes an embryo, it wouldn’t be able to implant in your uterus lining.
• Hormonal IUDs: Trigger an immune response similar to copper IUDs. They also release a small amount of the progestin hormone levonorgestrel over time. Progestins are a synthetic version of progesterone, a hormone that occurs naturally in your body. Levonorgestrel thickens your cervical mucus, making it harder for sperm to swim to your fallopian tubes. It also thins your uterine lining and partially suppresses your ability to ovulate (release an egg) each month.
• Implants: Release a small amount of etonogestrel over time. Etonogestrel is a form of progestin. It prevents you from ovulating and causes changes in your uterus similar to hormonal IUDs.

What are the benefits of using LARCs?

Many people choose IUDs and implants as their primary form of birth control because they’re:

• Safe: The current IUDs on the market go through rigorous vetting and testing to ensure that they’re safe before receiving FDA approval.
• Effective: LARCs are the most effective birth control method you can choose. Birth control pills — when taken consistently — have the same 99% effectiveness rate as LARCs. But many people forget to take them, decreasing their effectiveness to around 91%. LARCs don’t have the same margin of error.
• Low-maintenance: Once your provider inserts your IUD or implant, it will prevent pregnancy for years without any work on your part.
• Cost-effective: Although they’re expensive upfront (exceeding $1,000 out-of-pocket in some cases), they may be more cost-effective in the long run than contraception that requires frequent visits to the pharmacy. Medicaid and many insurance companies cover FDA-approved forms of LARC.
• Good for your sex life: With LARCs, you don’t have to interrupt the spontaneity of sex by having to reach for a condom or your diaphragm.

Certain types of LARCs offer additional benefits, such as:

• Relieving pain from endometriosis (implants, certain types of hormonal IUDs).
• Relieving pain associated with menstrual cramps (certain types of hormonal IUDs).
• Reducing heavy menstrual bleeding (Mirena® is FDA certified to treat HMB).
• Reducing your risk of endometrial, cervical and uterine cancer (certain types of IUDs).
• Preventing pregnancy if inserted within five days of having unprotected sex (copper IUD).

What are the side effects of LARCs?

All LARCs may disrupt your period. Copper IUDs may lead to heavier bleeding and more painful cramping during your period. Hormonal IUDs lessen period bleeding and may cause you to miss periods (amenorrhea). Implants can have either effect. These irregularities may last for several months or even a year before your period returns to normal. Your period may be irregular for the entire time you have your IUD or implant.

Side effects may include:

Copper IUDs

• Heavy period bleeding.
• Painful menstrual cramps (dysmenorrhea).
• Increased risk of developing non-cancerous ovarian cysts.

Hormonal IUDs

• Irregular periods.
• Missed periods.
• Increased risk of developing non-cancerous ovarian cysts.
• Breast tenderness.
• Headaches.
• Mood changes.
• Nausea.

Implants

• Heavy period bleeding.
• Irregular periods.
• Missed periods.
• Spotting in between periods.
• Mood changes.
• Mild levels of insulin resistance.

What are the complications associated with LARCs?

LARCs are considered safe, with very little risk of complications. When they do occur, complications may include:

• An IUD slipping out of your uterus (more likely within the first few months of insertion when you’re on your period).
• An IUD puncturing your uterus during insertion.
• An implant slipping out of your arm, often resulting from improper insertion or an infection.
• An infection after the insertion of an IUD or implant.

Your pregnancy may be considered high-risk if you do become pregnant. Given how effective implants and IUDs are, your chance of becoming pregnant is slim.

A note from Cleveland Clinic

Long-acting reversible contraception is one of the most effective forms of birth control you can choose.

Talk to your provider about the potential benefits of LARCs, based on your health and lifestyle. Don’t forget to protect yourself from STIs, too. Using LARC with condoms can prevent pregnancy and decrease your risk of contracting STIs.