LARC (Long-Acting Reversible Contraception)

Long-acting reversible conception (LARC) is birth control that provides long-term pregnancy prevention. LARC includes devices that a healthcare provider inserts into your uterus or implants under your skin. LARC provides protection for three to 10 years or more. Your healthcare provider can remove the device if you decide you’d like to become pregnant. LARC is the second most popular form of reversible birth control in the U.S.

Types of LARC

LARC comes in two forms:

• Intrauterine device (IUD): A device your provider inserts into your uterus
• Implant: A device your provider implants under the skin in your upper arm

IUD

An IUD is a small, T-shaped device that fits inside your uterus. There are copper IUDs and hormonal IUDs. The U.S. Food and Drug Administration (FDA) has approved various brands to prevent pregnancy.

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

Implant

An implant is a matchstick-sized plastic rod that your provider places in your upper arm. Nexplanon^® is the only FDA-approved implant in the U.S. It prevents pregnancy for five years.

Who could use LARC?

You could use an IUD or implant if you’re looking for the most effective pregnancy prevention available. LARC devices work on their own and don’t need daily or monthly attention. If you want a “set it and forget it” method, LARC may be a better choice than a pill or patch.

Who shouldn’t use it?

You shouldn’t get an IUD or implant if you:

• Are pregnant
• Have unexplained vaginal bleeding
• Have cervical cancer or uterine cancer
• Have a sexually transmitted infection (STI)
• Have a high risk for contracting an STI

In some instances, you may need to avoid using them. 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

How does LARC birth control work?

LARC devices work in several different ways. IUDs can cause changes in your uterus that create a toxic environment for sperm. They prevent sperm from potentially fertilizing an egg. Contraceptive implants also change your typical menstrual cycle.

• Copper IUDs: These trigger an immune response in your uterus that causes inflammation. This makes it difficult for sperm to survive.
• Hormonal IUDs: Like copper IUDs, these trigger an immune response. They also release a small amount of the progestin hormone levonorgestrel over time. It thickens your cervical mucus, making it harder for sperm to reach your fallopian tubes. It also thins your uterine lining and can affect ovulation.
• Implants: These 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 them?

IUDs and implants are often chosen as birth control because they’re:

• Safe: The current IUDs on the market go through rigorous testing to ensure that they’re safe.
• Effective: LARC is the most effective birth control method you can choose.
• Low maintenance: Once your provider inserts your IUD or implant, it will prevent pregnancy for years without any work on your part.
• Cost-effective: LARC may cost more up front, but it's very cost-effective over time. Because these devices last for years and are highly effective, they often end up saving you money in the long run.
• Good for your sex life: With LARC, you don’t have to interrupt the spontaneity of sex by having to reach for a condom or your diaphragm.

Certain types of LARC offer additional benefits, like:

• Relieving pain from endometriosis and menstrual cramps
• Reducing heavy menstrual bleeding
• Reducing your risk of cervical and uterine cancer
• Preventing pregnancy if inserted within five days of having unprotected sex (copper IUD only)

What are the disadvantages?

Some of the disadvantages of IUDs and implants are:

• No STI protection: Unlike condoms, LARC doesn't protect you from STIs.
• Side effects: All types of LARC can disrupt your period. They may cause heavier bleeding, lighter bleeding or no bleeding at all. You may have more painful menstrual cramping, too. These side effects can last several months to a year.

With a hormonal IUD, you can have breast tenderness, headaches, acne or mood changes.

Leaving an IUD or implant in beyond its approved timeframe will reduce how effective it is.

What are the complications associated with LARC?

LARC is considered safe. But possible complications include:

• An IUD slipping out of your uterus
• An IUD puncturing your uterus when it’s inserted
• An implant moving
• An infection developing after IUD or implant insertion

Your pregnancy may be considered high risk if you become pregnant while using LARC. Your chance of becoming pregnant is small, though.

What is the failure rate?

LARC prevents pregnancy 99% of the time. This means the failure rate is less than 1% — much lower than that of pills, patches and condoms. Most failures happen because the device was removed late or not placed correctly.