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Choosing the Right Birth Control: Options for Long Acting Reversible Contraception

Birth control pills and condoms are the most widely known forms of contraception, but they aren’t the only forms.

While condoms and birth control are effective in preventing pregnancy, their efficacy depends on being used properly.

“The least effective [forms of birth control] are those that are very user dependent,” said Dr. Victoria Myers, an Abington-Jefferson Health OB-GYN. With a pill or an injection, the user has to think about it every day or every few months, respectively.

According to Dr. Myers, the most effective forms of contraceptives are the ones that eliminate the possibility of user error.

“This past year, the American College of Obstetricians and Gynecologists recommended that long acting reversible contraception (LARC) should be the first line of contraception for adolescents and any women desiring contraception,” she said. This includes intrauterine devices and the birth control implant. Here’s everything you should know about these forms of birth control.

1. There’s more than one type of IUD

In fact, there are four types of IUDs: Mirena, Skyla, Paraguard and the new Liletta.

“Mirana and Skyla are very similar – they’re implanted with progesterone, which is slowly released over time,” Dr. Myers explained. They may decrease the flow of your period. One difference, she said, is that Skyla is a little bit smaller and it lasts for only three years. Mirena lasts five years.

And then there’s Paraguard, which doesn’t involve any hormones.

“Paraguard is a copper T. It impairs sperm mobility and can be used for 10 years,” she said. Paraguard can also serve as an emergency contraceptive if it is implanted within five days of unprotected sex.

Since Liletta is new, doctors have just started using it.

“It’s similar to Mirena and Skyla and lasts three years. The difference is that it’s going to be much cheaper upfront for patients,” Dr. Myers said.

2. IUDs aren’t your only LARC option

Some patients don’t want something implanted in their uterus and some patients have uterine abnormalities that pose a risk of IUD expulsion. In those cases, patients may opt for an under-the-skin implant called Nexplanon. This is a small, thin plastic rod inserted under the skin in the upper arm.

“It’s super easy to insert and it releases etonogestrel for three years,” Dr. Myers said. Etonogestrel is similar to a natural hormone your body produces and it works by preventing ovulation.

3. They have advantages

According to Dr. Myers, long-acting reversible contraceptives are “extremely effective;” it doesn’t matter how many times someone with one of these forms of contraception has sex – they will prevent pregnancy and the user doesn’t have to think about it.

“There’s no requirement for coming back to a doctor’s office for a prescription,” Dr. Myers said, citing that some people who use birth control pills may run out of pills and need a prescription or someone using Depo Provera may be due for a shot.

In addition, users don’t have to pay for this form of birth control on a regular basis.

“It may have a higher cost up front, but not in the long run. You don’t have to pay for it every month,” she said.

4. You can return to fertility quickly

This is where the “R” in LARC comes from.

“They are very reversible and you can go back to regular fertility very quickly,” Dr. Myers said. If you use an IUD or implant and decide you want to start a family or add to your family, you simply ask your OB-GYN to remove it and you may be able to get pregnant within just a few months.

5. They’re effective and safe for all women

IUDs have drastically changed over the last several decades. They were once thought of as only appropriate for women who already have children and were associated with some serious side effects. But that simply isn’t the case now.

“There used to be a lot of controversy around IUDs – all of that has changed. The research out there says IUDs and implants are terrific for teenagers and any woman at any age,” Dr. Myers said.

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