Get It and Forget It Birth Control: LARCs

How do LARCs work?

There are two types of LARCs: a small T-shaped device that is put into the uterus and a thin implant that is inserted into the upper arm. Most LARCs use progestin, a synthetic version of the natural hormone progesterone, but there is also a hormone-free option that releases copper into the uterus to prevent pregnancy. This makes LARCs a great option for people who want to avoid estrogen and those who are interested in an effective non-hormonal method.

The progestin released by hormonal LARCs primarily prevents pregnancy by thickening the mucus in the cervix to trap and block sperm and by stopping eggs from leaving the ovaries. In the case of the non-hormonal LARC, the copper ions create an environment where sperm can’t survive and are prevented from traveling to an egg.

LARCs must be inserted by a certified or trained provider. Placement can be performed at a doctor’s office or health clinic the same day and typically does not require sedation.

Birth control not only prevents pregnancy but also can be used for heavy and irregular periods, cramps, and acne. Hormone-based LARCs can be especially helpful with heavy and painful periods.

Cost:

Most Louisiana insurance companies cover LARC devices, including Medicaid, at 100% of the cost. Some clinics also have special sliding scale fees or may be able to provide LARCs for free as part of federally qualified services.

The Arm Implant

Hormonal

Name: Nexplanon

Duration: 3 years

What is it? A single plastic rod that is about 1.6 inches long and 1/8 inch wide. About the size of a matchstick.

Procedure: The implant is placed just below the skin in the inner part of the patient’s nondominant upper arm (if you’re right-handed, it will be placed in your left arm). Prior to insertion, the area is prepped and sterilized, then it is numbed with local anesthesia, which may sting a little. During the procedure, you will only lose sensation in the few inches of your arm where the implant is inserted. Placing the implant takes about 5 seconds.

After the procedure, you may take Tylenol or Motrin for any soreness as well as allergy medicine like Benadryl or Cetirizine for itching (which can be related to healing and scab formation). You will have a dressing placed on your arm that’ll stay in place for 24 hours and a special band-aid that should remain in place for 3-5 days. You’ll have full function of your arm.

Important: Depending on the timing of insertion and previous birth control use, the implant may be effective immediately or take up to 7 days to work. Make sure to discuss this with your provider!

Pros:

• Long-term effectiveness
• No need to remember to take birth control
• Little to no impact on weight
• Lighter or no periods
• May help with cramps

Cons & Possible Side Effects:

• Can be felt under the skin
• Irregular bleeding pattern or no periods
• Heavier and longer periods
• Breast tenderness
• Headache
• Mood changes
• Acne

NOTE: Side effects may improve within a few months or may not happen at all.

The Intrauterine Device (IUD)

Hormonal & Non-Hormonal

Names of hormonal devices: Skyla, Kyleena, Mirena, Liletta

Name of non-hormonal device: Paragard

Duration: 3-12 years

What is it? A small T-shaped plastic device that is about 1.25 inches long and has a string attached. The hormone-free version is wrapped in copper wire.

Procedure: The IUD is inserted into the uterus through the vagina and cervix. A pelvic exam with a speculum is required prior to insertion to rule out any abnormal uterine findings or infections that would alert the provider that an IUD is not the right option. This also prepares the patient for what to expect. If the pelvic exam is uncomfortable, you may not want to go through with having an IUD placed. Remember, your pain tolerance is not someone else’s pain tolerance, so don’t compare your journey with someone else’s!

After the pelvic exam, some providers use a local nerve block to numb the cervix prior to insertion of the IUD—this can be painful too. Others use special medicine to dilate (widen) the cervical opening a little to help with insertion.

Non-steroidal anti-inflammatory drugs like Ibuprofen, Toradol, or Naproxen can be used to relieve pain during the procedure and control bleeding afterwards.

Important: Depending on the timing of insertion and previous birth control use, the implant may be effective immediately or take up to 7 days to work. Make sure to discuss this with your provider!

Pros:

• Long-term effectiveness
• No need to remember to take birth control
• Little to no impact on weight
• Lighter or no periods
• May help with cramps
• Can be used as emergency contraception up to 5 days after unprotected sex

Cons & Possible Side Effects:

• Pelvic exam needed
• Post-procedure cramping and bleeding
• Irregular and heavier periods (likely with hormone-free IUD)
• The lower the dose of hormone, the less likely the IUD is to treat hormone-related issues (acne, cramps, heavy periods)

Note: Side effects may improve within a few months or may not happen at all.

Types of IUDs:

Skyla

• 3-year device
• 28 x 30 mm
• A smaller device with a lower hormone dose

Kyleena

• 5-year device
• 28 x 30 mm
• A smaller device that lasts longer

Mirena

• 7-year device
• 32 x 32 mm
• Recommended for heavy periods

Liletta

• 6-year device
• 32 x 32 mm
• Cost-efficient alternative to Mirena

Paragard

• 12-year device
• 32 x 36 mm
• Hormone-free option