By Dr. Vanessa Cullins
You may have heard some things in the news recently about LARC methods being recommended as the best form of birth control for young women and teens because they're safe, effective, and long-acting. If you don’t remember your gynecologist ever mentioning this method, which stands for “long-acting reversible contraception,” it might be because you didn't realize LARC was another way of saying IUD or implant. As these methods are highly effective and can prevent pregnancy for three to 12 years, they're worth knowing about.
The LARC method is often associated with young women (15 to 19), but it's a great, and underused, option for women in their 20s, 30s, and 40s, too. Pre-menopausal women in their 50s can opt for it as well. If you’re not ready to start a family but think you might want to have kids someday, and if you’re interested in the most effective and most cost-efficient birth control available, a LARC method might be just the ticket. Similarly, if you have kids and don't plan on having more — but also don't want to opt for permanent birth control — an IUD or implant may be your best bet.
To help you consider whether or not a LARC method is right for you, there are five things you should know:
LARC methods are the most effective reversible birth control methods available. IUDs and implants have extremely low failure rates that rival the rates of permanent birth control: less than 1%, in fact!
Unlike the pill, neither the IUD nor the implant requires you to remember to do something to prevent pregnancy every day — or just before intercourse, or once a month, or even every three months, the way that other methods do. Once an IUD or implant is inserted, you simply don’t have to think about it, which is great news for many a busy woman.
And, unlike with permanent birth control, your ability to get pregnant will return quickly once the device is removed. If you decide it’s time to start a family, you can use the device for a shorter time period than the stated expiration date; it just needs to be removed by a health-care provider trained in removal and insertion.
LARC methods are a good option for women of all ages. Just this past September, the American Academy of Pediatrics announced an update to its contraception policy, recommending IUDs and implants as the first-line birth control option for teens. And, a new study published in the New England Journal of Medicine on the use of LARC methods among teens aged 15 to 19 years old resulted in lower rates of pregnancy, birth, and abortion compared with the national rate for other sexually experienced teens not using the LARC method.
It is true that IUDs and implants are often suggested for young women, including teens, but they're certainly not the only ones who can benefit from this safe method. The reality is that the same holds true for women of all ages: A 2012 study found that LARC use among teens and women ages 14 to 45 led to greatly decreased rates of unintended pregnancy and abortion.
Condoms and LARC methods can be BFFs. So, LARC methods are great at preventing pregnancy (have I convinced you yet?). It’s important to remember, however, that this birth control is just that and does not protect you from sexually transmitted infections (STIs) like chlamydia, gonorrhea, HPV, and HIV. Thus, unless you know your partner’s STI status and you’re absolutely sure you’re in a monogamous relationship, you should be using condoms along with your preferred birth control method. Using condoms in addition to another form of birth control in order to prevent pregnancy AND protect yourself against STIs is just smart sex.
LARC methods are extremely cost-effective. Upfront costs can, of course, be a barrier for some women interested in using a LARC method, since an IUD typically costs between $500 and $1,000 (but that covers the exam, insertion, and follow-up visit). But, if you consider how long an IUD or implant can work to prevent pregnancy — in some instances, up to 12 years— it quickly moves to being quite cost-effective. Three to 12 years is a long time not to have to think about your birth control.
And, thanks to the Affordable Care Act’s birth control benefit, which requires health insurance to cover all FDA-approved prescription birth control methods without co-pays (that’s $0), millions more women have access to no-co-pay birth control, including LARC methods, and that means upfront costs are no longer a barrier.
LARC use among women of all ages is increasing — and that trend will probably continue. Given all the benefits of the IUD and implant, it’s not surprising that use of LARC methods in the U.S. is rising among women of all ages. For example, the rate of LARC use among young women ages 15 to 19 in the U.S. increased from less than 1% in 2002 to almost 5% in 2009. Planned Parenthood has seen the total number of patients using LARC methods increase 104% from 2008 to 2012, with IUD use increasing 75% and implant use increasing 396%. In just one year, from 2011 to 2012, we saw a 34% increase in patients with implants and a 19% increase in patients with IUDs.
And, now that the ACA’s birth control benefit is removing the cost barrier of LARC methods for millions of women, we expect these numbers to keep growing. As more and more women are exposed to the LARC method and are able to access the most effective reversible contraception available, we can't imagine interest and use not seeing a substantial increase.
If you're interested in the LARC method, it's really important to find a health-care provider skilled in IUD and implant insertions and removals. I'm not surprised when I hear from the mothers and grandmothers of today’s young women who express a negative association with the IUD because of the Dalkon Shield, an older IUD device that led to pelvic infections, pelvic inflammatory disease, and subsequent infertility. Although it was taken off the market in 1974, I realize not everyone is aware of how much this method has evolved. Current versions of the IUD simply don’t have those problems; in fact, both the World Health Organization and the American Medical Association named the IUD among the safest, most effective, and least expensive long-lasting, reversible methods of birth control available to women.
The bottom line is that every woman — no matter what her age — should have accurate information and resources on all of her options to prevent unintended pregnancy, meet her life goals, and start her family when the time is right for her.
You can talk with your provider about the different birth control methods, or visit your nearest Planned Parenthood health center to get information about the advantages and disadvantages of each method, and ask any questions you have before choosing the method that’s best for you. You can also find more information about IUDs, implants, and the full range of birth control methods on Planned Parenthood’s website, including the My Method quiz, which recommends birth control methods to fit your life based on your answers to a few simple questions.