Long-Acting Reversible Contraception (LARC)- Exploring the Benefits of Intrauterine Devices (IUDs) and Implants

Introduction

LARC is a contraceptive method that requires administration less than once per cycle or once per month. Contraception is a crucial strategy for the prevention of unwanted pregnancy. Long-acting reversible contraception (LARC) protects for three to ten years based on the brand of birth control. The LARC is available as a device inserted into the uterus and an implant placed in the arm. This method of contraception is reversible; when there is a change in opinion about getting pregnant, the clinician removes the device, and conception can occur. The LARC method of protection is accurate and widely accepted. Sexually transmitted diseases cannot be protected by long-acting reversible contraception (LARC).

What Are the Different Categories of Long-Active Reversible Contraception (LARC)?

There are two categories of long-acting reversible contraception (LARC): intrauterine devices (IUDs) and implants.

1. Intrauterine Devices (IUDs): IUDs are tiny,t-shaped plastic devices that the clinician places in the female's uterus. There are copper and hormonal intrauterine devices. The Food and Drug Administration (FDA) approves various brands and helps prevent unwanted pregnancy.

• Copper Intrauterine Devices (IUDs): The only FDA-approved copper intrauterine device is a paragard. It provides protection and prevents pregnancy for ten years.

• Hormonal Intrauterine Devices (IUDs): The five hormonal intrauterine devices approved by the Food and Drug Administration (FDA) are-

  • Mirena, which protects for seven years.

  • Liletta, which protects for six years.

  • Kyleena, which protects for five years.

  • Skyla is protected for three years.

2. Implants: The implant is about the size of a matchstick made of plastic. The clinician places the implant in the inner part of the non-dominant upper arm.

Nexplanon is the implant passed through the Food and Drug Administration (FDA), preventing pregnancy for three years. Nexplanon is the latest version.

Are Long-Acting Reversible Contraceptives (LARC) Effective?

• Long-acting reversible contraception (LARC) gives the maximum protection against unwanted pregnancy. Even after the expiry date, they are effective in preventing pregnancy.

• Ask the clinician regarding the time limit for wearing the intrauterine devices (IUDs) and implants.

What Are the Indications of Long-Acting Reversible Contraceptives (LARC)?

• Intrauterine devices (IUDs) and implants are indicated to those looking for an effective method of birth control.

• Other birth control methods require maintenance, like patches, pills, and injectables, but long-acting reversible contraceptives (LARC) do not require any maintenance.

• There is a need to consume pills and book an appointment with a physician to get a birth control shot, but long-acting reversible contraceptives (LARC) do not require anything after placing them.

• Diabetic and epileptic women can use these contraceptives.

What Are the Contraindications of Long-Acting Reversible Contraceptives (LARC)?

Intrauterine devices (IUDs) and implants are contraindicated in certain conditions. They are as follows:

• During pregnancy, long-acting reversible contraceptives (LARC) should not be inserted.

• If there is severe vaginal bleeding, long-acting reversible contraceptives (LARC) are not placed.

• History of cervical and uterine cancer.

• If there is a sexually transmitted disease (STD), (IUDs) and implants are not used.

• If there is a history of copper allergy, avoid copper intrauterine devices.

• If there is Wilson's disease (a rare inherited disorder that leads to a copper buildup in the brain, liver cells, and other vital organs), avoid copper intrauterine devices.

• Avoid hormonal intrauterine devices in severe liver disease and breast cancer cases.

What Is the Mechanism by Which Long-Acting Reversible Contraceptives (LARC) Work?

• LARCs are called long-acting and reversible contraceptives because they elicit a response at the level of the uterus (womb) that discourages the intrusion of sperms into the fallopian tubes where fertilization occurs, usually due to the changes the uterus environment undergoes. Also, contraceptive implants which suppress menstruation are used.

• The copper IUD agents provoke a significant immune reaction in the womb that leads to the deterioration of sperm and its motility as a result of inflammation. Besides that, this device also causes a reduction in the thickness of the uterine lining that will take place in embryo attachment even if fertilization has occurred.

• Also, hormonal IUDs like Copper IUDs stimulate an immune response similar to that of copper IUDs and release minute amounts of the progestin hormone levonorgestrel. Progestins, which are synthesized forms of progesterone, the natural hormone, make cervical mucus thicker and, as a result, slow the movement of sperm to get to the fallopian tubes. However, they present a wide range of side effects, such as the thinning of the uterus, the suppression of ovulation, etc.

• In a controlled amount, introducing etonogestrel, a progestin youth, reinforces the sterility of an active implant. This prevents the development of the mature thinking that occurs in the ovaries with the hormones operating, like the IUD, that inhibits ovulation and induces changes in the uterine lining, like hormonal IUDs, further contributing to contraception.

What Are the Advantages of Long-Acting Reversible Contraceptives (LARC)?

• Long-acting reversible contraceptives (LARC) are safe and have undergone several clinical trials before Food and Drug Administration (FDA) approval.

• Long-acting reversible contraceptives (LARC) are effective and give protection from pregnancy for a very long time. They do not have a margin of error and no need for any remainder to use, like birth control pills.

• The maintenance of long-acting reversible contraceptives is low, and there is no need for any effort from the women’s side; once inserted, they continue their effect.

• They are cost-effective and only a one-time investment, unlike pills.

• Good for intercourse.

• The implants and hormonal intrauterine devices decrease pain from endometriosis (the cells present in the uterus grow in other parts like fallopian tubes, causing pain).

• Reduction in pain associated with menstrual cramps.

• Decrease in severe menstrual bleeding.

• Decreasing the risk of endometrial, cervical, and uterine cancers.

• Copper intrauterine devices help to prevent pregnancy when placed within five days of unprotected intercourse.

What Are the Disadvantages of Long-Acting Reversible Contraceptives (LARC)?

• All the long-acting reversible contraceptives (LARC) disrupt the menstrual periods.

• The copper intrauterine devices cause heavy bleeding in periods, dysmenorrhea (painful menstrual cramps), and an elevated risk of developing non-cancerous ovarian cysts.

• The hormonal intrauterine devices cause irregular periods, missed menstrual periods, non-cancerous ovarian cysts, breast tenderness, severe headaches, mood fluctuations, and nausea.

• The implants cause heavy menstrual bleeding, irregular periods, slight bleeding between periods, mild levels of insulin resistance, and mood fluctuations.

What Are the Complications of Long-Acting Reversible Contraceptives (LARC)?

• The intrauterine device expels out of the uterus during the first few months, along with blood during periods.

• The intrauterine device punctures the uterus during insertion.

• The implant slips out of the arm due to inappropriate insertion.

• Infection due to implant placement in the arm.

Conclusion:

Long-acting reversible contraceptives (LARC) are the most effective form of contraception and protect in the long run. Even though it contains some side effects, long-acting reversible contraceptives are safe and can be removed if they want to conceive.