With so many birth control options available today, your best method might boil down to something simple: the one you will use correctly. 

Of course, your health history, family planning desires, and other factors should be discussed. But, bottom line, birth control only works if you use it as directed. And if one of your biggest concerns is user error…well…meet long-acting reversible contraceptives! 

Once placed, these methods—also known as LARCs—last for several months or years, and can be removed at any time should your birth control needs change. Not to mention, LARCs are over 99% effective at preventing pregnancy.  

At this rate, “LARCs are largely considered as effective as surgical sterilization with a lot less risk," says Lauren M. Beasley, M.D., an obstetrician-gynecologist in Raleigh, North Carolina. "I prescribe LARCs for women of all ages who are most concerned with preventing pregnancy. That includes young adults to women in perimenopause."

What Are Long-Acting Reversible Contraceptives?

LARCs are birth control methods that prevent pregnancy for an extended period, anywhere from three to 10 years, depending on the method you choose. They are "reversible," since your physician can remove them at any time, and they do not affect future fertility. 

LARCs include intrauterine devices (IUDs) and contraceptive implants, both of which are prescribed and administered by your doctor. With IUDs, you can get either a hormonal or copper IUD. 

LARCs are 20 times more effective than birth control pills, the patch, and the vaginal ring. Why? They take the worry and the work out of birth control. 

Let’s compare. With the pill, you’ve got to remember to take it every day. With barrier methods (like condoms), you must have one on hand and use it correctly. In this sense, LARCs are relatively low-maintenance. After they’ve been inserted, you don't have to do anything. 

Hormonal and Copper IUDs

How Do Hormonal and Copper IUDs Work?

The hormonal IUD is a plastic T-shaped device about the size of a quarter. It has two fine strings attached, for removal. It’s available from a variety of brands, including Mirena, Skyla, Liletta, and Kyleena.

Your doctor places it inside your uterus, where it releases progestin, a synthetic version of the hormone progesterone. This stream of progestin prevents eggs from being fertilized. Hormonal IUDs begin working within about seven days. Depending on the brand you choose, they can remain in place for three to eight years. 

The copper intrauterine device has similarities and differences to the hormonal IUD. Only available from the brand ParaGard, it is also approximately quarter-sized with strings attached.

But it does not release hormones. Instead, it has copper wire coiled around the device. 

The copper is slowly released into the uterus. This produces an inflammatory reaction in the endometrium (the inner layer of the uterus), making it toxic to sperm and, ultimately, preventing fertilization of an egg. A copper IUD begins working as soon as it’s in place, and remains effective for up to ten years.  

Does Getting an IUD Hurt?

The internet seems to think so! And they aren’t totally wrong. Having an IUD inserted can feel like moderate period cramps, or like a longer, pinchier Pap. 

Indeed, many patients avoid IUDs because they fear the pain associated with inserting the device, Dr. Beasley confirms. But for a lot of women, it’s worth it. 

"Placement of an IUD takes less than 15 minutes and may cause some cramping, but there are ways to mitigate that pain,” she explains. “I usually counsel my patients to take a pain reliever like ibuprofen before or after the procedure to help alleviate any discomfort."

What Are the Side Effects and Risks of IUDs?

For the first few months, hormonal IUDs may cause frequent spotting, as well as heavier and longer periods. Additional side effects may include headache, nausea, breast tenderness, and mood changes. All of these are typical for all hormonal contraception, including the birth control pill. 

On the bright side, over time with an IUD, your periods may lessen. In some cases, the hormonal IUD has been known to stop a woman’s period altogether. And in other silver linings, LARCS “do not contain estrogen, so they are safe for women who have a history of cardiac disease or clotting disorders,” explains Dr. Beasley. “These are really good options for patients when estrogen is not an option.”

The copper IUD does not contain any hormones, and it has different side effects than with the hormonal one. That said, during the first months of use, it’s pretty common for the copper IUD to cause more painful and heavier periods, irregular periods, and spotting between periods. According to reports, these period symptoms are also the reason why women may stop or avoid using the copper IUD.

With any object stuck inside your body, it’s natural to wonder: Any health concerns?

While rare, there are risks with using an IUD. Here are some things to watch out for:

• Your IUD may become dislodged. While this can happen at any time, it’s more common during the first three months after placement.  
• The IUD may perforate or puncture the wall of the uterus. This is very unlikely, happening in only about 1 out of every 1,000 placements (or 0.1%).
• If you do get pregnant using an IUD, there is an increased risk of ectopic pregnancy which is when a fertilized egg grows outside the uterus.

If you feel like something’s off, it’s important to get in touch with your doc. Contact them if you are experiencing any of the following:

• Severe cramping, unusual discharge, or an unexplained fever or chills
• Intense pelvic pain
• You can feel the IUD in your cervix or vagina
• You can feel the IUD during sex
• You can't feel the strings, or they have become shorter or longer than usual
• You are seeing signs of pregnancy, such as a positive pregnancy test, missed period with nausea, or breast tenderness

Who Shouldn't Use an IUD?

Almost all women can use an IUD, but there are instances where IUDs aren’t a good choice. If any of these are true for you, neither a hormonal or copper IUD should be used:

• You are currently pregnant or suspect you might be pregnant
• You have a sexually transmitted infection at the time of insertion
• You have known or suspected reproductive cancer
• You have an irregular shaped uterus (heart shaped or a uterine septum) that may prevent proper placement of the device  
• If a menstrual cup is your preferred means of period management, then an IUD is not a good option for you, using the cup can cause your IUD to slip out of place and will require you to check monthly that the strings are still in place.   

The hormonal IUD is also not prescribed for women with a history of breast cancer. And the copper IUD is not suitable for people with a copper allergy or sensitivity.  

Birth Control Implant

How Does the Birth Control Implant Work?

An implant may sound scary, but would you feel better knowing this one goes in your arm? Because it does, just beneath the skin of the upper arm. Under the brand name Nexplanon, the birth control implant is a flexible, plastic matchstick-sized rod. 

It releases progestin into the body, which helps prevent pregnancy in a few ways. It blocks ovulation, thickens the mucus of the cervix, and thins the lining of the uterus. Implants are typically effective within seven days of insertion. They can last for three years.  

Does Getting the Birth Control Implant Hurt?

You may feel a pinch as the physician applies an anesthetic to numb the insertion site. But the implantation itself is usually painless. The whole procedure takes just a few minutes. As with other shots, you may have some mild pain and bruising at the insertion site. 

What Are the Side Effects and Risks of Using the Contraceptive Implant?

Because the birth control implant is hormonal, it may cause spotting or changes to your menstrual cycle. Other reported side effects include headaches, acne, sore breasts, digestive changes, weight gain, and pain at the insertion site.

While rare, there are risks with using an implant:

• Infection at the insertion site
• An increased risk of ectopic pregnancy if you do get pregnant while using an implant

Be sure to contact your physician if you are experiencing:

• Discomfort at the insertion site that does not improve
• The implant feels like it has moved or changed shape
• You are seeing signs of pregnancy, such as a positive pregnancy test, missed period with nausea, or breast tenderness 

Who Should Avoid Using the Birth Control Implant?

The birth control implant is not recommended for women who are or might be pregnant. And it’s also not recommended if you have a history of breast cancer, liver disease, or unexplained vaginal bleeding. 

Can I See My Doctor Less Often When Using Long-Acting Reversible Contraceptives?

While LARC methods are somewhat set-it-and-forget-it, there are some essential appointments to schedule once you’ve got an IUD or implant. Dr. Beasley sees her patients within six weeks post-IUD insertion to check placement and help manage any side effects. With an implant, she suggests a follow-up at three months after.

Although IUDs and birth control implants last for years, it’s still crucial to keep up with your yearly gynecological exams. "I want to see my patients for routine reproductive wellness visits, as well as address any side effects resulting from contraception and do a check-in on family planning goals,” reminds Dr. Beasley.