February 16, 2019

I don’t want a pregnancy now, but maybe in the future. What are options in long term reversible contraception?

Although the birth control pill and sterilization are the most popular forms of contraception, these options are not for everyone. There is a large group of women that want to avoid pregnancy for several years, but want the option of a pregnancy in the future. For these women, who may worry about forgetting to take a daily pill, missing a doctor’s appointment or losing insurance coverage and not being able to pay for birth control pills or shots, long acting reversible contraception (LARC) methods are a safe and convenient option.

An increasingly popular example of a LARC is the Mirena Intrauterine Device (IUD). Mirena is a T- shaped device that is inserted in a woman’s uterus for up to 5 years. It slowly releases progesterone over that time period, making the uterus an unfriendly place for sperm, preventing pregnancy. A happy side effect of Mirena is that the hormones in it thins the uterine lining, lightening the monthly period to almost nothing. While there can be irregular bleeding at first, most women using Mirena have barely any bleeding each month. Fortunately, the dose of hormone in Mirena is quite low and mostly acts inside the uterus, so other side effects (weight gain, mood changes) are minimal.

Unfortunately, Mirena only comes in one size (designed for a uterus that has carried a pregnancy) and is not always a good option for the woman who has never been pregnant. Sometimes Mirena can be difficult to insert or can be pushed out by uterine cramps in these cases. Also, since Mirena goes into the uterus, it is not ideal for the woman who is not in a monogamous relationship and could be exposed to sexually transmitted diseases. These STDs, combined with an IUD can cause a more serious pelvic infection. For women who do not want these risks associated with an IUD, the Implanon device is a great alternative.

Implanon (soon to be called Nexplanon) is an small rod which is inserted into the inner arm in a painless office procedure, and slowly releases a form of progesterone over a 3 year period.¬† Side effects are minimal, but include irregular bleeding, which lessens with time. This method is ideal for women who want long term birth control, without the risks of a uterine method. The rod is small, can’t be seen by others unless pointed out to them, and is easy to remove when the time comes.

The third LARC is for the woman who wants to avoid hormones altogether. The Paragard IUD has been around for decades and is a reliable long term method. It is a copper device that is inserted in the uterus and creates an anti- sperm effect on the uterus which prevents pregnancy. Major side effects include heavier and crampier periods, making it a better option for the woman who has light, reasonable periods to begin with.

In conclusion, there are multiple birth control options for the woman who wants a few years of protection. A gynecologist can help a woman decide which one is best for her individual situation.

Tamar Gottfried is a Board Certified Obstetrician/ gynecologist  practicing  general Ob/gyn in Mesa Arizona and affiliated with Banner Desert and Banner Gateway Medical Centers. She can be contacted at 480-545-0059. This is a general interest article only and is not intended to be medical advice. See a medical professional before making medical decisions


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