Implantable Devices Should Be Offered as First-Line Contraception

The most effective forms of reversible contraception available to date are long-acting reversible contraceptives (LARCs), which include intrauterine devices (IUDs) and implants.¹ According to The American College of Obstetricians and Gynecologists (The College), LARCs are safe for almost all women of reproductive age, including nursing mothers, adolescents, and women who have not yet had a child, and The College recommends them as first-line contraceptive methods.

Almost half of all pregnancies in the United States are unintended, and of those, half of women who became pregnant unintentionally were using some form of birth control.1 Most women use contraceptive types other than LARCs. Between 2006 and 2008, fewer than 6% of women who used contraception chose IUDs.¹

“Women need to know that today’s IUDs are much improved from earlier versions, and complications are extremely rare. IUDs are not abortifacients-they work before pregnancy is established-and are safe for the majority of women, including adolescents and women who have never had children. And while upfront costs may be higher, LARCs are much more cost-effective than other contraceptive methods in the long run,” said Eve Espey, MD, MPH.¹ An additional benefit, according to Dr Espey, “is that after insertion, LARCs work without having to do anything else. There’s no maintenance required.”

IUDs

Two types of IUDs-small, t-shaped devices that are inserted by a clinician into the uterus-are currently available. One is copper-based (Paragard), and the other uses the hormone levonorgestrel (Mirena). The copper IUD releases a small amount of copper into the uterus, preventing fertilization and interfering with the sperm’s movement through the uterus and into the fallopian tubes. The copper device can effectively prevent pregnancy for 10 years and can also be used for emergency contraception when inserted within 5 days of unprotected sex.¹

The copper IUD does not interfere with ovulation or menstruation. Menstrual bleeding and cramping may increase after implantation, and spotting between periods may occur. Data suggest that these symptoms lessen over time, but heavy menstrual bleeding and pain are often cited as reasons for discontinuation by women who have used the device.

Effective for 5 years, the hormonal IUD releases the progestin levonorgestrel into the uterus, causing the cervical mucus to thicken and the uterine lining to thin. Sperm also seem to become less active, making it difficult for the egg and sperm to remain viable in the fallopian tube. Menstrual cycles are generally lighter with the hormone-type IUD, which is also approved by the FDA for the treatment of heavy bleeding.

Women who should avoid IUDs are those with a sexually transmitted infection, an allergy to copper or the hormone levonorgestrel, or an abnormally shaped uterus.² Although problems associated with IUD use are rare, sometimes the uterus can be punctured during placement. If this occurs, a different method of birth control should be chosen. Nothing should be done about the puncture site unless the wound fails to heal. A pelvic infection can occur within 30 days of placement, although this is rare; patients who have or who are at-risk for a sexually transmitted infection are more likely to experience this. Although IUDs are intended for long-term use, the devices occasionally slip from their placement site, increasing the risk of pregnancy.

Contraceptive implant

Offering protection against pregnancy for up to 3 years, the contraceptive implant (Implanon) is the most effective LARC available, with a pregnancy rate of 0.05%.¹ The implant is a matchstick-sized rod that is inserted under the skin of the upper arm; it releases progestin, which prevents ovulation. The most common adverse effect is irregular bleeding, which generally occurs in the first 6 to 12 months of use.3 Most women report fewer and lighter periods. After the first year of use, about a third of women who use the contraceptive implant will stop having periods altogether. However, some women experience longer, heavier periods, and others report spotting between periods.

More Information

ACOG’s Long-Acting Reversible Contraception HomepageACOG Education Pamphlet: The Intrauterine Device

Related Content

Case Study: Ring IUDStudy Points To Importance of Checking IUD Position
 

References:

References

1. Practice bulletin no. 121: long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2011;118:184-196.
2. Mara J, for the Association of Reproductive Health Professionals.A woman’s guide to understanding IUDs.  Accessed July 14, 2011.
3. Implanon Web site. Accessed July 14, 2011.