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August 12, 2022

What Is Long-Acting Reversible Contraception?

Author Affiliations
  • 1Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
  • 2Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
JAMA. 2022;328(13):1362. doi:10.1001/jama.2022.14239

Long-acting reversible contraception (LARC) is long-lasting and easily reversible birth control.

LARC includes contraceptive implants and intrauterine devices (IUDs), which are more than 99% effective in preventing unintended pregnancy. Although LARC devices should not be placed in currently pregnant individuals, they can be inserted shortly after giving birth because LARC is safe while breastfeeding. The LARC device can be removed on request, and pregnancy can occur right after LARC device removal.

Contraceptive Implants

The contraceptive implant is a plastic matchstick-sized device that is placed under the skin of the inner upper arm. The implant slowly releases a hormone (progestin) to suppress ovulation and provides effective contraception for up to 5 years. The implant is immediately effective for contraception if inserted within the first 5 days of menstruation (a period). If the implant is inserted more than 5 days after the start of a period, additional contraception or abstinence from sexual intercourse is advised for the next 7 days.

Contraceptive implant placement and implant removal are performed after injection of a numbing medication in the upper arm; this usually takes less than 5 minutes during an office visit.

Potential Side Effects of Contraceptive Implants

While a contraceptive implant is in place, approximately 30% of people experience unpredictable period-like bleeding, and approximately 20% of people have no periods. Patients with recently diagnosed breast cancer should not use contraceptive implants.

Intrauterine Devices

IUDs are T-shaped devices that are inserted into the uterus and have strings that extend through the cervix. There are 2 types of IUDs: hormonal and nonhormonal. Hormonal IUDs contain the hormone levonorgestrel, and their duration of effectiveness for contraception ranges from 3 to 8 years. The nonhormonal IUD is made of copper and can provide effective contraception for up to 12 years. Hormonal IUDs are immediately effective if inserted within the first 7 days of a period; if placed outside this time frame, additional contraception or abstinence is advised for 7 days. Copper IUDs are immediately effective after insertion and do not require use of backup contraception.

IUDs are placed and removed during an office visit using a speculum, which is the same device used during an examination for cervical cancer screening. Complications of IUD placement are rare but include injury to the uterus during insertion; atypical location of the IUD, which may require removal and replacement; or expulsion of the IUD out of the uterus. For IUD removal, a tool is used to grasp the strings and pull out the IUD. Rarely, a minor surgical procedure in the operating room is needed to remove the IUD.

Potential Side Effects of IUDs

People using copper IUDs commonly experience increased bleeding and pain during their periods. Those using hormonal IUDs often have lighter bleeding or no periods at all, and less menstrual pain. IUDs do not cause ectopic pregnancy (a pregnancy abnormally located outside the uterus). However, people who become pregnant while they have an IUD in place should notify their clinician right away because they are more likely to have an ectopic pregnancy.

IUDs should not be placed in individuals with a pelvic infection, endometrial or cervical cancer, or an abnormally shaped uterus. Patients with recently diagnosed breast cancer should not use hormonal IUDs.

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Article Information

Published Online: August 12, 2022. doi:10.1001/jama.2022.14239

Conflict of Interest Disclosures: Dr Gariepy reported receipt of personal fees from UpToDate and being on the board of directors of the Society of Family Planning. No other disclosures were reported.

Source: Averbach S, Hofler L. Long-acting reversible contraception with contraceptive implants and intrauterine devices. JAMA. 2022;327(20): 2013-2014. doi:10.1001/jama.2022.5448