Long-acting reversible contraception
| Long-acting reversible contraceptives (LARC) | |
|---|---|
| Background | |
| Type | Hormonal |
| First use | ? |
| Pregnancy rates (first year) | |
| Perfect use | ? |
| Typical use | ? |
| Usage | |
| Reversibility | Yes |
| User reminders | ? |
| Advantages and disadvantages | |
| STI protection | No |
Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs) and subdermal contraceptive implants. They are the most effective reversible methods of contraception because they do not depend on patient compliance. So their 'typical use' failure rates, at less than 1% per year, are about the same as 'perfect use' failure rates.
In addition to being long-lasting, convenient, and well liked by users, they are very cost effective. Typically, LARC users can save thousands of dollars over a five-year period compared to the use of condoms and birth control pills. Despite their safety and effectiveness LARCs are underutilized: only 15.5% of women worldwide use IUDs, and only 3.4% use subdermal implants.
Long-acting reversible contraception is recommended for adolescents to help decrease the teen pregnancy rate. LARCs are recommended for women of any age no matter how many times they have given birth. Women considering using LARCs should obtain contraceptive counseling from reproductive health professionals because those who do are more satisfied with them and use them for longer periods of time.
Available LARC methods include IUDs and the subdermal implant:
Some shorter-acting methods are sometimes considered LARC:
The effectiveness of LARC methods has been shown to be superior to other types of birth control. A study in 2012, with the largest cohort of IUD and implant users to date, found that the risk of contraceptive failure for those using oral contraceptive pills, the birth control patch, or the vaginal ring was 17 to 20 times higher than the risk for those using long-acting reversible contraception. For those under 21, who typically have lower adherence to drug regimens, the risk is twice as high as the risk among older participants. A statistically significant association has been observed in England between a decrease in teenage conception and increased LARC usage.
The discrepancy between LARC methods and other forms of birth control lies in the difference between "perfect use" and "typical use". Perfect use indicates complete adherence to medication schedules and guidelines. Typical use describes effectiveness in real-world conditions, where patients may not fully adhere to medication regimens. LARC methods require little to no user action after insertion; therefore, LARC perfect use failure rates are the same as their typical use failure rates. LARC failure rates rival that of sterilization, but unlike sterilization LARC methods are reversible. Other reversible methods, such as oral contraceptive pills, the birth control patch, or the vaginal ring require daily, weekly, or monthly action by the user. While the perfect use failure rates of those methods may equal LARC methods, the typical use failure rates are significantly higher. Even methods such as the DMPA injection require users to return to their provider every 12 weeks for the intramuscular shot or every 4 weeks for the subcutaneous shot. So, DMPA typical use failure rates are also higher than perfect use failure rates as more than 40% of women discontinue DMPA in the first year. In both effectiveness and continuation, LARC methods are considered the first-line option for contraception.
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