IUDs and Implants: Why long-acting birth control might be your best bet

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It’s not the sexiest topic, but it’s a necessary part of adulting: If you’re sexually active and unwanted pregnancy is a possibility for you, what’s the most effective way to prevent it? And how about methods that are safe, reliable, convenient, accessible, and free or low-cost?

Birth control implants and intrauterine devices (IUDs)—two methods of long-acting reversible contraception (LARC)—may be for you. “LARC methods are perfect for students with unpredictable schedules,” says Dr. Julie Strickland of the American College of Obstetricians and Gynecologists. Implants and intrauterine devices (IUDs) can prevent pregnancy for 3 to 10 years. These are the most reliable forms of birth control (more than 99 percent effective!) because they’re so low maintenance. No need to take a daily pill, replace a weekly patch, and so on. These factors make them an increasingly popular choice among students: In a recent survey by Student Health 101, over 20 percent of respondents said they use a hormonal or copper IUD as birth control. Here, we’ve got answers to your most common questions about implants and IUDs, along with experiences from real students who have tried them.

Long-acting reversible contraception: Your options

This T-shaped device is about the length of a paperclip. A health care provider inserts it into the uterus. A short string hangs down into the vagina, so the device can be easily removed by a health care provider when it is no longer viable or needed. There are two types of IUDs:

The hormonal IUD releases progestin.

This thins the lining of the uterus, making it harder for a fertilized egg to implant. It also thickens the cervical mucus, so sperm have less access to the uterus. It may also prevent the ovary from releasing an egg. The hormonal IUD is effective for three to five years. A newer brand, Skyla^®, is intended to be more comfortable to insert. Other brand names include Mirena^®, Kyleena^®, and Liletta^®.

The copper IUD does not contain hormones.

The copper IUD works by inhibiting sperm mobility and egg fertilization, and possibly inhibiting implantation of the egg. The copper IUD is effective for up to 12 years. Brand name: ParaGard^®.

This flexible, matchstick-sized rod is inserted under the skin of your upper arm. It releases progestin, like the hormonal IUD, thinning the uterine lining and thickening the cervical mucus to prevent pregnancy. It also prevents an egg from being released. The implant is effective for up to three years. Brand name: Nexplanon^®.

What makes IUDs and implants so convenient?

“With a LARC method, it’s unlikely that you’ll have to worry about a surprise pregnancy on top of everything else you juggle in your life. LARCs remove the human error from birth control, making contraception [almost] worry-proof. You make an appointment with your health care provider, and once the IUD or implant has been inserted, you don’t have to do anything or remember anything to be protected against pregnancy.” (It is a good idea to feel for the strings to check that it’s in place. There is a small risk of your body expelling an IUD and leaving you unprotected from pregnancy.)
—Dr. Julie Strickland, practicing OB-GYN, Truman Medical Center Hospital Hill in Kansas City, Missouri; chair, Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists 

How reliable are IUDs and implants at preventing pregnancy?

“LARCs are the most effective form of birth control available—[some LARC devices are] more than 99 percent effective at preventing pregnancy. With a LARC device in place, you’re protected from pregnancy for 3 to 10 years, depending on the method selected.”
—Dr. Alyssa Bennett, adolescent medicine physician at Connecticut Children’s Medical Center, Hartford, Connecticut

How does that compare to condoms and the pill?

“In comparison, [with typical use] birth control pills have a failure rate of about 9 percent, and condoms have a failure rate of 18 percent! A lot of young women don’t realize that accidentally taking the pill at different times during the day, or missing a pill, can actually lead to an unintended pregnancy.”
—Dr. Julie Strickland

What are the side effects of LARC methods?

With the hormonal IUD, approximately 25 percent of women won’t have a period at all, and many will have lighter periods or spotting. The copper IUD can cause periods to become heavier or crampier. For both, you may experience cramping or a low backache for up to a few weeks after insertion. There’s also a slightly increased risk of infection, called pelvic inflammatory disease (PID), during the first 20 days after the IUD is inserted. After that, the risk for PID is very low. Very rarely, the uterus can be injured when the IUD is inserted.

“With the birth control implant, changes in menstrual bleeding patterns are less predictable than those with an IUD. About a third of women have lighter periods and 20 percent will have no periods, while some have reported heavier bleeding. Other less common side effects include headaches, weight gain (likely related to changes in appetite), scalp hair loss, acne, and mood changes such as depression or nervousness.”
—Dr. Alyssa Bennett

“The IUD can make women’s periods more manageable and [sometimes] more predictable. The implant can make bleeding unpredictable. There is no way to know which group you are in beforehand.”
—Dr. Colleen Krajewski, practicing OB-GYN; assistant professor at the University of Pittsburgh Magee-Women’s Hospital, Pennsylvania

Will a LARC affect my ability to get pregnant later?

“The ‘R’ in LARC stands for ‘reversible.’ This means that LARC methods do not affect future pregnancies. If ever you want to become pregnant, simply have the device removed. You can start trying to become pregnant immediately.”
—Dr. Julie Strickland

Is it painful to get an IUD or implant?

“A lot of people hear stories about IUD insertion being painful or scary. Everybody’s experience is different, and it’s often not as bad as you think it will be. The cramping and scariness go away, but your birth control stays in place. Most patients that I place the IUD in say, ‘Oh, that wasn’t nearly as bad as I thought!’”

“Some women are more comfortable with getting the implant inserted in their arm, because it’s more familiar, like a tattoo or piercing.”
—Dr. Colleen Krajewski

How much do IUDs and implants cost?

“Most insurance plans will cover the full range of FDA-approved birth control methods (including the IUD and the implant) for free, without a co-pay (a fee charged to the patient, on top of what’s covered by insurance). Some plans will require a co-pay for certain brands of birth control, however, so you should check your insurance plan to find out which brands are fully covered.”
—Dr. Vanessa Cullins, vice president of external medical affairs, Planned Parenthood Federation of America, New York

With no insurance coverage, an IUD will generally cost between $500 and $900 for 5 to 10 years of protection. An implant generally costs around $800 for protection of up to three years. Many local Planned Parenthood health centers offer sliding-scale fees for an IUD or implant if you’re tight on funds.