Set It and Forget It: Comparing Long-Acting Birth Control Methods


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When pregnancy isn’t in your plans at the moment, finding a reliable birth control option is important.

If you’re busy (aren’t we all?) and looking for options that don’t require a daily pill or remembering to buy condoms, long-acting reversible contraception (LARC) might be a good option for you.

Long acting methods can offer several weeks’ to several years’ worth of protection and can be reversed if you decide you’re ready to start trying for a baby.

But as with other birth control methods, you should weight the pros and cons when deciding on a LARC that would work for you.

The following is everything you need to know when considering long-acting birth control.

Types of long-acting birth control

There are many different types of LARC you can choose from. Most are similar in effectiveness and reversibility, but they differ in terms of:

  • how they work
  • how often they are replaced
  • side effects they may cause
long-acting birth control options infographic
Design by Maya Chastain

IUD

Copper

There are two forms of intrauterine devices (IUDs), one of which is copper. Copper IUDs are sometimes referred to by the brand name Paragard.

How it’s used: A doctor uses a speculum to insert a copper IUD into the uterus. They typically perform this procedure during an office visit, and it takes only a few minutes. Some people report minor pain, cramping, and spotting after insertion.

How it prevents pregnancy: The copper IUD creates a foreign body response in the uterus. This means a person’s active immune system will target anything that enters the uterus, including sperm. The copper also releases ions that help encourage inflammation, which can prevent sperm from reaching the egg.

How long it’s good for: A copper IUD can last up to 10 years.

Approximate cost: Copper IUDs are available at no cost on most health insurance plans. If your insurance doesn’t cover a copper IUD, ask your doctor’s office about any available discounts. The costs can be higher than $1,000 if it’s not covered.

Effectiveness: Copper IUDs are effective right away and are more than 99 percent effective in preventing pregnancy.

Side effects: Side effects can include temporary pinching and cramping when inserted, faintness, dizziness, or nausea. You may also experience more intense periods.

Reversibility: Pregnancy is possible almost immediately after your doctor removes the IUD.

Hormonal

A hormonal IUD is similar to a copper IUD, but it also releases a low, continuous dose of synthetic progesterone. Brands of hormonal IUDs include Mirena, Kyleena, Liletta, and Skyla.

How it’s used: As with the copper version, a doctor uses a speculum to place the hormonal IUD directly into the uterus through the vagina.

How it prevents pregnancy: The hormonal IUD works in two ways. Like the copper version, it causes the immune system to inflame the uterus and attack foreign bodies, such as sperm. The second way it works is to release progesterone, which prevents the release of your eggs and thickens the cervical mucus.

How long it’s good for: Hormonal IUDs last for about 3 to 7 years, depending on which brand of IUD you choose.

Approximate cost: Most health insurance plans are required to fully pay for at least one form of hormonal IUD as well as the cost of insertion and removal. However, if they’re not covered by your insurance, they can cost more than $1,000. Check your specific plan to see which brand may be covered.

Effectiveness: You need to wait 7 days before having unprotected sex, but after the initial wait, hormonal IUDs are 99 percent effective.

Side effects: Hormonal IUDs may cause cramping and spotting for the first few months. After about 1 to 2 years, you may no longer have periods. They can also cause headaches, nausea, breast tenderness, spotting, or bloating.

Reversibility: Your doctor can remove the IUD at any time. Pregnancy is possible shortly after removal.

Implant

An etonogestrel implant provides long-term hormonal birth control when it’s inserted into your arm. It’s sometimes referred to by the brand name Nexplanon.

How it’s used: A medical provider places the implant under the skin of the upper arm using a special device. The Centers for Disease Control & Prevention (CDC) warns that you should be sure you’re not pregnant before insertion.

How it prevents pregnancy: A hormonal implant slowly releases progestin. The hormone thickens the cervical mucus and stops the egg from leaving the ovary.

How long it’s good for: An implant can last for up to 3 years.

Approximate cost: Though most insurance companies cover all the costs, they can cost more than $800 if not covered.

Effectiveness: The implant birth control is effective within 7 days of insertion. According to the CDC, an implant is more than 99 percent effective.

Side effects: The implant is generally safe, but may cause swelling, redness, or pain at the site of injection.

Reversibility: The implant will need to be removed by a healthcare professional. The effects of the implant are fully reversible and pregnancy is possible shortly after removal.

The shot

A birth control shot involves injecting hormones into your bloodstream that will help prevent pregnancy for up to 3 months.

The most common brand in the United States is Depo-Provera.

If you don’t mind injections, the shot may be a good choice for you. However, if you hate needles or are over 35 years old and smoke, the shot may not be the best option for you.

How it’s used: Your medical provider will use a needle to inject progestin into your upper arm or buttocks.

How it prevents pregnancy: Like other hormonal birth control, it creates more mucus around the cervix and prevents the ovaries from releasing an egg.

How long it’s good for: The shot is effective for up to 3 months and must be readministered at your doctor’s office.

Approximate cost: The shot can cost around $240 per year when factoring in a dose every 3 months. Most insurance plans should cover the costs.

Effectiveness: When used correctly, not missing doses, it is about 94 percent effective in preventing pregnancies.

Side effects: The shot can cause irregular bleeding or longer, heavier bleeding for the first 6 to 12 months. Over time, you may experience lighter periods or none at all.

Reversibility: The shot should wear off within 3 months from the injection. After that, pregnancy is possible.

Ring

A birth control ring is a soft, flexible ring inserted into the vagina. It slowly releases hormones into the body to help prevent pregnancy.

How it’s used: You’ll need to obtain a prescription from your doctor. You will insert the ring directly into the vagina every 21 days. During the 7 days it is not in use, you should have your regular period.

How it prevents pregnancy: A birth control ring slowly releases estrogen and progestin into the body. The hormones help thicken cervical mucus.

How long it’s good for: You need to remove the old ring and insert a new one every 21 days.

Approximate cost: Over the course of a year, it can cost around $1,000 for the ring without insurance coverage.

Effectiveness: The CDC estimates that the ring is about 91 percent effective.

Side effects: When using the ring, you may experience breast tenderness, headaches, nausea, breakthrough bleeding, vaginal discharge, or irritation around the vagina.

Reversibility: When you’re ready or want to try to become pregnant, you can remove the ring and not replace it with a new one. Pregnancy is possible shortly after removal.

Patch

A contraceptive patch is a small patch placed on the skin. The patch releases hormones through the skin into the body to help prevent pregnancy.

How it’s used: The patch is a small square placed directly on the skin of the upper back, upper arm, buttocks, chest, or abdomen. You’ll need to get a prescription from your doctor. You need to replace the patch once per week on the same day of the week. On the fourth week, you skip adding the patch and should get your period that week.

How it prevents pregnancy: The patch releases estrogen and progestin, which help thicken the cervical mucus and prevent ovulation.

How long it is good for: You need to replace the patch once per week on the same day of the week for continuous protection from pregnancy.

Approximate cost: Without insurance coverage, the patch may cost around $55 per month.

Effectiveness: If you use the patch as directed on the same day each week, you’re not likely to become pregnant. Less than 1 out of 100 women become pregnant within the first year of use when used correctly. The CDC estimates the patch is around 91 percent effective.

Side effects: In general, the side effects are mild and often go away within a few months. They include symptoms such as breast tenderness, breakthrough bleeding, skin irritation, or headache.

Reversibility: If you want to become pregnant, you can stop wearing the patch, and pregnancy is possible shortly after.

Other birth control options

If you’ve decided that babies aren’t on your radar now or in the future, you might be looking for a more permanent way to prevent pregnancy.

Tubal ligation and vasectomy are two medical procedures that can prevent pregnancy permanently.

While both methods have the potential to be reversed through surgery, the reversal is more complicated than other methods and may not always be effective.

Tubal ligation

Tubal ligation involves cutting and removing or tying off the fallopian tubes. The severed tubes prevent sperm from reaching the egg, which prevents pregnancy.

How it’s used: Tubal ligation can be done on its own or during other abdominal procedures. The procedure can take about 30 to 60 minutes. The surgeon will either completely remove or tie off the tubes to prevent the egg from entering the uterus.

How it prevents pregnancy: Tubal ligation prevents the egg from reaching the uterus or sperm.

How long it’s good for: This is a permanent procedure and may not be effectively reversed.

Approximate cost: Tubal ligation can cost anywhere from around $1,500 to $6,000 depending on the location where you have it done and your insurance coverage.

Effectiveness: Within 10 years of having the procedure, the likelihood of becoming pregnant ranges from 18 to 37 out of 1,000 women. The CDC notes that while abdominal and laparoscopic ligations are effective immediately, another form of birth control should be used for the first 3 months after a hysteroscopic occlusion ligation. With all three types, it’s over 99 percent effective.

Side effects: The most common risk of side effects is from reacting to general anesthesia. There is also a risk of tubal pregnancy and damage to surrounding tissue or organs during the procedure. Bleeding or infection from the incision may also occur.

Reversibility: The procedure can be reversed but reversal may not be effective.

Vasectomy

A vasectomy involves cutting the connection between the testicles and the penis, which prevents sperm from being ejaculated during sex. This is the only form of long-acting birth control that addresses the possibility of pregnancy from the side of the sperm-carrying partner.

How it’s used: A vasectomy involves an outpatient procedure where a doctor cuts or clips and then ties or cauterizes the vas deferens. The vas deferens is the tube that connects the testicles to the urethra, allowing sperm to be released during ejaculation.

How it prevents pregnancy: The procedure cuts off the pathway connecting sperm to penis, which means that sperm will not be released into the seminal fluid on ejaculation.

How long it’s good for: This is a permanent, but reversible, birth control method.

Approximate cost: The procedure varies in price based on location and insurance. It can cost between $350 and $1,000.

Effectiveness: It can take about 3 months, or 15 to 20 ejaculations, to become effective. Only a few couples will become pregnant following a vasectomy. A vasectomy is more than 99 percent effective.

Side effects: The procedure is generally low risk. Mild side effects can include infection, bleeding, or pain at the site.

Reversibility: A doctor can reverse a vasectomy if you want to try to have a baby at a later time. It’s important to note that reversals can be pricey, with costs ranging from $5,000 to $15,000.

Pros and cons of long-acting birth control

The following are some pros and cons that you should consider when looking into long-acting birth control methods.

Pros

Some pros of long-acting birth control include:

  • It’s easy to use and you’re less likely to forget.
  • There’s no need to stop sexual action to put on a condom or insert a diaphragm or sponge.
  • It has high effectiveness rates.
  • It lasts for anywhere from 1 week to several years based on the method.
  • Pregnancy is possible shortly after removal or stoppage of the method.

Cons

There are a few cons to using long-acting birth control, including:

  • Some can cause heavier bleeding or irregular periods.
  • Costs without insurance can add up.
  • Smokers over age 35 or with other risk factors for blood clots should talk with their doctor before using hormonal forms of birth control
  • You still need to use condoms or other barrier methods to prevent sexually transmitted infections.

The bottom line

Long-acting birth control can be a good choice for you if you want an easy method to prevent pregnancy that lasts for several weeks to years at a time.

Most methods are easy to reverse, and you can become pregnant shortly after removal of the device.

If you’re interested, you should speak with your doctor about whether or not a long-acting birth control method is right for you.


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