Patient education: Long-acting methods of birth control (Beyond the Basics)

INTRODUCTION — Several long-acting or permanent methods of birth control are available. These are best for people who do not want to become pregnant in the near future (or ever). These methods are very effective, mostly because you do not have to remember to do or take anything on a regular basis.

This article discusses long-acting methods of birth control, including the intrauterine device (IUD), contraceptive implant, and permanent birth control procedures. Hormonal and barrier birth control methods are discussed separately. (See "Patient education: Hormonal methods of birth control (Beyond the Basics)" and "Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)".)

An overview of all birth control methods is also available. (See "Patient education: Birth control; which method is right for me? (Beyond the Basics)".)

CHOOSING A BIRTH CONTROL METHOD — It can be difficult to decide which birth control method is best because of the variety of options available. The best method is one that you will use consistently and that does not cause bothersome side effects. Other factors to consider include:

●How effective is it in preventing pregnancy?

●Do I need to remember anything to use it?

●How long does it work?

●Can I get pregnant when I stop using it?

●Will it affect my monthly period?

●Will I have side effects?

●How much does it cost?

●Does it protect me against sexually transmitted infections?

●Can I stop using the method on my own if I choose?

No method of birth control is perfect. You must balance the advantages of each method against the disadvantages and decide which method you prefer. A list of helpful questions is in the table (table 1).

INTRAUTERINE DEVICE — Intrauterine devices (IUDs) are placed by a health care provider through the vagina and cervix, into the uterus. Most are made of molded plastic and have a string that you can feel inside the vagina but that does not extend outside of the body. IUDs currently available do not increase risk of infection, ectopic pregnancy, or infertility. An IUD can be removed by a health care provider at any time if you wish to stop using it (ie, if you want to get pregnant or switch to a different birth control method), and the birth control effect reverses rapidly.

Two types of IUDs are currently available in the United States:

●Copper-containing IUD (brand name: Paragard) (picture 1) prevents pregnancy by preventing sperm from reaching the fallopian tubes. The copper-containing IUD lasts for at least 10 years and is highly effective in preventing pregnancy; the pregnancy rate in people who use a copper-containing IUD is less than 1 percent in the first year of use. Some people who use a copper-containing IUD have heavier and longer menstrual periods.

●IUDs with progestin (levonorgestrel, brand names Mirena, Kyleena, Skyla, and Liletta) (figure 1) prevent pregnancy by thickening the cervical mucus and thinning the endometrium (the lining of the uterus). They also decrease menstrual bleeding and pain. Although IUDs can be removed at any time, the Mirena and Liletta IUDs can stay in place for up to eight years, Kyleena can stay in place for up to five years, and Skyla can stay in place for up to three years. All are highly effective in preventing pregnancy; the pregnancy rate in people who use a levonorgestrel-releasing IUD is less than 1 percent in the first year of use. In the first months after placement of a levonorgestrel-releasing IUD, irregular bleeding is common. Over time, less bleeding occurs; for many people this is a desirable side effect. Some people completely stop having menstrual periods while using a levonorgestrel-releasing IUD; this is not harmful and does not require treatment. Menstrual periods will return when the IUD is removed. Other benefits of progestin IUDs include fewer cramps with your periods, less pain if you have endometriosis (a condition in which cells like the ones lining the uterus grow outside the uterus), and lower risk of pelvic inflammatory disease.

Benefits — An IUD is an ideal method if you do not plan to become pregnant for at least one year (or longer) or you want a method that is highly effective and does not require daily or weekly attention. IUDs are also appropriate for people who do not want to or cannot safely use estrogen. In addition, there is evidence that using an IUD lowers the risk of getting cervical cancer.

IUDs have relatively few side effects and are reversible. If you decide you want to become pregnant or want the IUD removed for any reason, you can do so by having the IUD removed (a quick procedure) by a health care professional. IUDs do not affect your chance of becoming pregnant after the IUD is removed so you can try to get pregnant right away.

Risks — There is a small risk that the IUD will come out, sometimes during your period. The IUD is most likely to come out during the first few months after insertion. If you think your IUD might have moved or fallen out, use a backup method (eg, condoms) until you can see a health care provider. Some providers recommend checking to see if the IUD string ends can be felt within your vagina. This can be done periodically or monthly after your period ends. There is a very low risk of developing an infection after placement of the IUD.

Precautions — You should not use an IUD if you recently had a pelvic infection, such as gonorrhea or chlamydia. If you have more than one sex partner, talk to your health care provider about the risks and benefits of the IUD.

If you become pregnant while using an IUD, you need an ultrasound to be sure that the pregnancy is inside the uterus, rather than in the fallopian tube (called an "ectopic pregnancy"). The IUD should be removed, if possible, when the pregnancy is discovered. (See "Patient education: Ectopic (tubal) pregnancy (Beyond the Basics)".)

BIRTH CONTROL IMPLANT — A single-rod progestin implant, Nexplanon, is available in the United States and elsewhere. A health care provider inserts a small device under the skin in the upper inner arm (figure 2). It is highly effective for at least three years. The pregnancy rate is less than 1 percent in the first year of use.

The implant protects you from pregnancy within seven days of insertion. If the implant is inserted more than five days from the start of your period, backup birth control (such as condoms) should be used for seven days. Irregular bleeding is the most common side effect.

An implant can be removed by a health care provider at any time if you wish to stop using it (ie, if you want to get pregnant or switch to a different birth control method). After getting the implant removed, the birth control effect reverses rapidly.

PERMANENT BIRTH CONTROL PROCEDURES — These are procedures that permanently prevent a person from becoming pregnant or being able to have children (for example, tubal ligation and vasectomy). These procedures should only be considered if you are certain you wish to permanently prevent pregnancy. (See "Patient education: Permanent birth control for women (Beyond the Basics)" and "Patient education: Vasectomy (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Choosing birth control (The Basics)
Patient education: Vasectomy (The Basics)
Patient education: Intrauterine devices (IUDs) (The Basics)
Patient education: IUD insertion (The Basics)
Patient education: IUD removal (The Basics)
Patient education: Long-acting methods of birth control (The Basics)
Patient education: Permanent birth control for women (The Basics)
Patient education: Hormonal birth control (The Basics)
Patient education: Barrier methods of birth control (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Hormonal methods of birth control (Beyond the Basics)
Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)
Patient education: Birth control; which method is right for me? (Beyond the Basics)
Patient education: Ectopic (tubal) pregnancy (Beyond the Basics)
Patient education: Permanent birth control for women (Beyond the Basics)
Patient education: Vasectomy (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Intrauterine contraception: Candidates and device selection
Contraception: Issues specific to adolescents
Depot medroxyprogesterone acetate (DMPA): Formulations, patient selection and drug administration
Emergency contraception
Internal (formerly female) condoms
Fertility awareness-based methods of pregnancy prevention
Hormonal contraception for menstrual suppression
Pericoital (on demand) contraception: Diaphragm, cervical cap, spermicides, and sponge
External (formerly male) condoms
Contraception: Counseling and selection
Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use
Contraception: Progestin-only pills (POPs)
Combined estrogen-progestin contraception: Side effects and health concerns

The following organizations also provide reliable health information.

●National Library of Medicine

(https://medlineplus.gov/healthtopics.html)

●National Institute of Child Health and Human Development (NICHD)

Toll-free: (800) 370-2943

(www.nichd.nih.gov)

●National Women's Health Resource Center (NWHRC)

Toll-free: (877) 986-9472

(www.healthywomen.org)

●Planned Parenthood Federation of America

Phone: (212) 541-7800

(www.plannedparenthood.org)

●The Hormone Foundation

(www.hormone.org)

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