Raise your hand if you’re so over remembering (read: forgetting) to pick up birth control pill refills. Is your arm up? Then it’s high time you considered LARC—long-acting reversible contraception—such as an intrauterine device (IUD) or implant. When it comes to preventing pregnancy, these devices, which a gynecologist inserts into your uterus or under the skin of your arm, “are as effective as getting your tubes tied, but they’re easily reversible,” says Andrew Kaunitz, MD, a professor in the department of obstetrics and gynecology at the University of Florida College of Medicine—Jacksonville.
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In fact, research shows that LARC is more than 99 percent fail-safe. That’s because you can’t mess it up: Once it’s in, simply ignore it until you want to have it removed. Done.
IUDs and the implant are particularly good options if you’re over 35: Most release progestin, a hormone that can relieve bleeding associated with fibroids, which we’re more prone to as we age. They’re also safer for women who smoke or have high blood pressure than estrogen-based options like the pill or ring.
Intrigued? Read on to find the method that’s best for your life situation, and you’ll never have to agonize over an unfilled pill Rx ever again.
I want birth control without hormones in it.
Your pick: A copper IUD (ParaGard)
How it works: The only LARC that doesn’t release progestin, ParaGard has a copper frame that kills sperm. If a sperm did happen to get through, the lining of your uterus would be inhospitable to a fertilized egg.
When to skip it: Steer clear if you have Wilson’s disease, a rare condition that alters the way your body handles and removes copper. And if you’ve noticed reactions to copper jewelry in the past, talk to your doc before getting it. ParaGard may also make your periods heavier when you first start using it, so heavy bleeders might want to pass.
Lasts for: It’s FDA-approved for up to 10 years of use; research suggests it works even longer.
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My periods are the worst.
Your pick: A hormonal IUD (Mirena, Skyla or Liletta)
How it works: All three plastic devices release progestin into the uterus. The hormone seems to block sperm from entering your uterus by thickening mucus in your cervix. It may also thin your uterine lining so any eggs that do get fertilized can’t implant. A side perk: After one year, about 20 percent of Mirena users stop getting periods; most of the rest menstruate for just one to two days per cycle, says Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine. (Periods return when the IUD is removed.) Mirena can also reduce menstrual cramping.
Never had kids? Skyla, a compact version of Mirena, may fit more comfortably into your smaller uterus. It also stops periods for some women. Lastly, if cost is a factor, ask for Liletta at your local health clinic—this newer version works the same way as the others but can be more affordable.
When to skip it: If you’ve had breast cancer, your doctor will likely advise against any hormonal birth control.
Lasts for: Skyla and Liletta are approved for up to three years of use, and Mirena for up to five years, but studies show it may be effective for up to six years.
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Sticking something up my uterus? No, thank you.
Your pick: A hormonal implant (Nexplanon)
How it works: If you’re nervous about IUD insertion, or if your gyno determines that you’re not a good candidate, consider Nexplanon, a small, flexible plastic rod that’s placed under the skin of your inner upper arm, where it releases progestin into your bloodstream. “You can have it done in five minutes,” Dr. Kaunitz says.
When to skip it: Women who’ve had breast cancer shouldn’t use the implant. FYI: Nexplanon can cause spotting. Mirena can, too, but it typically stops after four months; with the implant, it may go on for longer, Dr. Minkin says.
Lasts for: Up to three years.
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