What is a LARC?
A LARC is a ‘Long-acting reversible contraceptive’. They are a group of contraceptives that provide very effective contraception, are long acting, don’t required you to do something every day and are reversible when stopped. They are known as ‘fit and forget’ methods and are the most effective reversible methods.
Common LARCs
Some common LARCs include:
Progestogen implants (ie: ImplanonNXT)
This is an implant inserted directly under the skin on the inner arm above the elbow. It slowly releases a continuous dose of progestogen hormone into the blood stream over a 3 year timeframe. The implant works by preventing ovulation and is 99.9% effective. It is immediately reversible on removal.
Insertion of the implant involves a small procedure under local anaesthetic by a trained doctor or nurse. Most GPs will be able to provide this service.
Implants are suitable for women of any age who have started menstruating and can be used in most women, however if you have any health issues this should be discussed with your doctor. They can be inserted immediately after a pregnancy and will change a woman’s bleeding pattern. For some women, this may mean no bleeding at all, but up to 1 in 5 women have irregular or persistent bleeding.
Intrauterine Devices
Both hormonal intrauterine devices (IUDs) and copper IUDs are available to women. The insertion is performed by a trained doctor or nurse, and devices last up to 5 to 10 years depending on their type. IUDs can be easily removed and are immediately reversible on removal.
Both types of IUDs are suitable for women of any age and can be used by most women. They require an insertion procedure which can be uncomfortable.
The hormonal IUD (Mirena) is a T-shaped plastic device which sits inside the uterus and slowly releases progesterone into the womb over a 5 year time frame. This thickens the mucus in the cervix, thins the lining of the uterus and effects the implantation of the egg. It is 99.8% effective. As with other LARCs, the Mirena can alter bleeding patterns, and may cause bleeding and spotting in the first few months after menopause.
The copper IUD is a small device made from copper, which also sits inside the uterus. It works by clocking the sperm from reaching the egg, and also preventing any fertilized egg from sticking to the wall of the womb. It is 99.2% effective and can increase the amount of bleeding associated with normal periods.
Contraceptive Injections (Depot Medroxyprogesterone Acetate (DPMA)):
DMPA is given as an intramuscular injection every 12 weeks. It works by preventing ovulation and is 99.8% effective with perfect use, however with typical use the effectiveness drops to 94%. This is because sometimes injections may not be given on time.
For continuing protection with the Depot, it is important to have follow-up injections every 12 weeks. In some women, fertility and periods can take quite a few months to return after cessation of the DPMA injection, however fertility is not permanently affected.
The depot can be used by most women, and requires a doctor’s visit every 12 weeks. It will change a woman’s usual bleeding pattern, but for most women this will be little to no bleeding, especially with ongoing use. If there are any side effects, there is no way to reverse these until the injection has worn off.
What next?
If you are thinking about a LARC, please book an appointment to discuss this with one of our friendly GPs. It is important to remember that when we discuss efficacy of these contraceptive methods, it refers to preventing pregnancy. Barrier methods such as condoms are still required to prevent transmission of sexually transmitted infections.
If you are interested in learning more about this topic, feel free to book an appointment with one of our friendly doctors by booking online or contacting us by phone on 8269 6000 .
References
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Sexual Health & Family Planning Australia 2013, Long Acting Reversible Contraceptives, Family Planning NSW, retrieved online 25/8/17, < https://www.fpnsw.org.au/sites/default/files/assets/larcs_fs.pdf >
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Shine SA 2017, Contraception, Shine SA, retrieved online 25/8/17, < https://www.shinesa.org.au/health-information/contraception/ >
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