Don't want to take daily contraceptive pills? Here's the alternatives
The arrival of the pill in 1961 was pivotal in enabling women to control their fertility with a method unrelated to sex.听Long-acting reversible contraception听(LARC) methods add another dimension to contraceptive choice, freeing women from having to remember a pill every day.
LARC methods include the contraceptive implant and hormonal intrauterine device (IUD), available in Australia since the early 2000s, and copper IUDs which have been around since the 1970s.
Global and local institutions from the听听to the听听补苍诲听听advocate for increased access to LARCs. But there is still a lack of awareness and negative perceptions about these methods.
What are the options?
Unlike condoms, which need to be used every time with sex, or the pill, which must be taken every day, LARC doesn鈥檛 require any action after placement in the body and is immediately reversible.
Arm implant
The contraceptive implant available in Australia, known under the brand name Implanon, is a 4cm flexible rod, placed under the skin of the upper inner arm. It slowly releases a progestogen hormone called etonogestrel over a three-year period.
Two-rod implants are available in other countries, including New Zealand. These last for up to five years.
Implants work by preventing the release of an egg each month from the ovary. They also thicken the mucus at the cervix to prevent sperm reaching the uterus.
Implants are more than 99.9 percent effective, which means听听using the implant will become pregnant in a year.
Implants are听subsidised by the Pharmaceutical Benefits Scheme听so patients pay A$39.50 for the device (A$6.40 concession).
Interuterine device
The hormonal IUD, known under the brand name Mirena, is a plastic T-shaped device placed in the uterus. It releases a low dose of a progestogen hormone called levonorgestrel for up to five years.
Copper devices don鈥檛 emit hormones and last between five years (for the Load-375 IUD) and ten years (for the Copper T380).
Above: Mirena IUD, a form of long-lasting reversible birth control. Image credit: via ,
IUDs mainly work by interfering with sperm movement, which stops them fertilising an egg. Sometimes they work by preventing implantation of a fertilised egg, but they never have an effect after implantation has occurred.
Hormonal IUDs also thicken the cervical mucus to prevent sperm reaching the uterus and can, less commonly, prevent ovulation.
While the hormonal IUD is slightly more effective than the copper device, especially in young women, both are more than听. This means fewer than one in every 100 women using IUDs become pregnant each year.
The hormonal IUD is also听subsidised by the PBS, so patients pay A$39.50 for the device (A$6.40 concession). Copper IUDs aren鈥檛 listed on the PBS and听cost up to A$150.
There are specific Medicare rebates for the insertion and removal of implants and the insertion of an IUD. Patients may also pay a gap fee for the consultations.
Choosing a contraception
As a family planning doctor, I know that finding the best contraceptive to suit a woman鈥檚 individual circumstances is based on a multitude of factors from side-effects to cost and personal preference.
While some women prefer a contraceptive they can stop and start themselves or one that is hormone-free, others like a method they can forget about from day to day.
Some women want a contraceptive that can eliminate their menstrual bleeding, while others prefer a regular bleeding pattern.
Individual experience is hugely variable:
- I鈥檝e just had my third Implanon taken out. So it鈥檚 been nine years. I think I got one taken out early, but yeah, nine years of Implanon. I just loved the convenience of that and the price鈥� 鈥撎�
- I kind of I feel like a, you鈥檙e being microchipped or something鈥� I think it鈥檚 amazing technology 鈥� but I just, I don鈥檛 think I could do it. 鈥撎�
Informed choice is fundamental. What suits a woman as a teenager may be very different to what suits her in her 30s or late 40s. Informed choice needs to be based on evidence that includes the pros as well as the cons of all options.
What are the pros of Long-Acting Reversible Contraceptives (LARC)?
There are very听听preventing women of any reproductive age using LARC.
None of the implants or intrauterine devices contain oestrogen, so they avoid the risk () of venous blood clots associated with the combined oral contraceptive pill or the vaginal ring.
LARC methods don鈥檛 rely on remembering to take a daily pill or stopping to put on a condom. Once in place, they don鈥檛 require a visit to the doctor or any ongoing costs.
The hormonal IUD thins out the lining of the uterus and is highly effective at reducing menstrual blood loss. It is听听as a first-line option for women with heavy menstrual bleeding, which can result in iron deficiency and anaemia.
It can also be听.
The copper IUD can be used as a highly effective method of emergency contraception when inserted within five days of unprotected intercourse. It can then be continued for up to ten years.
What are the cons of LARC?
Insertion of an implant just under the skin of the arm requires a simple procedure using local anaesthetic.
An IUD is inserted into the uterus through the cervix, which can be uncomfortable. Most women have their IUD inserted using local anaesthetic but some choose to have it put in under light sedation.
There are听听associated with these procedures, including a small risk of infection.
Once in place, the implant can cause unpredictable and sometimes troublesome vaginal bleeding. The copper IUD can be associated with heavier and longer-lasting periods.
Women using an implant or hormonal IUD can have hormonal side effects such as headache, acne, mood changes, or reduced libido.
While it鈥檚 impossible to predict who will experience side-effects, it鈥檚 important all women are aware of this risk and know to seek medical advice if needed.
How common are they?
The uptake of implants and IUDs in Australia has increased听听迟辞听.
But lack of awareness and persistent misperceptions prevent some women from considering this option. Some women (and听) erroneously believe an IUD cannot be used by young women or women who have not had children, or that LARC will cause a problem with future fertility.
Finding a clinic nearby to put in an IUD or an implant can also be difficult. To ensure equitable access, we need to increase the number of doctors and nurses inserting LARC across Australia through enhanced training programs and improved remuneration.
While the pill continues to serve many women well, and its introduction over 50 years ago is rightly regarded as a significant step in women鈥檚 empowerment, the highly effective (and cost-effective) LARC methods are increasingly chosen by women from adolescence through to menopause across the globe.
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This article was authored by , Clinical Associate Professor in the at the University of Sydney. It was originally published on as ''.