Dr. Skop answers some of your most important questions!
Is it true that LARCs have a lot of bad side effects?
Although any contraceptive method can have side effects, LARCs do not have nearly as many side effects as a casual internet search would suggest! About one out of a thousand times, the IUD can be misdirected during insertion to perforate the uterus, and may require surgical removal. Some women will have minor cramping or irregular bleeding. Nexplanon releases progesterone (the hormone that is high prior to your menstrual period), so some women will notice the symptoms they have premenstrually, such as irritability or bloating. This is not the case with IUDs, which release very little or no hormones systemically.
I heard that if I haven’t had a baby, that I shouldn’t have an IUD?
Whereas once doctors were hesitant to give an IUD to a woman who had not experienced childbirth, that is no longer the case. In fact, Skyla and Kyleena are designed especially for such women, as it is slightly smaller and easier to insert.
Do IUDs cause infections and infertility?
An IUD will not cause an infection to occur out of nowhere. However, if a woman has or contracts an infection while an IUD is in place, it can become a more serious infection, leading to pelvic inflammatory disease or infertility. For this reason, a woman considering an IUD should have STD testing performed prior to (or with insertion), and if an infection is discovered it should be treated (although the IUD does not need to be removed). Ideally, she should be in a monogamous relationship where her partner has also been tested, or she should practice safer sex and use condoms.
Do IUDs and nexplanon cause weight gain?
The average woman gains weight every year. All too frequently, the contraceptive method is blamed, when in fact, it is her lifestyle or diet that leads to weight gain. IUDs do not cause weight gain, but nexplanon can make some women hungrier. If she eats more in response to her appetite, she will gain weight.
If I get pregnant with an IUD in place, will it cause me to lose the pregnancy?
Pregnancies are very rare with LARCS, but if a pregnancy does occur, the LARC should be removed if possible. The hormones from the LARC do not cause birth defects, and the pregnancy can be continued safely. Most pregnancies occur if the IUD has fallen out and is not recognized, so an X-ray or sonogram should be performed to look for it if the strings cannot be seen. Rarely, some pregnancies do continue with an IUD in place, but they should be followed by a high risk OB doctor.
I am pregnant. How soon can I get a LARC after I deliver?
IUDs can be placed immediately postpartum (within 10 minutes of delivery, even if by C-section), but there is a higher risk of the IUD falling out (about 25%). Nexplanon can be placed immediately, or a day or two following delivery if you plan to breastfeed. Alternatively, you could wait and have the IUD or nexplanon placed in your doctor’s office 6 or more weeks postpartum.
Can you have a LARC placed the day you request it at the clinic?
It is possible to have a device placed the day you request it, although many offices may need to verify coverage, or possibly order the device, so it is possible you may need to return for a follow up visit. Placement will be more comfortable if you take an anti-inflammatory medication like Ibuprofen 600-800mg 30 minutes before insertion. You can also ask your doctor to use a numbing spray or gel on your cervix.
Are there any health benefits to LARCS?
Most women have lighter or absent periods, which are generally less painful as well. They can be used as treatment for endometriosis, dysfunctional uterine bleeding or polycystic ovarian syndrome, even if contraception is not needed.
I have been told it is dangerous for me to use birth control. Can I use a LARC?
When doctors become concerned about risks to women with hormonal contraception, it is usually the estrogen component that poses a risk (in conditions like high blood pressure, diabetes and increased tendency to form blood clots). None of the LARCs contain estrogen (only progesterone or no hormone), so they may be appropriate for high risk women to use. Be sure to discuss your concerns with your doctor.
I have heard that IUDs do not prevent fertilization, but instead cause abortions by preventing the implantation of fertilized eggs. Is that true?
It is true that the initial IUDs to be marketed in the 1970s, Dalkon Shield and Lippes Loop may have worked that way. They did not have a hormonal or spermicidal component, and thus worked through a mechanical effect to disrupt the uterine lining. However, today’s IUDs have very effective preimplantation mechanisms of action. I can say with confidence that we are certain that very few, if any, embryos are formed with the hormonal IUDs. Progesterone is well known to increase the risk of ectopic pregnancies if a pregnancy does occur, because it slows the transit through the Fallopian tubes, causing the embryo to implant before reaching the uterus. Yet we see ectopic pregnancies very rarely in women with IUDs in place. This confirms that very few eggs are actually fertilized with these devices.
If I want to get pregnant, how quickly will my fertility return once I remove a LARC device?
The return to fertility after removal of a LARC device is very fast. The medicine will be gone from your system in a few days, and you are able to conceive in your next ovulatory cycle, usually 1-2 months.
How can I get my LARC removed?
When you have decided you no longer need your LARC, or if you would like to have a baby, the LARC can be easily removed. The string leading to the IUD will protrude slightly from your cervix, and your gynecologist can grasp the string and pull gently. The IUD arms will fold upward, and it will slide out. For Nexplanon, your provider will numb the area of the small scar from insertion, and introduce a small instrument to grasp the device and pull it out. Difficulties with removal occur less than 1% of the time.
In addition, the American Congress of OB/GYN has a wonderful FAQ page for patients.