A newsletter from the office of Dr Mary Kirk
November 2017



WHAT ARE LONG-ACTING METHODS OF BIRTH CONTROL?

Long-acting reversible contraceptive (LARC) methods of birth control are devices or implants that prevent pregnancy, for months to years, and yet are reversible upon removal. These methods may be the best and safest choice for many women and teens who want long term birth control because they work so well to prevent pregnancy and are not affected by human error, antibiotics, or other medical illnesses. Women who use these also like not having to think about their birth control every single day. LARCS have reduced the number of unwanted pregnancies and the abortion rate in areas that previously were quite high by providing long term yet reversible and reliable contraception. LARC have dropped the pregnancy rate to less than 1% in the first year of usage.




WHAT ARE THE DIFFERENT TYPES OF LONG-ACTING 
REVERSIBLE METHODS OF BIRTH CONTROL?

Intrauterine Devices (IUDs) - These are small to medium sized T-shaped devices made of flexible plastic. An IUD may stay in place for contraception from 3-10 years depending on the type of IUD before being removed from the uterus.
 
Birth Control Implant
- This is a flexible plastic rod that is 1.5 inches long (about the size of a match) called Nexplanon. The implant is placed just under the skin of the upper inner arm and is effective for three years at which point it will need to be removed.
 


Some women use IUDs for reasons other than birth control. For example, one type of IUD can be used to treat heavy, painful periods.  An IUD should not be considered for emergency birth control.

HOW WELL DO LONG-ACTING METHODS OF BIRTH CONTROL WORK?  

Of all the birth control options available, long-acting methods provide the lowest pregnancy rate. Fewer than 1 in 100 women who have an IUD or birth control implant will get pregnant during the first year of use.  

WHAT ARE THE BENEFITS AND DOWNSIDES OF 
LONG-ACTING METHODS OF BIRTH CONTROL?

The main benefit of long-acting birth control is that you do not have to remember to do anything or take any medicines on a regular basis in order to have effective contraception.  The main downside of these methods is that unlike condoms, they do not protect against sexually transmitted infections.

These options are best for women who do not want to become pregnant for at least 1 year. A doctor or nurse needs to remove the IUD or implant when you don't want to use it anymore.  If you are wanting a pregnancy in less than one year then a shorter acting contraceptive (contraceptive pill, patch or vaginal ring) may be a better choice. 

WHAT IF I CHANGE MY MIND AND WANT TO GET PREGNANT?

If you have an IUD or birth control implant, you may have the device removed with a minor office procedure.  Menses should return within a few months.  You will likely be able to get pregnant within a few months of having the device removed.

THE INTRAUTERINE DEVICE

An intrauterine device (IUD) is a type of birth control. It is a small, T-shaped device that a doctor or nurse puts in your uterus by going through your vagina and cervix. These devices are made of flexible plastic and have 2 thin plastic strings that hang out of the cervix. They are very small - a little more than 1 inch (2.5 cm) in width and length.

WHAT ARE THE DIFFERENT TYPES OF IUDs?

There are 2 types of IUDs available in the United States. One type contains copper, and the other type releases the hormone progestin.  There are different progesterone IUDs with different dosages of progesterone.

Copper-containing IUD - There is only 1 copper-containing IUD. It is called Paragard and can stay in your uterus for up to 10 years to prevent pregnancy. Some women who use it get heavier or longer periods than they had before getting the IUD.  You should not consider this IUD if your periods are already heavy or long.

Progestin-releasing IUD - There are 2 progestin-releasing IUDs that we use in our office. They are called Skyla, and Liletta. Liletta can stay in your uterus for up to 4 years (ongoing studies should extend this date to five years) to prevent pregnancy. Skyla can stay in place for up to 3 years. Many women who use progestin-releasing IUDs to have lighter, less painful periods than they had before getting the IUD. Some women stop getting a period at all, but this is not harmful and does not need to be treated. Regular periods return when the device is taken out.

WHAT ARE THE BENEFITS OF USING AN IUD?
  • IUDs are very effective. Fewer than 1 in 100 women who use these devices get pregnant during the first year of using them.
  • You do not have to remember to do anything or take any birth control medicines on a regular basis.
  • IUDs have few side effects.
  • IUDs do not contain estrogen, a hormone that some women can't or don't want to take.
  • If you decide you want to get pregnant, you can have the IUD taken out.
  • If you use an IUD for several years, it costs less overall than many other types of birth control. That's because there are no costs after you have it inserted.
WHAT ARE THE DOWNSIDES OF AN IUD?
  • Unlike condoms, an IUD does not protect you against infections you can catch during sex, called "sexually transmitted diseases" or "STDs." But you and your partner can use a condom to prevent spreading infections.
  • There is a small chance the IUD will come out during your period. If this happens, you will need a new IUD. If you see your IUD in your underwear, on your pad, or in the toilet, call your doctor or nurse immediately.
  • The initial cost is higher than the cost of other methods. But, there are no more costs after it is inserted.
  • Only a doctor or nurse can insert or remove an IUD.
  • You should not get an IUD if you recently had an infection that spread to your uterus and other nearby organs, called a "pelvic infection." STDs such as chlamydia and gonorrhea can cause pelvic infections.
WHICH TYPE OF IUD IS BEST FOR ME?

Your doctor or nurse can help you choose the right IUD for you. 

DOES IT HURT TO HAVE AN IUD IMPLANTED?

You will likely feel some discomfort and slight cramping after the nurse or doctor puts the IUD into your uterus. Women who have not had a baby often feel more discomfort than women who have had a baby.

After the IUD is in place, you should not be able to feel it.

WHEN SHOULD I SEE A DOCTOR OR NURSE?

If you have an IUD, see your doctor or nurse right away if:
  • You have pain in your lower belly
  • Your period is late or very different from normal
  • You cannot feel the string of the IUD or if the string seems shorter than usual
  • You think your IUD might have moved or fallen out
  • You had sex with someone who has or might have an STD, or you think you have an STD
  • You have an unexplained fever

THE BIRTH CONTROL IMPLANT

A nurse or doctor inserts the implant just under the skin on the inner side of your upper arm. It contains a progestin, which is slowly released into the body.  The progestin is designed to lighten or stop the menstrual flow as well as provide contraception.  It thins the endometrial lining so thin that implantation will not occur and menses will cease.  It is highly effective for at least three years, and can be removed sooner if you want to become pregnant or are unhappy with this method. 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 bothersome side effect. Your ability to become pregnant returns quickly after the implant is removed.

Some people have side effects after getting Nexplanon, but many adjust to the implant with few or no problems at all. Negative side effects usually go away after a few months, once your body gets used to your implant.  It may take up to 90-120 days for your body to adjust.

The most common side effect is irregular bleeding (aka spotting), especially in the first 6-12 months. Sometimes the implant causes long-term spotting, or periods get longer and heavier. But for most people, the implant makes their periods way lighter - 1 in 3 people with the implant stop getting their periods at all after a year.

It's totally safe to not get a period while you're on Nexplanon. And you don't need to worry about being pregnant even if you don't get a period, because the implant is really, really effective birth control. (You can always take a pregnancy test if you want to be sure.)

Other possible side effects that aren't as common include:
  • Headaches
  • Breast pain
  • Nausea
  • Weight gain
  • Ovarian cysts
  • Pain or bruising where the implant was inserted
  • An infection where the implant was inserted
  • Irregular menstrual bleeding
HOW IS THE IMPLANT INSERTED?



First, your doctor or nurse will ask you some questions about your health to see if the implant Nexplanon is a good method for you. They may also give you a physical exam.  The doctor or nurse gives you a shot to numb a small area of your arm. Then, they use a special inserter tool to slide the implant under your skin.  Putting the implant in only takes a few minutes.

HOW DOES IT FEEL TO GET AN IMPLANT INSERTED?

Most people just feel a little pinch or stinging when they get the numbing shot. After that, you shouldn't be able to feel the implant being inserted. After the pain medication has worn off, your arm may ache a little where the implant was inserted, but it goes away quickly.

You may have some tenderness or swelling around the implant for a few days and it may look bruised for a week or two. Your doctor or nurse will tell you how to wash and take care of the skin around your implant for the first couple of days.

HOW SOON AFTER GETTING THE IMPLANT CAN I HAVE SEX?

You can have sex right away after getting the implant. But if you don't get the implant during the first 5 days of your period, you should use some other type of birth control (like condoms) for the first week after getting your implant. (If you do get the implant during the first 5 days of your period, you're protected from pregnancy right away.)

Nexplanon works for 3 years, and a nurse or doctor must remove it once it expires. You can also get your implant taken out any time before then if you want to get pregnant or stop using it.  If you've had your implant for 3 years and you still don't want to get pregnant, you need to replace it (or pick another birth control method). You can get a new implant when you have the old one removed.

HOW DOES IT FEEL TO GET THE IMPLANT REMOVED?

Nexplanon removal only takes a few minutes, but the process is a little longer than getting it put in.  Just like with the insertion, a doctor or nurse gives you a shot to numb a small area of your arm. Then they make a small cut and remove the implant. You usually just feel a little pinch or stinging when you get the numbing shot. After that, it shouldn't hurt when they make the incision or take the implant out.  If you want to continue using Nexplanon, you can get another implant put in during the removal of your old one.

HOW SOON CAN I GET PREGNANT AFTER GETTING THE IMPLANT REMOVED?

It's possible to get pregnant right away. It may take a few months for a regular cycle to return.

WHAT SHOULD I EXPECT AFTER I GET MY IMPLANT REMOVED?

Overall, you should feel completely normal after getting your implant taken out. Your arm may feel tender or swollen around where the implant was for a few days. It may look bruised for a week or two. Your doctor or nurse will tell you how to wash and take care of your skin for a couple of days after removal.  Unless you start another hormonal birth control method after removing the implant, your period will go back to how it was before you got Nexplanon.

Fun Fact:

(PLEASE DO NOT TRY THIS)


In the 1950's a rumor spread that Coca-Cola could be used as birth control. This rumor claimed that carbonic acid in Coca-Cola killed sperm, the sugar exploded sperm cells and the carbonation of the drink forced the liquid into the vagina. Some women started using Coca-Cola as an after-sex douche! Women would shake up a bottle, insert it, and let the soda fly.

Dr Mary C Kirk | 918-508-2200 | www.kirkobgyn.com