Patient education: Long-acting methods of birth control (Beyond the Basics)
- Andrew M Kaunitz, MD
Andrew M Kaunitz, MD
- Professor and Associate Chairman
- Department of Obstetrics and Gynecology
- University of Florida College of Medicine-Jacksonville
Several long-acting or permanent methods of birth control are available. These are best for women who do not want to become pregnant in the near future (or ever). These methods work well, mostly because the woman does not have to remember to do or take anything on a regular basis.
This article discusses long-acting methods of birth control, including the intrauterine device (IUD), contraceptive implant, and sterilization. These are the most effective contraceptive methods available and, therefore, should be considered as first-line choices. Hormonal and barrier birth control methods are discussed separately. (See "Patient education: Hormonal methods of birth control (Beyond the Basics)" and "Patient education: Barrier methods of birth control (Beyond the Basics)".) An overview of all birth control methods is also available. (See "Patient education: Birth control; which method is right for me? (Beyond the Basics)".)
CHOOSING A BIRTH CONTROL METHOD
It can be difficult to decide which birth control method is best because of the variety of options available. The best method is one that you will use consistently and that does not cause bothersome side effects. Other factors to consider include:
●How well does it work?
●Do I need to remember anything to use it?
●How long does it work?
●Can I get pregnant when I stop using it?
●Will I bleed more or less?
●Will I have side effects?
●How much does it cost?
●Does it protect me against sexually transmitted infections?
No method of birth control is perfect. You must balance the advantages of each method against the disadvantages and decide which method you prefer. A list of helpful questions is in the table (table 1).
INTRAUTERINE DEVICE (IUD)
IUDs are placed by a healthcare provider through the vagina and cervix, into the uterus. Most are made of molded plastic and have a string that you can feel in the vagina, but does not extend outside the body. IUDs currently available in the United States do not increase a woman's risk of infection, ectopic pregnancy, or infertility.
Two types of IUDs are currently available:
●Copper-containing IUD (brand name: Paragard) (picture 1) prevents pregnancy by preventing sperm from reaching the fallopian tubes. The copper-containing IUD lasts for at least 10 years and is highly effective in preventing pregnancy; the pregnancy rate in women who use a copper-containing IUD is less than one percent in the first year of use (table 2). Some women who use a copper-containing IUD have heavier and longer menstrual periods.
●Levonorgestrel-releasing IUDs (brand names Mirena, Kyleena, Skyla, and Liletta) (picture 2) prevent pregnancy by thickening the cervical mucus and thinning the endometrium (the lining of the uterus). They also decrease menstrual bleeding and pain. Although IUDs can be removed at any time, the Mirena and Kyleena IUDs can stay in place for up to five years, Liletta can stay in place for up to four years, and Skyla can stay in place for up to three years. All are highly effective in preventing pregnancy; the pregnancy rate in women who use a levonorgestrel-releasing IUD is less than one percent in the first year of use (table 2). Some women completely stop having menstrual periods while using a levonorgestrel-releasing IUD; this is not harmful and does not require treatment. Menstrual periods will return when the IUD is removed.
Benefits — An IUD is an ideal method if you do not plan to become pregnant for at least one year (or longer) or you want a method that is highly effective and does not require daily or weekly attention. IUDs are also appropriate for women who do not want to or cannot use estrogen. In addition, there is evidence that using an IUD lowers a woman's risk of getting cervical cancer.
IUDs have relatively few side effects, and are reversible. If you decide you want to become pregnant, you can do so by having the IUD removed by a health care professional. IUDs do not affect your chance of becoming pregnant after the IUD is removed so you can try to get pregnant right away.
Risks — There is a small risk that the IUD will come out, sometimes during your period. The IUD is most likely to come out during the first few months after insertion. If you think your IUD might have moved or fallen out, use a backup method (eg, condoms) until you can see a healthcare provider. Some providers recommend that a woman check to see if the IUD string ends can be felt within the vagina. This can be done periodically, or monthly after your period ends. There is a very low risk of developing an infection after placement of the IUD.
Precautions — You should not use an IUD if you recently had a pelvic infection such as gonorrhea or chlamydia. If you have more than one sex partner, talk to your healthcare provider about the risks and benefits of the IUD.
If you become pregnant while using an IUD, you need an ultrasound to be sure that the pregnancy is inside the uterus, rather than in the fallopian tube (called an ectopic pregnancy). The IUD should be removed, if possible, when the pregnancy is discovered. (See "Patient education: Ectopic (tubal) pregnancy (Beyond the Basics)".)
BIRTH CONTROL IMPLANT
A single-rod progestin implant, Implanon or Nexplanon, is available in the United States and elsewhere. A healthcare provider inserts a small device under the skin in the upper inner arm (picture 3). 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 (table 2).
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.
Sterilization is a procedure that permanently prevents a person from becoming pregnant or able to have children. Tubal ligation and vasectomy are the two most common sterilization procedures. Sterilization should be considered permanent, and should only be considered after a careful discussion of all available options with a healthcare provider. (See "Patient education: Permanent sterilization procedures for women (Beyond the Basics)" and "Patient education: Vasectomy (Beyond the Basics)".)
Tubal ligation — Tubal ligation is a sterilization procedure for women that surgically cuts, blocks, seals, or removes the fallopian tubes to prevent pregnancy. Women who have recently delivered a baby vaginally can undergo tubal ligation before going home by a having a procedure that uses a small (approximately one inch) incision near or in the belly button. For women delivering their baby by cesarean section, sterilization can be performed at the time of the cesarean birth. A separate topic review is available. (See "Patient education: Permanent sterilization procedures for women (Beyond the Basics)".)
Laparoscopic tubal ligation — Laparoscopic tubal ligation is done in an operating room, usually under general anesthesia as same-day surgery. The tubes are clamped, cauterized (burned), or removed, and the recovery takes one to two days.
Essure — Essure is a method of sterilization available only in the United States; it involves placement of a tiny coil mechanism into each of the fallopian tubes (picture 4). It does not involve incisions in the abdomen. It is done by approaching the tubes through the vagina and cervix. The procedure can be done in the office using local anesthesia, and the recovery is quick. Over the following three-month period, the fallopian tube tissue around the coil grows into the coil, causing blockage of the tubes in most women.
A backup method of contraception (eg, oral contraceptive or condom) is needed until testing confirms that the fallopian tubes are completely blocked; testing is usually done three months after coil placement.
Vasectomy — Vasectomy is a sterilization procedure for men that surgically cuts or blocks the vas deferens, the tubes that carry sperm from the testes. It is a safe, highly effective surgical procedure that can be performed in a healthcare provider's office under local anesthesia. Following surgery, another contraceptive (eg, condoms) must be used for approximately three months, until a semen analysis confirms that there are no sperm present. A separate topic review is available. (See "Patient education: Vasectomy (Beyond the Basics)".)
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Choosing birth control (The Basics)
Patient education: Vasectomy (The Basics)
Patient education: Intrauterine devices (IUD) (The Basics)
Patient education: Long-acting methods of birth control (The Basics)
Patient education: Sterilization for women (The Basics)
Patient education: Hormonal birth control (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Hormonal methods of birth control (Beyond the Basics)
Patient education: Barrier methods of birth control (Beyond the Basics)
Patient education: Birth control; which method is right for me? (Beyond the Basics)
Patient education: Ectopic (tubal) pregnancy (Beyond the Basics)
Patient education: Permanent sterilization procedures for women (Beyond the Basics)
Patient education: Vasectomy (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Intrauterine contraception: Devices, candidates, and selection
Contraception: Issues specific to adolescents
Depot medroxyprogesterone acetate for contraception
Fertility awareness-based methods of pregnancy prevention
Hormonal contraception for suppression of menstruation
Diaphragm, cervical cap, and sponge
Contraceptive counseling and selection
Overview of the use of estrogen-progestin contraceptives
Progestin-only pills (POPs) for contraception
Risks and side effects associated with estrogen-progestin contraceptives
The following organizations also provide reliable health information.
●National Library of Medicine
●National Institute of Child Health and Human Development (NICHD)
Toll-free: (800) 370-2943
●National Women's Health Resource Center (NWHRC)
Toll-free: (877) 986-9472
●Planned Parenthood Federation of America
Phone: (212) 541-7800
●The Hormone Foundation
- Westhoff C, Davis A. Tubal sterilization: focus on the U.S. experience. Fertil Steril 2000; 73:913.
- Peterson HB, Jeng G, Folger SG, et al. The risk of menstrual abnormalities after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 2000; 343:1681.
- Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril 2000; 73:923.
- Hubacher D. The checkered history and bright future of intrauterine contraception in the United States. Perspect Sex Reprod Health 2002; 34:98.
- Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev 2005; :CD002126.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.