“Long Acting Reversible Contraception” – with Dr. Caroline Friedman

Dr. Caroline Friedman joins host Dr. Fox to discuss Long Acting Reversible Contraception, or LARC. This includes several forms of birth control, primarily intrauterine devices (IUDs) and subdermal implants. Dr. Friedman and Dr. Fox discuss the reasons women choose these forms of birth control and what patients should know about them.

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In this episode, Dr. Caroline Friedman and host Dr. Fox discuss Long Acting Reversible Contraception, or LARCs. These forms of birth control include intrauterine devices and subdermal implants. Unlike permanent forms of birth control, like having a tubal ligation (“tubes tied”) or a vasectomy, these forms of birth control last for several years but are reversible.  

Dr. Fox and Dr. Friedman discuss the various birth control options that are available. Dr. Friedman notes that the less effective options she discusses with patients include natural family planning, withdrawal, and condoms. More effective options include hormonal birth control pills, which Dr. Fox notes must be taken at the same time each day to remain effective, which for some can be difficult. Patients also have the option of a ring that is placed into the vagina, and the Depo-Provera shot, which is administered every three months. 

Hormonal birth control options may use progesterone, estrogen, or both, and the correct dosage and form of hormone vary from patient to patient. Some patients can’t take estrogen for several reasons, including a history of blood clots or family history of breast or ovarian cancer, among other medical factors.  

Long acting birth control methods are beneficial especially for patients who are very busy or travel often and know they don’t want to get pregnant within the next several years. However, Dr. Friedman notes that LARCs can be taken out in as little as six months for patients who do decide they want to get pregnant. The range of a LARCs use is as little as six months to up to 10 years for copper IUDs. 

Both hormonal and copper IUDs are available, and each is placed in-office. Initially, this procedure is comparable to a pelvic exam, after which the IUD is placed through the cervix into the uterus. Cramping is normal during and after the procedure, and Dr. Friedman typically recommends that patients take ibuprofen beforehand. Dr. Fox notes that Maternal Fetal Medicine Associates also schedules an ultrasound two weeks after IUD placements to ensure they remain in the correct place. There is a risk of an IUD falling out, migrating, or partially embedding itself in the uterus, but Dr. Friedman says these cases are “exceedingly rare.”  

A subdermal implant called Nexplanon is another LARC option. This device is the length of a matchstick and delivers hormones similarly to a pill or ring. However, it is inserted using a special device under the skin of your arm. Dr. Fox notes that the pain of having a subdermal implant inserted is “the equivalent of getting a mole removed at the dermatologist,” and that Nexplanon lasts three years.  

Dr. Friedman explains that the most common side effects of LARCs are irregular bleeding. She says she usually encourages patients to “wait it out,” as these effects are usually temporary, lasting only the first few months of having the LARC in place.  

Finally, Drs. Friedman and Fox comment on the growing popularity of LARCs. Dr. Friedman suggests that this may be because of new literature that has shown they’re very effective and relatively easy. Dr. Fox notes that it is also possible that popularity has grown because as more women hear that their friends or family members have and enjoy them, they decide to try it as well, and women are generally busier.