Long-Acting Reversible Contraception (LARC)

What is a LARC?

LARC stands for Long-Acting Reversible Contraception. These are forms of birth control that are very effective and can last multiple years. Yet they have the benefit of being completely reversible when removed so a woman can become pregnant if desired.

Long-Acting Reversible Contraception

By Dr. Mary Powell


What is a LARC?

LARC stands for Long-Acting Reversible Contraception. These are forms of birth control that are very effective and can last multiple years. Yet they have the benefit of being completely reversible when removed so a woman can become pregnant if desired. This form of birth control includes the implant, called Nexplanon and the various Intrauterine Devices (IUDs) (Skyla, Mirena, Kyleena, or Paragard).


The Nexplanon is a three-year contraceptive implant that is inserted in a woman’s upper arm, just below the skin. It is a bit shorter than a toothpick, but about the same width. It is embedded with a progesterone hormone that is slowly secreted over the time it is in place. The progesterone hormone will change the cervical mucus and prevent sperm from reaching the egg. This will prevent fertilization and makes it highly effective at preventing pregnancy. Once it is in position no maintenance is needed which is why it works so well. Most women tolerate this form of contraception quite well. The most common side effect is a change in periods. In approximately 15% of women, they will have unpredictable bleeding patterns that may lead to them wanting it removed prior to the end of the three years. Placing the implant and removing it can usually be done quite easily in an office setting using a small amount of local anesthetic.


The Intrauterine Devices or IUDs are small T-shaped devices that are inserted directly into a women’s uterus. There are hormonal versions of the IUDs that have progesterone embedded in the device that will be released directly into the uterus over a three-to-five-year time depending on which device is used. The devices have different doses of progesterone. The higher dose is effective for pregnancy prevention up to five years and is also used to treat heavier periods. The lower dose progestin containing IUDs are still quite effective at pregnancy prevention. The menstrual period will often get lighter, but many women with the lower dose progestin containing IUDs will still have some monthly bleeding. A woman’s body may take 3-6 months to adjust to all of the progesterone containing IUDs. During this adjustment phase she may have more frequent light bleeding days.


The non-hormonal IUD, Paragard, is made with copper. Copper makes the uterine environment hostile to sperm. Basically, sperm do not swim well in this environment and therefore fertilization of the egg is prevented. The copper IUD is effective up to 10 years. Because there is no hormone the women’s periods will not stop or get lighter.


The IUDs are all safe and very effective. They can be inserted and removed in an office setting. Insertion is associated with some cramping, so if you can tolerate ibuprofen, it is smart to take a dose prior to your appointment. It is safe to insert during a period and may actually be easier as your cervix is slightly more open during your period. Many women have heard horror stories about the IUD moving through the uterine wall or getting stuck in the wall. These complications are NOT very common at all. Please let us know if you have questions. We would be happy to review these LARCs with you at your next appointment!