This interactive tool can be used to review relevant research and practice tips with residents and other learners who will be counseling patients on contraceptive options. PDF versions also available for download in English and Spanish. For a detailed comparison of Long-Acting Contraceptive options, see Which Long-Acting Contraceptive Is Right for Me?

What are long-acting
contraceptives?
Long-acting contraceptives are plastic birth control devices. These include copper and hormonal IUDs (intrauterine devices) and a hormonal implant. A long-acting contraceptive prevents you from getting pregnant as long as it is in your body.
How well do long-acting
contraceptives work?
All long-acting contraceptives prevent pregnancy more than 99% of the time, which is more effective than the pill, the patch, the ring, or the shot.
Are long-acting
contraceptives safe?
Long-acting contraceptives are safe. Serious problems are rareIUD risks are uncommon but may include expulsion, infection, or uterine injury. Implant risks are also rare and may include infection, minor scarring, or difficulty in removal. and tend to occur within the first few days of use.
Can I get a long-acting
contraceptive if I’ve never
had a baby?
Yes. Long-acting contraceptives are a good choice even if you have never been pregnant.There are minimal differences between how nulliparous and parous patients experience IUD insertion; however, those differences seem to have little or no clinical impact.
                           

For patients who are more sensitive to pain, one consideration is to schedule IUD insertion during menstrual bleeding, when the cervix is slightly more open. Consider asking patients about their past experiences with pelvic exams and pap smears to elicit any history of intense cervical or pelvic pain.
                           

For more, see:

Lohr, P et al. Use of intrauterine devices in nulliparous women. Contraception, Volume 95, Issue 6, 529-537.

How do I get a long-acting
contraceptive?
A long-acting contraceptive can be placed by a trained professional. It is done in a medical office and takes only a few minutes. You can return to the office to have it removed at any timeWe stress the importance of removing LARC as soon as a patient requests it, for whatever reason. Reluctance to remove the IUD may damange trust and the physician-patient relationship. For many patients, such resistance from physicians may also evoke broader patterns of reproductive coercion and injustice.
                           
For more, see:
                           
Amico J et al. “She just told me to leave it”: Women’s experiences discussing early elective IUD removal. Contraception. 2016 Oct; 94(4): 357–361. doi: 10.1016/j.contraception.2016.04.012
                           
Gold RB. Guarding against coercion while ensuring access: a delicate balance. Guttmacher Policy Review, 2014, 17(3): 8–14.
                           
RHEDI Contraceptive Counseling: Patient Provider Perspectives
.
What are the benefits of
long-acting contraceptives?
The main benefit is that you don’t need to think about or plan for birth control as long as the device is in your body. It is different from surgery (tubal ligation) since you can have the device removed if you don’t like it or if you want to get pregnant. A long-acting contraceptive can prevent pregnancy for an extended period of time. You do not need to buy refills or come back to the office for a shot. Long-acting contraceptives are safe to use while breastfeeding.
Do long-acting
contraceptives protect
against HIV and other
sexually transmitted
infections?
No, these contraceptives do not protect you from sexually transmitted infectionsMany patients will choose to discontinue condoms once they initiate another method on ongoing contraception, so it is important to review with patients that IUDs and implants only prevent pregnancy and do NOT provide protection against STIs and HIV. Counseling may increase dual-method use. See, for example:
                           
Williams, RL et al. Dual Use of Long-Acting Reversible Contraceptives and Condoms Among Adolescents. Journal of Adolescent Health, Volume 52, Issue 4, S29-S34.
                           
Peipert, J et al. Adherence to dual-method contraceptive use.Contraception,Volume 84, Issue 3, 2011, 252-258.
                           
However it is always important to identify and support the patient’s priorities (i.e., pregnancy prevention) even when that may conflict with public health concerns (i.e., STI prevention). The following article provides an ethical framework for such scenarios and concludes that the medical community should never restrict access to contraception:
                           
Haddad LB et al. Contraception and prevention of HIV transmission: a potential conflict of public health principles. J Fam Plann Reprod Health Care 2015;41:20-23.
. You should use a condom every time you have sex, even with an IUD or implant, to prevent HIV and other sexually transmitted infections.
Do I need to have my
long-acting contraceptive
checked regularly?
No routine visits are necessary. Schedule a visit with your provider if you have any questions, want to change your method, or would like to have your long-acting contraceptive removed.
How much do long-acting
contraceptives cost?
The cost varies based on insurance coverage. Some insurance providers completely cover the cost of long-acting contraceptives. If the contraceptive is not covered by your insurancePatients may be able to find help with coverage via the following resources:
                           
CoverHer
                           
Local resources may also provide reduced cost contraceptives or sliding-scale plans. Some clincs may allow payment plans.
, it may cost several hundred dollars.
Do IUDs cause abortion?
No. IUDs work primarily by preventing sperm from fertilizing eggs.The mechanism of action for both copper and levonorgestrel IUDs is prevention of sperm from fertilizing an egg. The copper IUD is a functional spermicide and the levonorgestrel IUD thickens the cervical mucus to block the sperm from entering the os. See:
                           
Ortiz, ME and Croxatto, H. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception, vol. 75, 6, S16-S30.
                           
Nelson AL, Massoudi N. New developments in intrauterine device use: focus on the US. Open Access J Contracept. 2016;7:127-141. Published 2016 Sep 13. doi:10.2147/OAJC.S85755
What happens if I want
to get pregnant?
Your health care provider can remove your long-acting contraceptive at any time. Some people remove their own IUDs.See, for example:
Greene D et al. Interest in and experience with IUD self-removal. Contraception, Volume 90, Issue 1, 54–59.
You can get pregnant right after the IUD or implant is removed.