After declining for nearly 20 years, the number of women using long-acting reversible forms of contraception (LARCs), like the IUD and the hormonal implant, has increased nearly five-fold over the last decade, according to a report released Tuesday from the CDC’s National Center for Health Statistics.
Women ages 25-34 and those who have already had a child use long-term contraception the most, but younger women ages 15-24 are starting to use them at an increasingly growing rate.
LARCs are as effective as sterilization, require minimal care after they’re put in, and have no long-term fertility effects, making them a favorite of gynecologists around the world.
“I seriously didn’t think that would be happening during my professional career,” said Dr. Eve Espey, leader of the American College of Obstetrics and Gynecology (ACOG) LARC working group.
But while the improvements highlighted in the CDC report are impressive, still only about one in 10 women who uses birth control chooses long-acting contraception. If IUDs and implants are so effective, why aren’t more women catching on?
1. They don’t know what they are
According to Espey, a major reason why they aren’t more popular comes down to awareness. Until recently, these contraceptives hadn’t been well marketed — and many women just don’t know what their options are.
Long acting reversible contraception comes in three forms. The first is a non-hormonal, copper intrauterine device (IUD), commercially known as the ParaGard, which sits in the uterus and creates an environment that is toxic for sperm for up to 10 years.
The second, a hormonal IUD commercially known as Mirena or Skyla, releases a small amount of progestin into the uterus, thinning the lining to prevent implantation and thickening cervical mucus to prevent the sperm from getting in. These are FDA approved for three to five years, although new research suggests they may work even longer.
Finally, the hormonal subdermal implant, known as Implanon or Nexplanon, is a matchstick-sized rod that is inserted under the skin in the upper arm and releases progestin into the bloodstream, with an effect similar to the hormonal IUD. These are FDA approved for three years.
2. Their moms tell them IUDs can make them infertile
The fear of infertility is a common held misconception about IUDs, rooted in a controversy from the 1970s over an early IUD, the Dalkon Shield. The Dalkon Shield had a different tail string that appeared to “wick” bacteria up into the uterus, causing pelvic infections that could lead to infertility. After a major class-action lawsuit, it went off the market, and the negative press brought down all other IUDs with it.
But according to Dr. Espey, infertility fears are unfounded. “There’s really this accumulating body of evidence that they’re safe and effective and they don’t cause pelvic infection and they don’t cause ectopic pregnancy.”
Since the 1980s, the design has been improved and repeated studies have found that infertility is no more likely after using an IUD or hormonal implant. In fact, for most women, baseline fertility returns rapidly after removal.
3. They’re afraid of side effects
As with any medical treatment, long-acting contraceptives do have side effects which vary by device, mainly in terms of bleeding patterns. But overall, these side effects are minimal.
The copper IUD can cause heavier bleeding in some women. The hormonal IUD and implant, on the other hand, can cause irregular bleeding patterns at first, but eventually lead to lighter or non-existent periods, which can be a huge benefit for women with a history of heavy bleeding.
Compared to short-acting forms of birth control — like condoms, the pill and the patch — LARCs have lower discontinuation rates, meaning women are less likely to stop using them.
“They have a very high patient satisfaction rate,” says Espey.
4. They hear IUDs can’t be inserted in a woman who hasn’t had a baby
There’s some concern among both women and providers that putting in an IUD, which must be inserted through a woman’s cervix, isn’t recommended for adolescents who haven’t had a baby.
“I was afraid it would hurt,” said Rachel Witt, 25, who used birth control pills for seven years before getting an IUD. “Getting it put in was a little uncomfortable, but I haven’t had any problems since.”
According to The American Congress of Obstetricians and Gynecologists, there’s very little evidence that IUDs are technically more difficult to insert in nulliparous women. In fact, they recommend LARCs as first-line birth control for most women, including teenagers.
5. They worry about cost
Many women have heard that IUDs and implants are expensive, but they are incredibly cost-effective. Unlike the pill and the patch, which require regular monthly co-pays, LARCs cost virtually nothing after the initial insertion. It is true that this upfront cost can be quite hefty — up to $1,000 for the IUD itself and up to $800 for the hormonal implant, not including insertion charges. Fortunately, more and more insurance plans are starting to offer coverage, including plans under the Affordable Care Act.
“Ultimately it’s the woman who should decide what she wants, but there are very few who aren’t good candidates,” says Espey. “If I had a daughter, I’d say ‘you need an IUD.'”