IUDs, implants, and shots: What’s the best long-term birth control?

Elinor Milder, M.D.
Hallmark Health Medical Associates

Dr. Elinor Milder

For years, women have had limited options for birth control. The pill works, but you have to remember to take it every day. It’s easy to forget if your schedule is disrupted (which happens way too often).

Condoms can break or simply come off during intercourse. Some people are allergic to the latex in condoms, and, quite frankly, it’s inconvenient to run out to buy them when the “mood” strikes. Getting your tubes tied is effective, but not all women want to have surgery.

So what’s a busy woman to do for contraception? Today, women have several highly effective options for long-term birth control.

The three long-term birth control options that are most popular with my patients are:

• Intrauterine devices
• The Nexplanon implant
• “The shot”

All are much more effective than the pill, which is only 91 percent to 99 percent effective if you never miss a pill. Long-term birth control options can take the worry out of family planning and pregnancy prevention.

Intrauterine device (IUD)

IUDs have become very popular among women of any childbearing age. In the past, we recommended it only to women who had already had children, but IUDs have been proven safe and effective for women who haven’t given birth, too.

IUDs are more than 99 percent effective for pregnancy prevention, and we recommend them often. Most of my patients love their IUDs because they cause lighter periods, and many patients end up having no periods at all after a few months of use. Bonus!

A healthcare provider has to insert your IUD, but it only takes a few minutes. The procedure is a little uncomfortable for some women – kind of like an extended pelvic exam. We use an insertion device to guide the IUD (which is about the size of a sugar packet) through the cervix and place it in the uterus, which means you have to lie still to ensure proper placement. Once it’s been placed, you won’t be able to feel it inside your body.

There are two different types of IUDs: One uses the hormone progestin to stop ovulation and prevent sperm from fertilizing your eggs. The other is made of copper, which deactivates sperm and does not use hormones.

Depending upon which IUD you choose, one device can last three to 10 years. When you’re ready to get pregnant or it’s time for a new one, your healthcare provider can easily take out your IUD in just a few minutes. After your IUD is removed, you can get pregnant right away. Some women find removal to be a little uncomfortable, again similar to an extended pelvic exam.

Nexplanon implant

The Nexplanon implant is a rod the size of a matchstick that we insert into your upper arm. The rod releases the hormone progestin into the bloodstream, which prevents your ovaries from releasing eggs and prevents sperm from reaching the eggs. Nexplanon is more than 99 percent effective at preventing pregnancy.

The rod must be inserted by a healthcare provider. It’s a simple process that doesn’t require stitches, though you may have a little bruising where we insert it. Nexplanon is popular with young women because once it’s inserted, you don’t have to check or fiddle with it. You may have irregular periods or spotting at first, but many women stop having a monthly period after a year of use.

The Nexplanon implant can stay in your arm for three years. If you decide you want to get pregnant or if you want to remove it early, your doctor can remove it as easily as it was inserted with just a small incision. You can get pregnant right away once your implant is removed.

Depo-Provera (“The Shot”)

The Depo-Provera shot is exactly what it sounds like. Your healthcare provider gives you a shot in the arm every 12 weeks. The hormones in the shot prevent pregnancy by stopping ovulation and thickening your cervical mucous so sperm can’t get through.

Of the three, this one is the least popular among my patients. While most women stop having periods while on the shot, some notice weight gain, depression, and changes in their sex drive. It’s important to come back for your next shot on time to reduce the risk of pregnancy. Also, it can take up to six months after your last shot to get pregnant if you decide you want to do that.

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It is very unlikely to get pregnant while using a Nexplanon implant, an IUD, or the shot. If you do, there is a higher risk of ectopic (tubal) pregnancy. Instead of a fertilized egg implanting in the uterus, it implants in the fallopian tube. This can be a medical emergency, but as mentioned, the chance of this happening is extremely rare.

If you’re interested in short-term options, you may want to consider other forms of contraception such as NuvaRing (which is replaced monthly) or “The Patch” (which is replaced each week). Ask your doctor for details.

It’s important to remember that none of these forms of birth control protect you from sexually transmitted infections. We recommend at least one screening for HIV during your lifetime. Patients 25 and younger also should be tested regularly for chlamydia and gonorrhea.

Curious if long-term birth control is right for you? We’re happy to talk you through these options and more.

Whether you’re worried about getting an implant, nervous about having a device inserted, or anxious about gaining weight because of your birth control, schedule an appointment and we’ll help you weigh your options and select the best method for you.