Contraceptive Chronicles: Accessible and Affordable Care Means Contraceptives that Fit Everyone’s Needs

The Contraceptive Chronicles series explores current contraceptive options, how they work and their benefits. In this issue, Dr. Kelly Culwell, Senior Vice President and Chief Medical Officer at Afaxys, weighs in on Long-Acting Reversible Contraception (LARCs).

Choosing a contraceptive is about as personal as it gets and recently an American College of Obstetricians and Gynecologists (ACOG) committee released new guidelines on how providers can counsel patients on methods of contraception that best fit their needs. This recommendation aims to limit potential bias so a patient can make informed decisions.

“There is no ‘one-size-fits-all’ when it comes to contraception,” says Dr. Kelly Culwell. “That’s why Afaxys focuses on providing a full suite of affordable and accessible contraceptive options to community and public health centers across the United States.”

Since the introduction of the first contraceptive pill in the 1960s, more novel devices and contraceptives have come to market. Along with pills and condoms, we now have innovative choices such as the ring, vaginal gels, the patch, implants, injectables and long-acting reversible contraception (LARC).

Over the last decade LARCs have become more popular according to the Centers for Disease Control and Prevention, and usage has remained highest among women aged 25-34. LARCs are highly effective (99 percent)[1] in preventing unintended pregnancies, and convenient and reversible, so patients can stop using them if they want to become pregnant. LARCs come in two methods: the intrauterine device (IUD) and the birth control implant. Both methods require placement and removal by a healthcare provider.

The IUD is a small “T-shaped” device, about the size of a quarter, that is inserted into the uterus to prevent sperm from fertilizing an egg. IUDs can be hormonal or hormone free and, depending on the product, they can protect against pregnancy for up to 10 years. The hormonal type of IUD thickens the cervical mucus, making it more difficult for sperm to make its way into the uterus and tubes to fertilize an egg, it can also thin the uterine lining leading to lighter periods or no periods at all. The hormone free IUD has copper wire coiled around the device that produces an inflammatory reaction that is toxic to sperm, preventing pregnancy.

The birth control implant is a small, thin rod, about the size of a matchstick, that is placed under the skin of the upper arm. The rod releases the hormone progestin that helps suppress ovulation and thickens cervical mucus preventing sperm from entering the uterus. The implant prevents pregnancy for up to three years. After three years, it must be removed and replaced at the three-year point to continue offering protection against unintended pregnancy.

“The ‘set it and forget it’ convenience of LARCs appeals to women of all ages,” notes Dr. Culwell. “LARCs are among the most effective forms of contraception, but women need to have them inserted and removed by a healthcare practitioner and be aware of any potential side effects or costs. It comes down to personal choice and that’s where a patient-centered approach is so important.”

While LARCs offer long-term pregnancy prevention, they do not protect against sexually transmitted infections (STIs). Condoms, when used properly, remain the only contraception that prevent pregnancy and help protect both partners from STIs.[2] Dual protection, or condoms plus a LARC or another form of birth control, is recommended by the Centers for Disease Control and Prevention.[3]

Considering which options to use depends entirely on one’s lifestyle and needs. Here are some questions to ask a doctor to see if a LARC may be the best option for you:

• How effective is it in preventing pregnancy?
• What are the side effects?
• Should I still use condoms to protect against STIs?
• How does it work (hormones vs. non-hormonal)?
• Will it hurt to have the LARC inserted and removed?
• How soon does it start working once in place and how long will it work?
• What are the risks if I get pregnant while using it?
• How is it removed and how quickly can I get pregnant if I decide to have it removed?
• How expensive is it and will insurance cover it?

To learn more about your contraceptive options, check out our full blog series or visit bedsider.org.

 

[1] Hatcher RA, Trussell J, Nelson AL, Cates WJ, Kowal D, Policar MS. Contraceptive technology. 20th rev. ed. New York (NY): Ardent Media ; 2011.

[2] Department of Health and Human Services, Office on Women’s Health. (2012). Birth control methods fact sheet. Retrieved February 23, 2016, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html (PDF 136 KB)

[3] Centers for Disease Control and Prevention, Division of Reproductive Health. It’s your future. You can protect it. Available at: https://www.cdc.gov/teenpregnancy/pdf/teen-condom-fact_sheet-english-march-2016.pdf. Accessed: Feb. 24, 2022.