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What Is Long-Acting Reversible Contraception?

Long-acting reversible contraception (LARC) is long-lasting and easily reversible birth control.
LARC includes contraceptive implants and intrauterine devices
Long-acting reversible contraception (LARC) consists of birth control
(IUDs), which are more than 99% effective in preventing unin- methods which are easily reversible, safe, and 99% effective.
tended pregnancy. Although LARC devices should not be placed Contraceptive implants are small Intrauterine devices (IUDs) are T-shaped
in currently pregnant individuals, they can be inserted shortly after plastic devices placed under the skin devices inserted into the uterus.
in the upper arm.
giving birth because LARC is safe while breastfeeding. The LARC de- Hormonal IUDs contain levonorgestrel
Release progestin, which and are effective for 3 to 8 years
vice can be removed on request, and pregnancy can occur right af- suppresses ovulation Nonhormonal IUDs contain copper and
Effective for up to 5 years are effective right after insertion
ter LARC device removal. for up to 12 years

Contraceptive Implants IUD in uterus

The contraceptive implant is a plastic matchstick-sized device that
is placed under the skin of the inner upper arm. The implant slowly
releases a hormone (progestin) to suppress ovulation and provides Hormonal
IUD
effective contraception for up to 5 years. The implant is immedi-
ately effective for contraception if inserted within the first 5 days Implant Copper
IUD
of menstruation (a period). If the implant is inserted more than 5 days POTENTIAL SIDE EFFECTS
after the start of a period, additional contraception or abstinence • Unpredictable period-like • Lighter or no bleeding, less cramping
bleeding or no bleeding (hormonal IUD users)
from sexual intercourse is advised for the next 7 days. • Increased bleeding and cramping
Contraceptive implant placement and implant removal are per- during periods (copper IUD users)
formed after injection of a numbing medication in the upper arm; IUDs should not be used in people who are pregnant or who have endometrial
this usually takes less than 5 minutes during an office visit. ! or cervical cancer, a pelvic infection, or an abnormally shaped uterus.
LARC is safe while breastfeeding, can be placed shortly after giving birth,
and is removable. Pregnancy is possible immediately following removal.
Potential Side Effects of Contraceptive Implants
While a contraceptive implant is in place, approximately 30% of
the IUD out of the uterus. For IUD removal, a tool is used to grasp
people experience unpredictable period-like bleeding, and approxi-
the strings and pull out the IUD. Rarely, a minor surgical procedure
mately 20% of people have no periods. Patients with recently di-
in the operating room is needed to remove the IUD.
agnosed breast cancer should not use contraceptive implants.
Potential Side Effects of IUDs
Intrauterine Devices
People using copper IUDs commonly experience increased bleed-
IUDs are T-shaped devices that are inserted into the uterus and have
ing and pain during their periods. Those using hormonal IUDs often
strings that extend through the cervix. There are 2 types of IUDs: hor-
have lighter bleeding or no periods at all, and less menstrual pain.
monal and nonhormonal. Hormonal IUDs contain the hormone le-
IUDs do not cause ectopic pregnancy (a pregnancy abnormally lo-
vonorgestrel, and their duration of effectiveness for contraception
cated outside the uterus). However, people who become pregnant
ranges from 3 to 8 years. The nonhormonal IUD is made of copper and
while they have an IUD in place should notify their clinician right away
can provide effective contraception for up to 12 years. Hormonal IUDs
because they are more likely to have an ectopic pregnancy.
are immediately effective if inserted within the first 7 days of a pe-
IUDs should not be placed in individuals with a pelvic infection,
riod; if placed outside this time frame, additional contraception or ab-
endometrialorcervicalcancer,oranabnormallyshapeduterus.Patients
stinence is advised for 7 days. Copper IUDs are immediately effective
with recently diagnosed breast cancer should not use hormonal IUDs.
after insertion and do not require use of backup contraception.
IUDs are placed and removed during an office visit using a specu-
lum, which is the same device used during an examination for cer- FOR MORE INFORMATION
vical cancer screening. Complications of IUD placement are rare but Centers for Disease Control and Prevention
include injury to the uterus during insertion; atypical location of the www.cdc.gov/reproductivehealth/contraception/index.htm
IUD, which may require removal and replacement; or expulsion of

Authors: Elisabeth L. Stark, MD; Aileen M. Gariepy, MD, MPH, MHS; Source: Averbach S, Hofler L. Long-acting reversible contraception with
Moeun Son, MD, MSCI contraceptive implants and intrauterine devices. JAMA. 2022;327(20): 2013-2014.
Published Online: August 12, 2022. doi:10.1001/jama.2022.14239 doi:10.1001/jama.2022.5448

Author Affiliations: Department of Obstetrics, Gynecology, and Reproductive
Sciences, Yale School of Medicine, New Haven, Connecticut (Stark, Son); Department
of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York (Gariepy).
Conflict of Interest Disclosures: Dr Gariepy reported receipt of personal fees from
UpToDate and being on the board of directors of the Society of Family Planning. No
other disclosures were reported.
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