The unforgettable Long Acting Reversible Contraception (LARC) Implant (Nexplanon), and 2 IUDs (progesterone and copper) are currently the world’s best form of birth control. No single form of birth is right for everyone. Large studies, like the St. Louis CHOICE Study (1), have shown that when women are given their choice of all common contraceptives, LARC turns out to be the best.
Many women came into my office saying they were “here for the pill” when in fact what they needed was a full discussion of the risks and benefits of all common methods of contraceptives, so they could make an informed and educated choice for the best method for them. See the BEDSIDER web site for a more detailed discussion of the common modern methods of contraception (2). If you are not in a long term, monogamous sexual relationship, condoms, in addition, should be used to prevent sexually transmitted diseases (STDs), even when using the best contraceptive. LARC and the pill will not prevent STDs.
The implant is like a birth control pill under the skin for 3 or 4 years that you do not have to remember to take. IUDs can be inserted and then “forgotten”. About 10% of women get pregnant on the pill, mainly because they forget to take them, and 40% discontinue the pill during the first year (1). They may not start another method but remain sexually active and have an unplanned pregnancy. The failure rate on LARC was less than 1% (only 0.27%). The pill has a 15 times higher failure rate (4.55). Satisfaction was over 80% with LARC (still using after 1 year) and only 50-60% of other methods are still using them one year later. Most women notice lighter periods and less cramps with the progesterone IUD, the implant, and the pill; which is another benefit that prevents missing work or school.
The long acting shot (every 3 months), depot medroxyprogesterone acetate [DMPA] has a low failure rate (0.22) but also has a high discontinuation rate of 40-50% at one year (1). Two of the main reasons for discontinuation of DMPA are weight gain and irregular bleeding.
References
