If the pill's not for you, you may want to consider one of these long-acting reversible contraceptives.

By Kerri-Ann Jennings
July 31, 2018

If you’re not looking to get pregnant anytime soon, there’s a category of birth control you should know about: long-acting reversible contraceptives (LARC). These methods, which include the intrauterine device (IUD) and the contraceptive implant, are not only highly effective (over 99%), they also require minimal effort on your part.

To get a LARC requires a one-time doctor’s appointment every three years or more—and then you don’t have to think about it for several years. In contrast, other methods of birth control require you to take action more frequently, from every day to every few months, which translates into the potential for user error and, therefore, lower effectiveness.

For this reason, the American College of Obstetricians and Gynecologists recommends LARCs as the most reliable form of reversible birth control.

Of course, there’s no one form of birth control that’s right for everyone, and you should talk with your doctor to choose the one that’s right for you. But getting informed about all the options is a good first step. Here’s what you should know about the three types of LARCs that are available today.

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Hormonal IUD

An intrauterine device (IUD) is a small, flexible, T-shaped piece of plastic that’s inserted inside the uterus during a doctor’s visit. It prevents pregnancy by delivering a steady, low dose of progestin, a hormone that causes your cervical mucus to thicken, preventing sperm from making their way through your cervix. The progestin may also stop you from ovulating, meaning you may not release an egg each month while you have the IUD.

Like other forms of hormonal birth control, it’s effective immediately if you get it placed within seven days of the start of your period. Depending on the brand, it’ll last for three to five years before you need to get it removed or replaced.

Having irregular periods and spotting can be common for the first few months after IUD insertion, but these side effects usually taper off over time. Some women completely stop having periods, and some may experience breast tenderness, nausea, and mood changes.

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Copper IUD

As you might guess from the name, the copper IUD is wrapped in copper wire, but otherwise looks the same as the hormonal IUD. It is the longest-lasting form of LARC currently available (it can stay in place and work effectively for 10 to 12 years). It prevents pregnancy by releasing copper into the uterus. The copper prevents sperm from moving normally, so they are unable to reach and fertilize the egg. It doesn’t contain any hormones, so if you don’t want to use a hormonal form of birth control, the copper IUD may be a good choice.

As a bonus, if you have it inserted within five days of having unprotected sex, it can act as emergency contraception—more effective than the morning-after pill.

For the first several months after getting a copper IUD, you may experience heavier periods and cramping. However, this should lessen over time and over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs, like aspirin, ibuprofen, and naproxen) can help reduce discomfort.

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Contraceptive implant

The contraceptive implant is a short plastic rod that’s inserted right under the skin of your upper, inner arm, by your biceps muscle. Like the hormonal IUD, it contains the hormone progestin. The main way it prevents pregnancy is by stopping ovulation, but it also thickens the cervical mucus and thins the lining of the uterus wall, which can also help prevent pregnancy.

You’ll be able feel it under your skin, but you won’t be able to see it–and it can be left in place for three years.

The biggest side effect experienced by women using the implant is changes to their menstrual cycle. Some women experience less frequent, less heavy periods, or their periods may stop altogether. But others experience heavier, more frequent bleeding.