Quick review on long term contraceptives.

LARCS (Long Acting Reversible Contraception)

IMPLANON Contraceptive

IMPLANON

- Lasts 3 years
- 99% effective
- May cause irregular or prolonged periods
- Can be hard to remove

COPPER IUD Contraception

COPPER IUD

- Lasts 10 years
- 99% effective
- Does not contain hormones
- Bleeding can be longer, heavier or more painful
- Painful insertion

HORMONAL IUD Contraception

HORMONAL IUD

- Lasts 5 years s
- 99% effective
- Periods are lighter or no periods at all
- Periods are lighter or no periods at all
- Irregular bleeding in first few months
- Painful insertion

WHAT ARE LARCS

LARC stands for Long Acting Reversible Contraceptive. They are methods of birth control that are effective, reversible, easy to use and long acting (thus not user dependent). They include methods that do not require usage more than once per menstrual cycle. Injectables, implants and IUD’s are all forms of LARC’s. Here, we will be discussing implants and IUD’s.

WHAT ARE THE ADVANTAGES OF LARCS

  • Last for several years
  •  Reversible
  • Easy to use
  • Not user dependent

IUD/IUCD/LOOP (INTRAUTERINE DEVICE)

These are small T-shaped plastic devices that are inserted inside the uterus.

There are two types, hormonal (the Mirena and Kyleena are available in South Africa) and non-hormonal (copper T and copper pearls).

We will look at and compare both types:

INSERTION

  1. Insertion of IUD can be painful
  2. It is done at the time of a pelvic exam
  3. Taking a non-steroidal anti-inflammatory pill prior to insertion may help minimize cramps and discomfort
  4. Your doctor will prepare the equipment necessary for insertion
  5. He/she will use a speculum to open the vagina and visualize the cervix
  6. An instrument is then used to stabilize the cervix and straighten the cervical canal
  7. Your doctor then measures the size of your uterus and uses that measurement to insert the IUD
  8. The IUD strings are then cut short
  9. This procedure only takes a few minutes

CAN THE MIRENA BE FELT ONCE ITS INSERTED?

The IUD itself cannot be felt and the strings should not bother the woman.

If the partner feels them during intercourse, the doctor can trim the strings further.

HOW IS THE MIRENA REMOVED?

The IUD is removed during a pelvic exam.

Strings are grasped with an instrument and the IUD is pulled out.

IMPLANT

The implant is a flexible rod about 4cm in length and 2mm in diameter.

The implant available in South Africa is the implanon NXT.

It lasts 3 years

HOW DOES IT WORK?

It releases the hormone progestin into the body

Progestin:

-stops ovulation

-thickens the cervical mucus making it harder for sperm to enter the uterus

-thins the lining of the uterus making it hard for the embryo to implant 

HOW IS IT INSERTED?

The implant is inserted under the skin in the upper arm

This procedure is done in the doctor’s rooms

A small area is numbed with a local anaesthetic

An incision is made in your skin

The implant is then inserted using an applicator

One or two stitches are usually required

SIDE EFFECTS

-unpredictable bleeding

-abdominal cramps

-headaches

-breast pain

-weight gain

-acne

HOW IS THE IMPLANT REMOVED

A small area is numbed with a local anaesthetic

One small incision is made

Implant is removed through the small incision 

About the Author

Dr Lucia Chimanga is a specialist Obstetrician and Gynaecologist who has a private practice at Netcare Rosebank Hospital.After completing her AS levels, Dr Chimanga studied medicine at the University of the Witwatersrand and qualified with her MBBCh degree in 2010. She was awarded the University Merit Scholarships in 2005,2006,2007,2009 for passing the respective years with distinctions.

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