A Parent's Guide to Long-Term Contraception
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With the landmark reversal of Roe v. Wade, many people are seeking plans for birth control if they're not quite ready to bring a child into the world. Amidst reports of Plan B shortages and questionable access to abortions, long-term contraception has once again become a topic of conversation among those of reproductive age. Thankfully, there are a few options to consider if you're finished having kids, don't want any children, or simply wish to put this huge decision on the back burner for a while.
Here, we' break down need-to-know information about four types of long-term contraception: intrauterine devices (IUDs), birth control implants, tubal litigation (female sterilization), and vasectomies (male sterilization). Always talk to your health care provider to determine which long-term contraception option may be right for you.
Intrauterine Device (IUD)
An intrauterine device (IUD) is a small, T-shaped contraption that's inserted into the uterus to prevent pregnancy. There are two kinds of IUDs: copper and hormonal, according to Lisa Czanko, M.D., an internist, female health specialist, and chief medical officer at SimpleHealth.
Copper IUDs (Paragard): Copper IUDs contain no hormones. "They work by interfering with sperm transport and fertilization, as well as possibly preventing implantation," says Dr. Czanko.
Hormonal IUDs (Kyleena, Liletta, Mirena, Skyla): These IUDs also contain a hormone (progestin) that enhances its contraceptive benefits. According to Planned Parenthood, the hormone thickens cervical mucus so sperm can't travel to the egg, and it can also stop ovulation.
Getting an IUD is a one-time procedure that takes about 1-2 minutes; the procedure must be completed by a health care provider. After that, the IUD can usually stay in place for 3-10 years, depending on the type and brand. IUDs can be removed at any time, and people may become pregnant immediately after removal.
IUD Effectiveness
IUDs are among the most effective forms of birth control besides sterilization, with a success rate of over 99%, says Dr. Czanko. After the initial doctor's visit, they require very minimal upkeep.
Pros and Cons of IUDs
Is an IUD right for you? Here are some pros and cons of having an IUD inserted as a form of long-term contraception.
IUD Pros:
IUDs can be implanted at any time, and they're highly effective right away. (Though hormonal IUDs only work immediately if they're inserted during the first seven days of your period, according to Planned Parenthood.)
Hormonal IUDs might help improve heavy or painful periods.
Copper IUDs can be a great option for people who want to avoid hormones.
IUDs have a one-time cost and require no maintenance.
IUD Cons:
The insertion of IUDs can cause pain and may be followed by a few days of cramping.
IUDs don't protect against sexually transmitted infections. If you're sexually active with more than one partner, it's important to also use a barrier contraception, such as a condom.
IUDs can sometimes move out of place, though this occurrence is rare.
Hormonal IUDs can cause side effects, including spotting and irregular periods, but these often subside with time. Some people with copper IUDs will experience more bleeding and cramping on their period.
IUDs are associated with an increased risk of ectopic pregnancy (a pregnancy occurring outside the uterus). But again, any pregnancy with an IUD is rare.
Who Might Consider an IUD?
IUDs are a safe contraceptive option for most people, Dr. Czanko says. "However, people who have severe anatomic abnormalities of the uterus, abnormal uterine bleeding, an active pelvic infection, or a confirmed or suspected pregnancy are usually not good candidates. Additionally, hormonal IUDs are often avoided if a person has had breast cancer." Certain STDs might also affect whether you can get an IUD.
RELATED: Can You Get Pregnant With an IUD?
Birth Control Implant (Nexplanon)
The birth control implant (Nexplanon) is a small matchstick-sized rod that's inserted into the arm directly under the skin. It contains a synthetic hormone (progestin) that can protect from pregnancy for up to three years. The hormone thickens cervical mucus to prevent sperm from reaching your egg, and it also stops ovulation.
Effectiveness of the Birth Control Implant
Birth control implants have similar efficacy rates as IUDs at more than 99%. Pregnancy prevention starts immediately if you get Nexplanon during the first five days of menstruation; otherwise, you should use a back-up birth control method for the first week.
Contraceptive Implant Pros and Cons
Because they're highly effective at preventing pregnancy, hormonal implants can be a great option for long-term contraception. Below, we've listed some pros and cons of this method.
Birth Control Implant Pros:
The contraceptive implant is easy to insert and requires zero maintenance over time.
It's discreet and often not visible under the skin.
It provides excellent long-term protection against pregnancy.
Birth control implants are useful for people who need to avoid estrogen, which is a common component of other combined hormonal birth control options, says Dr. Czanko.
The implant can help with period cramps and heavy periods.
Birth Control Implant Cons:
Side effects can be more extensive than other forms of contraception, including spotting, changes in periods, headaches, nausea, breast pain, or weight gain, says Dr. Czanko. Most side effects go away in a few months.
Some people can experience bruising, pain, or (much less commonly) infections where the implant was placed into the arm.
The implant doesn't protect against STDs, so you may want to use a barrier method (such as a condom) during sex.
Who Might Consider the Birth Control Implant?
Birth control implants are generally well tolerated by most people. If you change your mind about getting pregnant while the implant is in, you'll have to have it removed. Those with breast cancer or liver disease should not get a hormonal contraceptive implant; people with a history of blood clots, heart attack, or stroke may not also be approved by their physician.
Female Sterilization (Tubal Ligation)
Female sterilization is a type of surgical procedure. A health care professional will remove, close, or cut the fallopian tubes, which connect the ovaries to the uterus, says Dr. Czanko. The procedure is commonly referred to as "getting your tubes tied," and it prevents the egg and sperm from meeting.
Tubal Ligation Effectiveness
Having your tubes tied is essentially a permanent form of birth control, and it's more than 99% effective against pregnancy. Therefore, it's not a decision that should be taken lightly, says Dr. Czanko. While a tubal ligation can be reversed in some cases, it's not always possible. Reversal can also be expensive and complex.
Pros and Cons of Tubal Ligation
When considering whether or not to have your tubes tied, you'll want to closely weigh the pros and cons. Here are a few to think about:
Tubal Ligation Pros:
Sterilization is more than 99% effective in preventing pregnancy. In the majority of cases, the procedure is permanent. That said, tubal ligation doesn't work for about 1 out of 200 people, and if a pregnancy occurs, it's more likely to be ectopic.
Tubal ligation may lower your risk for ovarian cancer, according to Mount Sinai.
The permanent birth control option doesn't rely on hormones, which is important for some people.
Tubal Ligation Cons:
It's permanent, and some people regret the decision later.
The procedure can cost thousands of dollars without insurance.
Tubal ligation will not prevent sexually transmitted infections.
Many people have pain and tenderness after getting their tubes tied. Also, it's a surgery that comes with some risks, including a small chance of infection, organ damage, or negative reaction to anesthesia.
Who Might Consider a Tubal Ligation Procedure?
According to Dr. Czanko, tubal ligation is most often chosen by people with conditions that make pregnancy dangerous for them or people who have firmly decided that they don't want more children in the future.
Male Sterilization (Vasectomy)
Male sterilization (vasectomy) is surgical procedure that blocks the supply of sperm to the semen. After a vasectomy, a person's ejaculate will no longer contain sperm, which is necessary to form a pregnancy. This minimally invasive procedure can be done in a doctor's office under local anesthesia, and it doesn't require a stay in the hospital.
Vasectomy Effectiveness
Vasectomies involve closing off the tubes that carry sperm to the penis. According to Dr. Czanko, they're almost 100% effective in preventing pregnancy, but not until a few months after the procedure. Often, there can be a bit of sperm left "downstream" of the procedure, which can result in a pregnancy if unprotected intercourse is resumed too quickly. "It's important to have a follow-up appointment with your physician before engaging in sexual activity to ensure the sperm count has returned to zero," says Dr. Czanko.
Vasectomy Pros and Cons
Considering a vasectomy as your preferred method of long-term contraception? Here are some pros and cons to consider:
Vasectomy Pros:
It's a permanent and extremely effective form of contraception.
A vasectomy is a relatively painless procedure that's quick and simple. Most people will experience mild and short-lived discomfort afterwards.
There's very low risk of complications.
Vasectomy Cons:
If someone changes their mind about the procedure, vasectomy reversals are complicated and very expensive, says Dr. Czanko. There's no guarantee a reversal will work.
Vasectomies come with a very slight risk of infection or injury. About 1-2% of people will develop post-vasectomy pain syndrome (PVPS)—persistant discomfort that's treated with therapies, medications, or surgeries. Other rare complications are also possible, including infection, hematoma, and lumps caused by sperm leakage (sperm granulomas).
A vasectomy does not prevent sexually transmitted infections.
Who Might Consider a Vasectomy?
Because it can be difficult and pricey to reverse a vasectomy, this form of long-term contraception is best for people who have firmly decided that they don't want to have children in the future, says Dr. Czanko.
RELATED: How Does a Vasectomy Work?
