The three types of long-term contraception work in three related, but different ways.
Implanon® is a single matchstick-sized rod containing progestin that is placed underneath the skin in your upper arm. It must be inserted by your health care provider. Once inserted, a small amount of progestin is slowly and continuously released which stops the release of the egg from the ovary and thickens the cervical mucus making it more difficult for sperm to reach the egg.
Mirena® Progestin-Only Intrauterine System or IUS is a T-shaped device inserted into the uterus by a health care provider. This IUS is similar to an IUD, but also contains a very small dose of a progestin hormone.This female hormone is slowly released over time thinning the lining of the uterus, with minimal levels circulating into the rest of the body. The IUS prevents pregnancy by interfering with the movement of the sperm inside the uterus. Progestin also thickens the cervical mucus, thus further preventing the possibility of pregnancy.
Paragard® Intrauterine Device or IUD is a T-shaped copper-releasing device inserted into the uterus by a health care provider. The IUD works by interfering with the movement of the sperm inside the uterus. Sperm die within the uterus before they can fertilize the egg.
Additional information about all these methods can be found on the Women's Health website
Long-term contraception requires minimal or no ongoing effort to use. Unlike other methods of birth control that require you use it every time you have sex, or remember to take a pill every day, long-term contraception is "forgettable". Once long-term contraception is inserted it requires little or none of your time and attention.
Second, long-term contraceptives are highly effective at preventing pregnancy. All long-term options are over 99% effective with typical use -- meaning that over a course of a year more than 99% of women using the method will not become pregnant. This percentage is higher than other methods, due to the fact that there is no possibility for running out of your method or forgetting to take a pill.
Finally, long-term contraception provides private methods of birth control. No one can tell you're using it. There is no packaging or other evidence of use.
All long-term contraceptives are not hormonal.
Paragard®, also known as the copper IUD, does not contain hormones. This may be a good method for you if you want to avoid hormonal side effects or if you want to keep having a regular monthly period. It is possible that while using the Paragard® your periods may become a few days longer and heavier than usual.
Mirena® Intrauterine System or IUS contains a low dose of progestin (a hormone) which is slowly released over time and affects the lining of the uterus only. The progestin in the IUS also decreases menstrual bleeding and cramping. Implanon® also contains progestin. A small amount of progestin is slowly and continuously released over a 3-year period. Neither the Mirena® nor Implanon® contain estrogen.
The most common side effect when using Implanon® is irregular and unpredictable bleeding. During clinical trials, women reported less heavy but more frequent bleeding and spotting between periods. Additionally, side effects reported by 5% or fewer women using Implanon® include: mood swings, headaches, depression, weight gain, and acne.
The most common side effects with the Mirena® IUS and the Paragard® IUD are menstrual changes. With the Mirena® IUS, you may experience irregular bleeding or spotting during the initial months of use. Eventually your periods may stop completely, but this is a normal effect of the progestin. In contrast, you may experience longer and heavier bleeding, as well as some spotting, with the Paragard® IUD.
This is not a complete list of side effects for long-term contraception. You should talk to a health care provider to learn more about the potential side effects of using long-term contraception.
Pelvic infection immediately after insertion of an IUD or IUS is extremely uncommon. In very rare cases, bacteria enter into the uterus during insertion and an infection then develops. Infection usually comes with the following warning signs: severe pain or cramps, deep pain while having sex, fever or chills, foul smelling fluid from your vagina, or very heavy bleeding from your vagina.
Additionally, some women may develop pelvic inflammatory disease or PID while using an IUD or IUS as a result of being exposed to sexually transmitted bacterial infections, such as Chlamydia or Gonorrhea. The long-term consequences of PID are an increased risk of infertility, ectopic pregnancy (occurring outside the womb), and chronic pelvic pain.
Serious problems with Implanon® are also extremely uncommon. Very rarely, the Implanon® insertion site can become infected early after insertion before the nick on the skin has healed.
Most people cannot see the Implanon® after it has been inserted, but you will be able to feel where Implanon® is by gently pressing on your skin. Once the Paragard® IUD or Mirena® IUS is inserted you will not feel it. You will be able to feel the strings attached to the end of the IUD or IUS when you do a string-check. String-checks are recommended by your health care provider in order to insure that the IUD or IUS is in place.
Using a long-term contraceptive will not interfere with you or your partner's pleasure during sex. If you are using an IUD or IUS, your partner may feel the strings during sex, but this is not common, and it doesn't harm you or your partner. If you think your strings are too long, you can ask your health provider to cut the strings shorter.
Yes, you can use tampons while using long-term contraception. Tampons won't pull out the IUD/IUS, or cause it to move.
No, long-term contraceptives do not provide protection from STIs or HIV. It is recommended that you use a condom consistently and correctly unless both you and your partner have been tested and have no STIs and are only having sex with each other.
More information about using condoms consistently and correctly can be found on the Women's Health website.
If and when you decide to discontinue the use of a long-term contraception, there is no evidence of a delay in your ability to become pregnant. Your ability to become pregnant will quickly return.
An IUD or IUS insertion will only take a couple of minutes. Women generally feel cramping during insertion and sometimes after insertion of the device. Your health care provider may recommend that you take ibuprofen in order to reduce cramping associated with the insertion. After your insertion, you will likely be advised to feel the strings in your vagina, so you will know how to do a monthly check for IUD or IUS placement.
Women's Health is working to make Implanon®, IUDs, and the IUS accessible and affordable for all who decide to use long-term contraception. Thanks to generous private funding, Women's Health may be able to provide you with long-term contraception at low-cost or no-cost. Please contact us by phone at 303-442-5160 to learn more about long-term contraception at a price that all women can afford.
Also, long-term contraception is covered by some health insurance plans. To determine if your policy covers long-term contraception, call the customer service number often listed on the back of your insurance card.
By Colorado law, teens can access reproductive healthcare without parental or guardian consent. While Women's Health does encourage you to discuss your visit to the clinic with a parent, guardian or other trusted adult, parental/guardian consent for using long-term contraception is NOT required.
Women's Health has Teen Clinics in both Boulder and Longmont where free and confidential clinical services are available specifically for teens. More information about our Teen Clinics can be found on the Teen Clinic website.
Long-term contraceptives are made to last a long time (3 years with the Implanon®, 5 years with the Mirena® IUS, and 10 years with the Paragard® IUD), but you can always have it removed sooner if you want.
Removal of long-term contraception is done in the clinic by a trained health provider, and only takes a few minutes. Women should never try to remove long-term contraception themselves.
Removal of Implanon® is a minor surgical procedure performed in the clinic. A health provider will make a small incision in your arm and remove Implanon®. A local anesthetic is used for the procedure. It is possible that you may experience minor bruising, redness, swelling, and/or pain. There is minimal risk that you will get a scar as a result of the removal of Implanon®.
Removal of the Mirena® IUS or the Paragard® IUD is usually simple. Your health care provider will remove the device. Most women report that removal is less uncomfortable than insertion.
Permanent birth control methods are appropriate for women and men who have completed their child-bearing or are absolutely sure that they never want to bear children.
Permanent contraception should be considered by a woman or a man only when she/he is completely certain she/he wants to bear no (further) children. Women’s Health offers permanent sterilization at low or no cost to income-qualified patients. The following methods are available:
- Outpatient laparoscopic tubal ligation
- In-office placement of Essure® through the cervix
- No-scalpel vasectomy(for men)
A complete description of these permanent methods can be found on the Women's Health website.
