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What You Need to Know: Long Acting Contraception

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When it comes to contraception, you immediately think of the pill. However, while the pill was one of the most empowering medical discoveries of the past century, there are other options. Long Action Reversible Contraception, LARC, encompasses many methods and devices that help control a woman’s fertility, and doctors are increasingly telling their female patients to consider LARC. Not only can LARC turn out to be cheaper than the pill in the long run, but it can be more convienent. Say goodbye to that pesky mid-afternoon phone alarm. MyContraception.ie have launched a new campaign to encourage women to explore their options. Your Perfect Match has a dedicated website full of information for curious souls/wombs.

Meanwhile, we talk to Dr. Sinead Beirne, a GP working in Dublin, about Long Acting Reversible Contraception.

What is LARC?
LARC stands for Long Acting Reversible Contraception. Bit of a mouthful isn’t it?
LARC covers a group of contraceptives that are long acting and therefore don’t need to be taken every day, every week or every month. Instead LARC can last anything from three months up to 10 years. Because you don’t have to remember to take them, they are much more reliable than the short acting forms of contraception. The really great thing about LARC is that although they can potentially last for a long time, once you stop taking them your fertility returns to normal.

When I hear LARC, I think the IUD and the bar. Am I missing out on anything?
Yes, you are missing out! There are four types of LARC; the Intrauterine System (IUS), the Intrauterine Device (IUD), the Injection and the Sub-dermal Implant (also known as the bar).

Why do you think there is such a lack of knowledge about LARC options in Ireland?
We’re very organised about many areas of our life such as career, education and travel but when it comes to contraception, I think we’re still a little shy as a nation. It’s still a bit of a taboo subject. This is especially true in the teenage years and in the 20-29 year age group; the time when an unplanned pregnancy is most likely!
If I was to ask people off the street to name types of contraception, they’d probably say the pill and the condom. While these are the most well-known, they are also the least reliable. This is because they are completely dependent on who’s using them and how meticulous and experienced they are.
Contraception can be a little bit like car insurance in that you stick with what you know rather than shop around for a better more reliable and cheaper deal. Typically the pill is the first form of contraception that someone tries. It can be a bit of a nuisance to have to take the pill every day and I’ve seen women go through periods of extreme anxiety over forgetting to take their pill. Yet women seen to put up with this and not question whether there is something better.
Women often panic when they realise they’ve missed a pill and may seek emergency contraception if they feel that they’re at risk of pregnancy. Because it’s now possible to get the emergency pill in the pharmacy, doctors don’t always get the opportunity to let these women know about the other options. Whereas if they had used LARC they wouldn’t have needed emergency contraception at all.
I think doctors are also responsible for the lack of knowledge about LARC. Sometimes it’s really busy in the surgery and because of time pressures, it’s not always possible to discuss all the options with your patient.

Is this down to a lack of education in Irish secondary schools?
I’m not sure what the extent of contraception education in Irish secondary schools is these days. I think it would be beneficial if doctors visited local secondary schools and discussed contraception with students. Unfortunately these days General Practice is poorly resourced and we’re barely coping with the amount of work in the surgery let alone in schools!
I believe parents have an important role too. They should have open discussions about sex and contraception with their teenagers.

Considering we don’t have a system like the NHS in this country, do you think the initial cost of LARC is off-putting to Irish women?  And do you think there is anything the government could do to encourage women to opt for LARC?
Yes the initial cost of LARC can be a deterrent. But it’s false economy as the pill costs significantly more in the long run. On average the pill costs €10 per month, plus two annual GP visits bringing the cost to €240 per year. In comparison the IUS costs €90 per year, the IUD costs €30 per year and the Implant is about €160 per year. It would make sense for the government to fund LARC as this would undoubtedly reduce the number of unplanned pregnancies. It would also obviously remove cost as a barrier.  The cost of LARC for the government would cost a lot less than the obstetric care of a pregnant women! Health insurance companies should also give their female members benefits on their insurance plans towards covering the cost of LARC

How do the different types of IUDs work?
There are two types of intrauterine device (or IUD): hormonal and non-hormonal.
The hormonal device is called the IUS and the non-hormonal device is called the IUD. The IUS is a small soft plastic device that contains the hormone progestogen which is placed in the womb. A low dose of progestogen is continually released from the system. The IUS prevents pregnancy by thickening cervical mucus at the entrance of the womb (making it difficult for sperm to get through). It also thins the lining of the womb.
The non-hormonal device is called the IUD. This is a small device with copper that is placed in the womb. The copper immobilises sperm, making it difficult for the egg and sperm to fertilise. If the egg is fertilised the IUD prevents it from implanting itself in the womb.

There’s a myth that only women who have had children should get fitted with IUDs. This isn’t the case, is it?
This is a complete myth! You don’t have to have had children to have an IUD fitted. Similarly if you’ve only ever had caesarean sections to have your babies, you can still have an IUD fitted. There’s a relatively new IUS that’s very tiny and it goes in very easily.

And what about the rumours IUDs can be painful when inserted?
Most people will have a small bit of crampy discomfort. Some people don’t even feel any discomfort. A few will have some cramps. I’ve fitted hundreds at this stage and most people have very little discomfort during insertion.

For women and girls experiencing difficult and heavy periods, it is often recommended they try hormonal contraception. Which method of contraception is best to tackle painful menstruation?
I would highly recommend the IUS for this. Initially after insertion the periods can be a bit irregular and sometimes heavier however after three months the periods usually become lighter and sometimes even disappear. Obviously the pill can also be used, but you have to take it every day and because of this it’s not as reliable.

Will LARC affect your fertility?
No. As soon as you remove the IUS, the IUD or the Implant your fertility is back to normal. There is one caveat however and that is the injection. Fertility can take up to a year to return to normal after stopping the injection. So be warned!

What contraception trends are you seeing among your patients?
I’ve noticed my female patients are delaying starting their family now until their 30’s. The average age to have a first child in Ireland is now 31.8 and this statistic reflects what I’m seeing in the surgery. I think awareness of LARC is slowly growly. I find once I talk my patients through all the options, more of them are choosing LARC. And I think they are very wise to do so!

Answers by Dr. Sinead Beirne, a GP working in Dublin and the resident doctor on TV3’s Ireland AM & Newstalk Breakfast. Follow her on Twitter @drsineadbeirne

See yourperfectmatch.mycontraception.ie for more information.

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