Currently, approximately 49% of pregnancies in the United States are unplanned. In Los Angeles, the emergency contraception (EC) pill is available in pharmacies without a prescription for women age 17 and over. However, the EC is not the best option—a reliable, effective, and reversible contraceptive is far superior.
According to a Practice Bulletin released by the American Congress of Obstetricians and Gynecologists (ACOG), Long-acting reversible contraceptives (LARCs), specifically intrauterine devices (IUDs) and contraceptive implants, are the most effective reversible contraceptives. The Bulletin, entitled “Long-Acting Reversible Contraception: Implants and Intrauterine Devices” is published in the July 2011 issue of the journal Obstetrics & Gynecology and offers information regarding appropriate patient selection and management of clinical issues and complications associated with LARC use.
The three LARC methods available in the U.S. are the copper IUD, the levonorgestrel intrauterine system, and the etonogestrel single-rod contraceptive implant. All must be inserted by a physician. Fertility promptly returns after the device is removed. Via the continued release of a small amount of copper into the uterus, the copper IUD effectively prevents pregnancy for 10 years; the device prevents fertilization or implantation of a fertilized egg to the uterine wall and interferes with sperm motility. Furthermore, when inserted within five days of unprotected intercourse, it can also be used for emergency contraception. Ovulation continues in women using the copper IUD, which may increase menstrual bleeding and cramping. These symptoms may decrease with time; however, heavy menstrual bleeding and cramping are the leading causes of IUD discontinuation.
The hormonal IUD releases progestin into the uterus, which thickens cervical mucus, thins the uterine lining, and may reduce sperm motility. The hormonal IUD is effective for five years. Because the hormonal IUD may make menstrual cycles lighter, it is also approved by the US Food and Drug Administration (FDA) for treatment of heavy menses. The contraceptive implant has a pregnancy rate of 0.05%; thus, it is the most effective method of reversible contraception available. A matchstick-sized rod is inserted under the skin of the upper arm, allowing controlled release of an ovulation-suppressing hormone for up to three years.
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Psst, ladies: Men can tell when you are ovulating