Long-Acting Reversible Contraception (LARC) is a group of highly effective, well tolerated prescription contraceptives. There are 3 distinct groups of LARC. There is an injectable, a subdermal implant, and intrauterine devices. With the exception of the Paragard IUD, which is a copper containing IUD without any hormone, all other LARCs are progesterone only forms of contraception (meaning they do not contain the hormone estrogen).

Depo Provera (150mg medroxyprogesterone acetate) is an IM injection given in the deltoid or gluteal muscle every 3 months (4 times per year). It is the option with the highest dose of progestin and is the most likely to lead to amenorrhea (no menstrual bleeding). There can be a delay in the return of fertility after stopping Depo Provera. It is associated with a possible decrease in bone density especially in the first 2 years of use, although this is typically temporary and reversible. I recommend daily calcium and vitamin D supplements as well as regular weight bearing exercise in women using this LARC as their contraceptive choice.

The Nexplanon (68 mg etonogestrel) is an implant that is a 4 cm rod, about the size of a matchstick that is placed under the skin in the upper arm. It is designed to be easier to place and remove then an IUD and does not have the associated cramping and pain of IUD placement or removal. The Nexplanon can cause an irregular bleeding pattern. Amenorrhea is possible but about 15% of users will experience prolonged bleeding or more frequent bleeding. Nexplanon is to be removed in 3 years.

Intrauterine devices or IUDs makes up the largest category of LARC. The Paragard IUD is the only copper containing IUD. Because of this and its lack of any progesterone (hormone), it is associated with menses that may be longer and heavier. It is to be removed in 10 years. The Skyla IUD (13.5 mg levonorgestrel) has the lowest dose of hormone of any LARC and is a smaller size to better accommodate (be more comfortable) a uterus that has not experienced a full term pregnancy. It is to be removed within 3 years. The Kyleena IUD (19.5mg levonorgestrel) is also a smaller size IUD but is a contraceptive for up to 5 years. Both a Mirena IUD and a Liletta IUD contain 52 mg of levonorgestrel and are full size IUDs. The Mirena IUD has the approval to treat heavy menstrual bleeding for up to 5 years and both of these IUDs are contraceptives for up to 6 years. All IUDs are associated with cramping, bleeding, and discomfort with their placement and removal. All of the progestin IUDs can cause irregular bleeding patterns especially during the first 6 months of use.

LARC contraceptives offer the advantage of protection against pregnancy for a longer period of time without having to remember to take something that is daily, weekly, or monthly. Additional pros and cons of each LARC should be discussed prior to making a decision as to whether any LARC is the right choice for you.

Type:	Name and Link to Website:	FDA Approved for:
Copper IUD	Paragard	10 years
Progestin IUD	Liletta	6 years
	Kyleena	5 years
	Skyla	3 years
	Mirena	6 years (5 years for bleeding)
Arm Implant	Nexplanon	3 years