Contraception: long-term options for women

Long-lasting forms of contraception include intrauterine devices (IUDs), contraceptive implants and contraceptive injections. These types of contraception offer from 3 months to 10 years of protection against pregnancy. They are also reversible - meaning that they can be stopped or removed at any time and do not have a long-lasting impact on your ability to get pregnant.

Because you don’t need to think about this type of contraception day to day, it is very effective at preventing pregnancy. In fact, these options are among the most reliable types of contraception available in Australia.

Women who try long-term reversible contraception tend to continue using it because it is convenient, cost-effective and very reliable.

Women using long-term contraception should always use condoms if there is a risk of getting a sexually transmitted infection (STI).

Which long-term contraceptive is best for me?

Long-term reversible contraceptives are only available on prescription in Australia, so you’ll need to visit your doctor or Family Planning Clinic, where you can discuss the pros and cons of the different options.

Choosing the best option for you will depend on:

  • your personal preferences;
  • whether you plan to have a pregnancy in the near future; and
  • whether any options would not be suitable for you due to other health conditions.

Among the long-term contraceptive options, all release progestogen (a synthetic hormone) into the body except the copper IUD. Hormonal contraceptives may not be suitable for some women, including those who have had breast cancer in the last 5 years. The risks of progestogen-containing contraception may also outweigh the benefits in women with certain conditions (including liver disease, heart disease, stroke, blood clots and unexplained vaginal bleeding).

It should be noted that hormone injections are less effective than other long-term forms of contraception. That’s because they are user-dependent, meaning that women need to remember to have repeat injections every 12 weeks.

Hormone injections are also not recommended for women who may want to try to get pregnant within a year or so, because it can take several months for your fertility to return to normal after having hormone injections.

The different long-term contraceptives

The following types of long-term reversible contraception are available in Australia.

Contraceptive implant

The contraceptive implant - brand name Implanon NXT - provides 3 years of contraceptive protection. The implant, which is similar in shape and size to a matchstick, is placed under the skin of your upper arm and slowly releases the progestogen etonogestrel (a synthetic hormone) into your bloodstream.

Hormone implants are more than 99 per cent effective in preventing pregnancy.

How the contraceptive implant works

The progestogen in the hormone implant mimics the natural female sex hormone progesterone. It prevents ovulation (the release of an egg from an ovary) each month, meaning no egg is available for fertilisation, so pregnancy is avoided.

Implanon NXT also thickens cervical mucus (mucus made in the cervix - the lower part of the uterus), which makes it difficult for sperm to enter the uterus.

Precautions and side effects of Implanon NXT

Prolonged, irregular or absent periods, acne, weight gain, headache and breast tenderness are among the side effects that have been reported in some women using Implanon NXT.

Removing the hormone implant

Hormone implants can be removed at any time, and fertility returns soon after removal.

If you wish to continue using Implanon NXT, the implant needs to be replaced every 3 years. A new implant can be inserted at the time of removal of the previous one.

Hormone-releasing intrauterine device (IUD)

The hormone-releasing IUD (brand name Mirena) provides continuous contraceptive protection for 5 years. Mirena is a small, T-shaped device that is placed inside the uterus (womb) where it releases a progestogen (synthetic hormone) called levonorgestrel.

Mirena is more than 99 per cent effective in preventing pregnancy.

How Mirena works

The progestogen in Mirena (levonorgestrel) thickens the mucus made in the cervix, preventing sperm from entering the uterus. It also inhibits movement of sperm within the female reproductive tract, and acts directly on the lining of the uterus to make it thin and unsuitable for pregnancy.

In some women, Mirena also stops ovulation (the release of an egg from an ovary).

Mirena precautions and side effects

The most common side effect of Mirena is a change in the pattern of your periods. This can include irregular bleeding and spotting, especially in the first 3 to 5 months of use. The longer that Mirena is in place, the more likely that periods will become lighter or, for many women, absent altogether.

Acne, breast tenderness, mood changes and headaches are also possible side effects.

It is possible for the device to be expelled (come out of the vagina) without you realising. Mirena has 2 small strings attached that pass out through the cervix — feeling the strings high up in the vagina lets you know that the device is still in place.

Rarely, IUDs can perforate - break through the wall - of the uterus. They can also increase your risk of pelvic infections for a few weeks after insertion.

Removal of Mirena

Hormone-releasing IUDs are effective for up to 5 years, but can be removed at any time. Fertility returns straight away after removal.

Copper intrauterine device

A copper IUD is a small plastic device with a stem wound with fine copper wire. The IUD is inserted into the uterus (womb) and provides 5 to 10 years of contraceptive protection, depending on the brand used.

The copper IUD is more than 99 per cent effective in preventing pregnancy.

How copper IUDs work

Copper IUDs prevent pregnancy by making the conditions inside the uterus unsuitable for the movement of sperm and eggs, and for the implantation of a fertilised egg.

Precautions and side effects

Periods can be heavier, longer and more painful than previously when a copper IUD is in place.

It is possible for IUDs to be expelled (come out of the vagina) without you realising. Copper IUDs have 2 small strings attached that pass out through the cervix and can be felt with the fingers high in the vagina. Checking for the strings each month reassures you that the IUD is still in place.

Rarely, IUDs can perforate - break through the wall - of the uterus. They can also increase your risk of pelvic infections for a few weeks after insertion.

Removal of copper IUDs

Copper IUDs can be removed at any time and fertility returns immediately once removed.

If you want ongoing contraception, copper IUDs need to be replaced every 5 to 10 years (depending on the brand used).

Hormonal contraceptive injection

Hormonal contraceptive injections of depot medroxyprogesterone acetate (DMPA) provide reliable contraception for 3 months.The injections are available in Australia under the brand names Depo-Provera and Depo-Ralovera. The injections can be repeated every 12 weeks, for as long as needed.

The failure rate in the first year of typical use of hormonal contraceptive injections is around 6 per cent (6 pregnancies for every 100 users). These failures are usually due to running late with repeat injections. So, it’s very important that you always remember to have your next injection on time. If you forget to have your injection on time there is a significant risk of getting pregnant unless you use a backup form of contraception.

How DMPA works

Depot medroxyprogesterone acetate is a progestogen (synthetic hormone) that mimics the action of the natural hormone progesterone. DMPA works by stopping the release of an egg from the ovary (ovulation) each month.

DMPA also thickens the cervical mucus, making it difficult for sperm to penetrate and enter the uterus (womb), and makes the lining of the uterus unfavourable for a pregnancy.

Precautions and side effects of DMPA

DMPA can result in altered vaginal bleeding, such as unpredictable spotting, irregular periods or no periods. Other possible side effects of DMPA include weight gain, acne and mood changes. Long-term use may be associated with a possible loss of bone density (bone thinning).

Stopping DMPA injections

Following one or more DMPA injections, a return to regular monthly periods and ovulation can be delayed, in some cases by 6 to 12 months. For this reason, Depo-Provera or Depo-Ralovera are not recommended if you want to fall pregnant soon after stopping your contraceptive.

Talk to your doctor if you are considering long-term contraception. There are are many benefits associated with long-term options, which are becoming increasingly popular in Australia.

References

1. Hormonal contraception (published March 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Mar. https://tgldcdp.tg.org.au (accessed Jun 2018).
2. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Long acting reversible contraception (July 2017). https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Long-acting-reversible-contraception-(C-Gyn-34)-Review-July-2017.pdf?ext=.pdf (accessed Jun 2018).
3. Stewart M, Bateson D. Choosing non-oral, long-acting reversible contraception. Aust Prescr 2016;39:153-8. https://www.nps.org.au/australian-prescriber/articles/choosing-non-oral-long-acting-reversible-contraception (accessed Jun 2018).
4. Family Planning Victoria. LARC overview (updated 5 Jun 2016). https://www.fpv.org.au/for-you/contraception/long-acting-reversible-contraception-larc/long-acting-reversible-contraception-larc (accessed Jun 2018).
6. Royal Women’s Hospital. Depo Provera. https://www.thewomens.org.au/health-information/contraception/depo-provera (accessed Jun 2018).
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