Educating Teens About Long-Acting Birth Control

FNP2writer, ASN, BSN, MSN, NP

US News and World Report recently reported a sharp increase in the number of teenagers seeking more reliable forms of birth control due to the overturning of Roe versus Wade by the Supreme Court. As many states change laws banning or severely restricting abortions, teens just do not want to risk an unplanned pregnancy with the use of less reliable birth control methods. Additionally, the US News article also notes teens and young women are concerned about pregnancies from sexual assault or rape because their state may no longer allow abortions in these instances. As health care providers, we know teenagers' bodies are still developing and carry a higher risk with pregnancy. We can provide a valuable role in counseling teens on the most reliable birth control methods available, known as LARCs (long-acting reversible contraceptives).

What are LARCs?

There are two types of LARCs currently available in the United States, intrauterine devices (IUDs) and the single-rod implantable device. These forms of birth control are frequently referred to as “forgettable methods” as there is nothing routinely done by the user to keep them effective. This lack of daily or weekly maintenance of the birth control method is why the LARCs are considered more effective than other methods. Once placed, these methods provide dependable birth control for 3-12 years, depending on the method, with greater than 99% efficacy.

IUDs

IUDs were first introduced in 1909 and have undergone many design changes to the highly effective, safe options in use today. The current devices available are all T-shaped and are either hormonal or non-hormonal. IUDs are placed in the uterus through the lady parts by a trained medical provider, including midwives and nurse practitioners. The hormonal IUDs release levonorgestrel which prevents pregnancy by significantly increasing the amount and thickness of mucous in the cervical canal, making it nearly impossible for sperm to penetrate. The four IUDs available release different amounts of levonorgestrel which affects the duration of use:

Mirena - 20 mcg per day is FDA approved for five years of use
Kyleena - 17.5 mcg per day is approved for five years of use
Liletta - 18.6 mcg per day is approved for four years of use
Skyla - 14 mcg per day is approved for just three years due to its smaller size

The amount of the levonorgestrel hormone released daily with these devices is small, but some women will still experience side effects of the hormone. These include:

Headaches
Nausea
Mood changes
Breast tenderness
Ovarian cysts
Decreased menstrual bleeding

The Paragard is the only non-hormonal IUD. The device is made with copper, and the copper itself is the birth control. It works by decreasing sperm mobility keeping the sperm from reaching eggs. Because it does not contain hormones, women do not experience negative hormonal side effects. However, the Paragard has side effects of its own. Commonly women using the Paragard will experience heavier menstrual bleeding and cramping. This device has FDA approval for ten years of use, but is shown to be effective for up to 12 years of use.

Complications with the IUDs are uncommon. Risks include pelvic infection, expulsion of the device, failure of the method, and perforation of the uterus. None of the IUDs induce abortion.

Implant

The implant is considered the most effective method of birth control as it cannot be forgotten or accidentally removed. Hormonal implants were first developed in 1966 and, like the IUDs, have gone through design modifications. The current devices are Nexplanon and Implanon. They consist of a porous vinyl rod encapsulating etonogestrel. The porous nature of the vinyl rod allows the release of the hormone slowly over three years. The implant prevents pregnancy by suppressing ovulation and possibly some thickening of the cervical mucus. The matchstick-sized device is placed subdermally in the upper inner arm. Like the IUD, the implant must be inserted by a trained medical provider. Unlike the IUD, providers are required to go through training from the manufacturer before inserting or removing these devices. Complications with insertion and removal are very rare. The commonly reported side effects include:

Changes in menstrual bleeding
GI upset
Headache
Breast pain
Vaginitis

LARC methods have few contraindications and are safe to use. With their high efficacy and low risk, the LARC birth control methods are ideal for helping teens and young women prevent unplanned pregnancies. As healthcare providers, we are in a unique position to help educate teens and young women on these highly effective birth control options and can guide teens and young women in making informed decisions regarding their reproductive health. Additional information regarding reproductive health to help guide your counseling is available through the CDC.

References

Teen Interest in Long-Lasting Birth Control Soars After Roe

Long-Acting Reversible Contraception: Implants and Intrauterine Devices