Wednesday, July 31, 2013

What in the world is LARC?

Imagine you need new tires for your car. You go to your local tire store, and the guy behind the counter offers you decent tires that will last exactly a month (you are welcome to return next month to get new ones) versus perfectly equivalent tires that will last five years. Same cost for either offer. Which would you choose? Now let’s say the offer was the same cost but the five-year tires are way safer and definitely of higher quality. Does that change your decision?


What if you were offered a 28-day filling for your cavity?
A four-week pair of eyeglasses?
A monthly bra? (imagine that, monthly Victoria Secret fittings...)

Would you really want to go back every month to pick up a new something only to go back again the next month for the same thing?  Well, this is what plenty of women of childbearing age do every month for their birth control--whether it’s pills or a patch or a ring (ehem, is this you?)

Why do we make us do this?  (And, when I say ‘we’, I mean ‘we healthcare providers’ and when I say ‘us’, I mean reproductive-age women).  Deep breath here, because if I am not careful, I will launch into a prolific diatribe about gendered power and the reign of masculine decision-making and will hold my own self back from raging about  how so many health insurers only permit women to pick up one birth control pill pack (i.e. one month) at a time and how if men could get pregnant, contraception would be so over the counter. . .and you might be stuck here for awhile.

Instead, I will keep it simple.  The number one hands-down most important question a woman of childbearing age who is actually having any amount of sex should ask herself when considering contraception is this:

When do I want to have a baby? If the answer is anywhere near any of the following:
"maybe five or ten years from now"
"never"
"not in the foreseeable future"
“I just had a baby last month, are you serious, doctor?”
"at least a year from now"
"when pigs fly"
"baby?! I don’t want a baby, but yes, I'm having sex!”
"hmm, definitely not this year, but maybe when I finish school”
"once I get married, though not sure when that’ll happen because I haven’t had a date in months”
“I’m only 16, why are you asking me?”

Then my question to you is“What are you doing messing around with birth control pills, girl?’
Followed by the less sexy question, Why aren't you using Long Acting Reversible Contraception (aka LARC)?

LARC in doctor-speak usually refers to two or three types of long acting contraception that don’t depend on your humanness to ensure effectiveness. These are 1) Intrauterine devices (IUDs), 2) implants (Implanon and/or Nexplanon), and 3) some people include injections in this category.  These are all varieties of contraception that your healthcare provider (your family doctor, gynecologist, midwife or nurse practitioner) inserts/injects in you and then you don’t have to think about for at least 3 months. . .but even better, 3 or 5 or even 10 years. Yes, three or five or TEN years.

At last count, only 8.5% of US women were using LARC for contraception.  From my perspective, I see two reasons women don’t opt for LARC:
1)  Women don’t know enough about LARC. (If you’re interested, you can find a pretty good, though at times a bit slow, short video from England here)
2) For some reason, women are more scared of LARC than they are of unintended pregnancy.

Seriously, ladies, let's educate ourselves, be realistic about our risks, and make the best decisions for ourselves possible. Carrying and delivering a baby are two of the riskiest things we will do with our beautiful bodies. Getting an IUD or an implant don't even compare.

In the US, there are currently two great IUD options: the Mirena ( LNg20, licensed for 5 years) and the Paragard (TCu380A or "Copper T", licensed for 10 years). Many people (including providers) still believe that you have to be a certain age or have had a certain number of children or even be in a uniquely monogamous relationship to use LARC, and this just isn’t true anymore.

Imagine a world where you don’t have to think about contraception for years at at time? That world is the here and now.


So, I’ll ask you again: “What are you doing messing around with birth control pills, girl?’

Get off the line with your pharmacy to request a refill and call your healthcare provider, tell him/her you want a LARC. Go to http://www.reproductiveaccess.org  for some more excellent information including risks/benefits,  costs. Also here is the website for a really cool study showing how dramatically LARC prevents unintended pregnancy, http://www.choiceproject.wustl.edu. More interesting data on contracepting here: http://www.cdc.gov/nchs/data/series/sr_23/sr23_029.pdf.

Oh, and stay off the internet looking for horror stories. Yes, LARC methods are not perfect (nothing is), but they are definitely less painful, less risky, and less drama  than childbirth!


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Other great reference
http://www.guttmacher.org/pubs/journals/j.fertnstert.2012.06.027.pdf

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