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Why should teens consider long-acting reversible contraceptive (LARC) methods?

The American College of Obstetrics and Gynecology, the Society for Adolescent Health and Medicine, and other international organizations now recommend that LARC methods be offered as “first line” contraceptive options for adolescents. Find out more LARC methods here.

    by Rima Himelstein, M.D.
    Published 

My female teenage patient:  "Yes, I have sex. No, I don't want a pregnancy!"

Me:  "You're 17 years old.  If you were to have a baby someday, how old would you like to be when this happens?"

My patient:  "After I'm done school and I'm financially stable ... maybe when I'm 25."

Me: (Good answer!) "Then we need to help you not get pregnant for at least eight years."

  1. 3 in 10 become pregnant before the age of 20

  2. 2,800 get pregnant each day

For girls like these, and for others who know that they don't want a pregnancy for years, LARC methods are safe and effective options. According to a recent three-year study of 7,500 sexually active females aged 14 to 45, a LARC method was 20 times better at preventing unintended pregnancies than short-term hormonal methods like the birth control pill, patch or ring. Less than 1 percent of those using a LARC method became pregnant within one year – regardless of age.

Why a LARC? Three reasons: they're safe, reversible and require no attention.

  1. An intrauterine device (IUD) is a small plastic T-shaped device that is inserted into the uterus and prevents pregnancy primarily by preventing sperm from fertilizing an egg. The 'Mirena' and 'Skyla' IUDs release a small amount of the hormone progestin into the uterus; 'Mirena' prevents pregnancy for 5 years and 'Skyla' for 3 years. The copper IUD 'ParaGard' releases a small amount of copper into the uterus, which also works as a spermicide. 'ParaGard' prevents pregnancy for 10 years.

  2. A contraceptive implant ('Implanon' or 'Nexplanon') is a thin plastic rod the size of a "match-stick" that is inserted under the skin of the upper arm and releases a small amount of progestin. An implant also works primarily by preventing sperm from fertilizing an egg and prevents pregnancy for 3 years.

Some teens may find it easier to stick with a LARC method. In one study of over 4,000 females aged 14 to 45, the continuation rate for a LARC method for all ages was 86 percent at 12 months, compared with 55 percent for the pill, patch or ring. A "B" versus an "F"; that's why we're having this blog.

Weighing the pros and cons: a teenager's medical care provider should review all of the pregnancy prevention options and their side-effects.  For example, teens who choose a LARC method can expect changes in their menstrual bleeding; 'Mirena' often causes a decrease in bleeding over time, 'ParaGard' can cause periods to be heavier and the implant can cause irregular bleeding.

My advice:

  1. If you are the parent of a pre-teen or a teenager, it's time to talk about sex. Maybe you can "break the ice" by exploring a website like www.youngwomenshealth.org together.

  2. If you would like them to wait until they're older to have sex, tell them! Believe it or not, teenagers consistently say that parents—not peers, not partners and not popular culture—influence them the most about decisions related to sex.

  3. At the same time, give them with accurate information about all of their options for preventing pregnancy. And remind them that if they decide to have sex, then they should use condoms to prevent sexually transmitted infections.

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