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July 25, 2021
Uncovering Issues in Long-Term Contraception

Barriers to LARC implementation include deficits in healthcare provider (HCP) education and training. Insufficient education on the latest practice guidelines contributes to fewer correctly identified women who are eligible for LARC. Providers who lack training in the insertion and removal of these devices may not suggest LARCs as a first-line method and must refer patients to other HCPs for LARC provision. Referring candidates causes delays in care, access, and the establishment of trust towards providers. Surveys and interviews with women accentuate a lack of information regarding the accessibility of LARCs as well as concerns pertaining to the procedures required and possible side effects.

  1. Do you have patients who reject LARCs because of the procedure?
  2. How important is it to recommend a birth control that fits into a women’s lifestyle?
  3. What alternative birth control options are recommended when a patient rejects a LARC, and why are these recommended?


• Bahamondes, Luis, et al. "Long-acting reversible contraceptive (LARCs) methods." Best Practice & Research Clinical Obstetrics & Gynaecology (2019).
• Baron, Melyssa, Beth Potter, and Sarina Schrager. "A review of long-acting reversible contraception methods and barriers to their use." WMJ 117.4 (2018): 156-159.
• Beshar, Isabel, et al. "Socioeconomic differences persist in use of permanent vs long-acting reversible contraception: An analysis of the National Survey of Family Growth, 2006 to 2010 vs 2015 to 2017." Contraception 103.4 (2021): 246-254.
• Festin, Mario Philip R. "Overview of modern contraception." Best Practice & Research Clinical Obstetrics & Gynaecology (2020).
• Phillips, Jessamyn, and Prabjot Sandhu. "Barriers to implementation of long-acting reversible contraception: A systematic review." Journal of the American Association of Nurse Practitioners 30.4 (2018): 236-243.
• Strasser, Julia, et al. "Bridging the Divide White Paper: Long-Acting Reversible Contraception (LARC) in the United States." (2016).

  • July 25, 2021
    Of course. I order more IUDs than we put in because the patient opts for a non procedure type birth control after thinking about it.
  • July 16, 2021
    As a women's health physician --gynecologist obstetrician I provide contraceptive care/counseling for most women of reproductive age as well as many adolescents who are brought in by their mothers for such recommendations. A LARC method is my first recommendation -- preferably a non hormone containing method such as the CuT380A which is already FDA approved for use in nulligravid women. If women have a history of heavier menses then all the hormone containing devices Mirena/Skyla/Liletta serve well for the medical management as well as hassle-free contraception. If the woman does not desire a 'procedure' to place the LARC then I suggest the non-uterine LARC Nexplanon and most adolescents are well accepting of this. If both these are not acceptable, then I now suggest the vaginal ring Annovera because of the convenience that one prescription is sufficient for 13 cycles -- most women are comfortable enough with their bodies to be able to place the ring correctly, I observe them at the first placement which is done in my office by the woman under my supervision. Fewer and fewer women are selecting oral contraceptives in my practice; selecting the LARC methods over the cocps. I am happier with this trend because LARC methods are proven to be more efficient for pregnancy prevention and also have non-contraceptive benefits such as decreasing menstrual bleeding, which is much liked by women. I place LARCs even for nulligravid women who desire it.
  • July 03, 2021
    I offer IUDs to my patients and the ones who are most accepting are ones who have acquaintances who have also had them placed. I feel that the women who tend to either not consider or, once placed and that desire to retain them, are many younger women who have not had children yet. Trying to inform them before hand about the issues of having an IUD in utero in regards to cramping and/or spotting may increase compliance. Offering the use of either Annovera or Nuvaring with continuous dosing has also been well accepted by most patients and they offer long-term benefits for them without requiring the added risk of uterine perforation, cramping or irregular bleeding associated with IUD placement in an office.
  • June 07, 2021
    Most of my patients do not avoid IUDs due to procedure related concerns unless they have had a personal or friend/family member who had an embedded or perforated IUD in the past. In this population, I do not try to change their minds. Nuvaring (and now Anovera where covered) and the patch are alternatives for those without contraindications to estrogen. I have not had women reject Nexplanon due to fear of placement. My biggest barrier to getting women devices has been the hospital not paying for postplacental IUDs and inpatient Nexplanons for postpartum patients. I also use ocps in those who are interested and advise them to set an alarm on their phone if they cannot remember to take it at the same time as some habitual activity like brushing teeth. I think it is critical to have contraception that fits a woman's lifestyle as half of US pregnancies are unintended. There is not an easy out once pregnant. Adoption, parenting and abortion can all have long term impact on an individual's life.
  • June 07, 2021
    Most of my patients do not avoid IUDs due to procedure related concerns unless they have had a personal or friend/family member who had an embedded or perforated IUD in the past. In this population, I do not try to change their minds. Nuvaring (and now Anovera where covered) and the patch are alternatives for those without contraindications to estrogen. I have not had women reject Nexplanon due to fear of placement. My biggest barrier to getting women devices has been the hospital not paying for postplacental IUDs and inpatient Nexplanons for postpartum patients. I also use ocps in those who are interested and advise them to set an alarm on their phone if they cannot remember to take it at the same time as some habitual activity like brushing teeth. I think it is critical to have contraception that fits a woman's lifestyle as half of US pregnancies are unintended. There is not an easy out once pregnant. Adoption, parenting and abortion can all have long term impact on an individual's life.
  • June 07, 2021
    Most of my patients do not avoid IUDs due to procedure related concerns unless they have had a personal or friend/family member who had an embedded or perforated IUD in the past. In this population, I do not try to change their minds. Nuvaring (and now Anovera where covered) and the patch are alternatives for those without contraindications to estrogen. I have not had women reject Nexplanon due to fear of placement. My biggest barrier to getting women devices has been the hospital not paying for postplacental IUDs and inpatient Nexplanons for postpartum patients. I also use ocps in those who are interested and advise them to set an alarm on their phone if they cannot remember to take it at the same time as some habitual activity like brushing teeth. I think it is critical to have contraception that fits a woman's lifestyle as half of US pregnancies are unintended. There is not an easy out once pregnant. Adoption, parenting and abortion can all have long term impact on an individual's life.
  • June 06, 2021
    I do provide an overview of all contraceptive methods to women who are just starting or looking for a new birth control option. With regard to LARC, patients using injectables or implants have generally not been happy with the side effects and have often requested early discontinuation. For this reason, I am not a strong advocate of these methods. I also have a low acceptance rate for IUDs, which I do favor, because of various concerns, I.e. they don't want to carry a device in their uterus, fear of pain during placement, worries about side effects, etc. I really don't understand how to fit a contraceptive choice into a woman's lifestyle per se, or even what that means. Most women generally want oral contraceptives because that is what they are familiar with and what their friends and family use. For those who cannot manage a daily pill intake, contraceptive rings and the new contraceptive patch are reasonable alternatives.
  • June 06, 2021
    I do provide an overview of all contraceptive methods to women who are just starting or looking for a new birth control option. With regard to LARC, patients using injectables or implants have generally not been happy with the side effects and have often requested early discontinuation. For this reason, I am not a strong advocate of these methods. I also have a low acceptance rate for IUDs, which I do favor, because of various concerns, I.e. they don't want to carry a device in their uterus, fear of pain during placement, worries about side effects, etc. I really don't understand how to fit a contraceptive choice into a woman's lifestyle per se, or even what that means. Most women generally want oral contraceptives because that is what they are familiar with and what their friends and family use. For those who cannot manage a daily pill intake, contraceptive rings and the new contraceptive patch are reasonable alternatives.
  • June 06, 2021
    I do provide an overview of all contraceptive methods to women who are just starting or looking for a new birth control option. With regard to LARC, patients using injectables or implants have generally not been happy with the side effects and have often requested early discontinuation. For this reason, I am not a strong advocate of these methods. I also have a low acceptance rate for IUDs, which I do favor, because of various concerns, I.e. they don't want to carry a device in their uterus, fear of pain during placement, worries about side effects, etc. I really don't understand how to fit a contraceptive choice into a woman's lifestyle per se, or even what that means. Most women generally want oral contraceptives because that is what they are familiar with and what their friends and family use. For those who cannot manage a daily pill intake, contraceptive rings and the new contraceptive patch are reasonable alternatives.
  • June 05, 2021
    I personally have very few women who want a LARC and don’t get for procedure related concerns - especially with IUDs I am willing to prescribe an anxiolytic and do a paracervical block for my patients who are concerned about pain. For those who can’t tolerate a pelvic, nexplanon is an option. If a LARC is not right for a woman or she rejects it, we talk salpingectomy if childbearing complete or short term if not.
  • June 05, 2021
    I personally have very few women who want a LARC and don’t get for procedure related concerns - especially with IUDs I am willing to prescribe an anxiolytic and do a paracervical block for my patients who are concerned about pain. For those who can’t tolerate a pelvic, nexplanon is an option. If a LARC is not right for a woman or she rejects it, we talk salpingectomy if childbearing complete or short term if not.
  • June 05, 2021
    I personally have very few women who want a LARC and don’t get for procedure related concerns - especially with IUDs I am willing to prescribe an anxiolytic and do a paracervical block for my patients who are concerned about pain. For those who can’t tolerate a pelvic, nexplanon is an option. If a LARC is not right for a woman or she rejects it, we talk salpingectomy if childbearing complete or short term if not.