3 Long-acting contraceptive methods: Which one suits you?

By: Wendy Wielenga

With contraception that works for a long time, you don't have to think about your contraception yourself. A healthcare provider places these agents for a longer period of time and then you have years of reliable contraception. There are three long-acting contraceptive methods: a copper IUD, a hormonal IUD and an implantable rod. But what are the similarities and differences between these three methods?

The copper IUD is a long-acting contraceptive method that may last between 5 and 10 years. Copper coils contain no hormones and therefore do not interfere with your cycle and bleeding pattern. Also, a copper IUD does not cause side effects that agents with hormones sometimes do. As crazy as it sounds to carry something with copper in your body, copper is a body-friendly metal. In fact, you get more copper in food than you absorb through the IUD. How does a copper IUD work? A copper IUD releases copper ions, and those copper ions paralyse the sperm cells. Because the sperm cells are no longer swimming, they will never reach the egg waiting in your fallopian tube for fertilisation.

So with a copper IUD, you simply have your ovulation, monthly hormone fluctuations and periods as you would have if you were not using contraception. Blood loss outside your periods is not a side effect of the copper IUD. However, you do see women menstruating 10% more on average. This can be in amount of millilitres, but also in number of days, and sometimes both. In addition, you may experience more cramps during your periods for the first 3 months. Many women report that these two side effects return to normal after 6 months.

The hormonal coil is a long-acting contraceptive method that is allowed to remain in place for between five and eight years. Almost all hormonal contraception has the main effect of preventing ovulation by means of the hormone progestogen. So does the hormonal coil. The hormone progestogen does three things: it inhibits the maturation of eggs, inhibits the production of endometrium and makes the mucus in the cervix thicker and more rigid. Of all hormonal contraceptives, the hormone IUD is the only one that releases hormones locally. As a result, the IUD releases fewer hormones than other methods and still provides high protection against pregnancy.

With a hormone IUD, you 75% have a chance of still just ovulating and having some kind of cycle with maybe even the waves you know from your natural cycle. Despite the low levels and localised release, the hormones from the IUD do reach your brain. You may therefore experience side effects from this. The hormone progestogen can cause side effects such as headaches, acne, sensitive breasts or mood swings. Unfortunately, whether you feel these side effects less than with a pill or other method with fewer hormones varies from person to person. With a hormone IUD, you 16% have a chance of no more bleeding, but most users bleed less over time than before. Bleeding can be neatly monthly, or it can be irregular or intermittent. Sometimes your uterus has to get used to this localised release of hormones, so the first six months of the IUD, the bleeding pattern may not be as you hope.

An IUD is inserted into your uterus using a duck's mouth in the vagina, through a thin tube. During insertion, a small clip is placed on your cervix to properly stretch your uterus, so that the IUD will lie properly in the space of the uterus. You can see a midwife, GP, or the gynaecologist for the placement. If you choose an IUD after giving birth, wait until at least six weeks after giving birth before placing an IUD, especially if you are breastfeeding. This will give your uterus a chance to recover properly.

The implantable rod is a long-acting contraceptive method that may remain in place for between 2 and 3 years. Of all contraceptive methods, it is the most reliable contraceptive method. A healthcare provider places the implantable rod in the upper arm, just under the skin. This is done with a local anaesthetic. After insertion, the rod releases a small amount of the hormone progestogen daily. The rod mainly prevents your ovulation. It also changes the mucus in the cervix and reduces the production of endometrium.

Because the implantation rod reduces the production of the endometrium, many women have a different bleeding pattern than without the rod. About 22% no longer have any bleeding at all. Also 20% have irregular bleeding, or occasional drops in between. Women who suffer from painful periods say they have less pain with the rod. Sometimes your body and uterus need some time to get used to the hormone levels. Therefore, the first few months may give a different bleeding pattern than later. Therefore, other side effects may also go away or diminish after 3 months.

The three long-acting contraceptive methods have a few important similarities. First: all methods are very reliable (> 99%). In addition, all three have the advantage that you do not have to think about it on a daily basis. So you can't forget the remedy or use it incorrectly. Also, you can use all these options for longer periods of time, some even longer than others.

Differences also exist. Those involving hormones (hormone IUD, implantable rod) are prone to side effects. Consider, for example, the amount and timing of blood loss. A copper IUD doesn't change your cycle, but blood loss during your period may be slightly more. Another difference is that IUDs are placed in your uterus through your vagina, an implantable rod with local anaesthetic in your upper arm. Have you given birth? Then it's good to know that a rod can be placed quite soon after you give birth, an IUD is better to wait a bit longer.

In short: the three long-acting methods have similarities, but also some important differences. That's good, because everyone has different needs, and then it's nice to have a choice! Do you still have questions about which method suits you best? Then ask your midwife, GP or obstetrician. Or take a look at spiraalplaatsen.nl for a healthcare provider near you.