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Long-acting reversible contraceptives, also known as LARCs, are contraception methods that are over 99% effective at preventing pregnancy. LARCs include hormonal and copper intrauterine devices (often called IUDs) and the contraceptive implant.

These methods are reversible and can be inserted and removed by a trained doctor or nurse. After removal, fertility usually returns quickly to what is normal for each person. LARCs are widely used because they are convenient and don’t rely on remembering to take a daily pill.

Although LARCs are the most effective reversible contraceptives for preventing pregnancy, they do not protect against sexually transmitted infections (STIs). To reduce the risk of STIs, it is recommended to also use condoms.

IUDs are small, T-shaped devices placed inside the uterus. There are two types of IUDs: hormonal IUDs and copper IUDs. They can be inserted at any time, except when there may be a chance of pregnancy.

Hormonal IUDs last for either 5 or 8 years. Copper IUDs last for either 5 or 10 years. Hormonal IUDs release a hormone called progestogen, which prevents pregnancy by thinning the lining of the uterus and thickening the mucus at the cervix.

Copper IUDs do not release hormones. They prevent pregnancy by stopping sperm from reaching the egg. Copper IUDs can also be inserted up to five days after a pregnancy risk as a form of emergency contraception.

Copper IUDs start working immediately, while hormonal IUDs start working after seven days. IUDs are a popular choice because they are highly effective, usually easy to insert and remove, and there is no need to remember daily medication or repeat prescriptions.

Hormonal IUDs often make bleeding lighter. In the first three to five months, it is common to have frequent light bleeding. After this time, many people have very light periods or no periods at all, which is safe. Copper IUDs do not change the timing of periods, but some people may experience heavier bleeding. People with painful periods often notice less pain with hormonal IUDs.

IUDs are inserted through the vagina and placed into the uterus. Before insertion, the doctor or nurse will check the uterus by feeling the lower abdomen and inside the vagina. A speculum is inserted into the vagina to view the cervix, which can feel uncomfortable or stretchy. A local anaesthetic spray can be used on the cervix to reduce discomfort.

The uterus is measured, and then the IUD is inserted. Pain during insertion varies greatly between individuals, with average discomfort often rated between 4 and 6 out of 10. It is usually recommended to eat, drink, and take pain relief before the procedure.

Cramping is common for a few minutes, and sometimes for a few hours or days after insertion. Pain medication, rest, and heat packs can help increase comfort. People should follow the instructions provided and contact the clinic if they have any concerns. In some clinics, IUDs can also be inserted under general anaesthetic.

IUDs can be removed at any time. It is recommended to use condoms for seven days before having an IUD removed to reduce the risk of unplanned pregnancy. To remove the IUD, the doctor or nurse inserts a speculum and gently pulls the strings. Removal is usually quicker and less uncomfortable than insertion.

A new IUD can be inserted at the same time as removal, or another form of contraception can be started straight away.

Like any medical procedure, using an IUD involves some risks and possible side effects. These are uncommon, but it is important to be informed. With hormonal IUDs, some people may experience acne, mood changes, or breast or chest tenderness, which usually settle within a few months.

Copper IUDs do not contain hormones, so they do not cause hormonal side effects. In some cases, an IUD may come out unexpectedly, most commonly within the first three months. For this reason, it is recommended to check for the strings about once a month.

There is a very small risk during insertion that the IUD could go through the wall of the uterus. If this happens, the IUD will not work to prevent pregnancy and must be removed with keyhole surgery. There is also a small risk of infection in the first three weeks after insertion.

IUDs are very effective at preventing pregnancy, but if a pregnancy does occur while an IUD is in place, there is a higher risk of ectopic pregnancy. An ectopic pregnancy occurs outside the uterus.

A person should see a doctor or nurse if they cannot feel the IUD strings, experience ongoing pain or side effects, or think they may be pregnant.

IUDs are safe, effective, reversible, convenient, widely used, and suitable for most people.