Long-term Acting Reversable Contraception: The Facts

Anne Sexton

Though not YET as well-known as other forms of contraception HERE IN IRELAND, long-acting reversible contraception has much to offer, as the medical director of the Dublin Well Woman Centre explains.

Since 1978, the Well Woman Centre has been helping Irish women make smart contraceptive and reproductive choices. The range of options is now greater than ever – which is why it is increasingly important to take advice from a sex-positive doctor.

“We’re finding that people are increasingly moving to long-acting contraception,” says Dr. Shirley McQuade, medical director at the Well Woman Centre, in Dublin. “It’s a combination of things. I’m getting people in who don’t want to have to remember to take the pill every day — so ease of use is one of the major attractions.

"Quite a few are canny and they do the sums on how much contraception is going to cost," Dr. McQuade adds. "Pills are relatively inexpensive in the short term. But if you look at long-acting contraception that lasts for three or five or even 10 years, it really is more cost effective.”

The upfront cost for LARCs is certainly seen as a disencentive for those on lower incomes. However, this need not be the case. “Medical card holders can have long-acting contraception free," Dr. McQuade says. "The device itself is free, for a start, and then most general practitioners will fit it. That said, there is a bit of an access problem when it comes specifically to the intrauterine device: specialist training is required to fit this, and not every practice will have someone who has received that training.”

Some young women in particular have been discouraged from using LARCs because there is a perception that the the hormonal coil, or intrauterine system (IUS), is, in particular, only suitable for women who’ve had kids. Unmarried and childless women have reported that some doctors simply won’t allow them switch to a hormonal coil.

This is a myth that has long been perpetuated in Ireland, Dr McQuade explains. But this country is not alone in this respect. “I see women from all over Europe," Dr. McQuade avers, "and when I suggest that they are suitable for a coil some of them will say, ‘But in my country they do not fit them in women who have never had children'. Well, there is no medical reason not to. Last year, in the Well Woman Centre, we fitted more intrauterine devices for women who’ve never had children, than we did for women who’ve had children.”

What about women in their thirties who have not had children – but hope to at some point in the future? Are LARCs suitable?

“Yes, they are. The reversibility of long-acting contraception is a key part of its appeal to many people because, while the devices can last from three to 10 years, you can remove them at any point. Once the device is removed, the person is back to normal fertility within one or two monthly cycles at most. In contrast, if you’re on the pill it can take six to 12 months. And the injection can take 12 months as well, so these factors have to be weighed up and every individual has to make her own choice. Many women want something that’s effective, that they don’t have to remember to take, and that’s reversible when they want it to be.”

Irish women are increasingly confident in their sexuality – and as a result, they are also increasingly knowledgeable about the varieties of contraception available to them. But, as with any medical issue, it is important not to allow yourself get carried away by ill-informed speculation on the internet. There are, after all, reliable places that you can look...

“Most of the patients coming in to me will already have done a bit of research," Dr. McQuade reflects. "There are lots of websites that people can look at. What's important is that they look at reputable ones and get accurate information.” For the record, she recommends thinkcontraception.ie and ifpa.ie...

“When they come in to see me, we’re mostly looking at the finer details," she adds. "For example, some women don’t want to have any hormones at all – so they could have a copper coil fitted. The coil is cheap and can last 10 years, so it is a good option for many women. But if a woman has heavyish periods, the copper coil tends to make those periods more pronounced than normal – so the coil might not be appropriate for everybody. On the other hand, they can potentially use coils that have hormones.

"So these are the judgements you are helping people to make. If someone has a particularly heavy period, it would definitely be better to use the five-year coil. If their periods are not particularly heavy, the three-year one would be better.”

Depending on who you ask, having a coil fitted can be painful, making some women wary. “Some women seem to have more discomfort than others,” says Dr McQuade. "The initial pain or discomfort that they might experience is similar, whether they have had children or not. After a coil is fitted, women who’ve never had children tend to have more crampy sensations, which can go on maybe for a couple of weeks. Whereas women who’ve had children don’t tend to have that.”

The best way to ensure that there is as little pain as possible is to seek out a doctor or clinic, where coils are fitted as a regular part of their practice.

“Having a practitioner who is skilled and adept at doing the procedure, operating in a dedicated environment, means that the patient is generally more confident,” Dr McQuade says. "And rightly so. It’s not practical for every practitioner in the country to be able to fit a coil or implants because, as with other medical procedures, you need to a volume of patients coming in to become proficient at doing it.”

Specialist sexual health clinics like the Well Woman Centre have seen the issue of contraception from every angle – and they are entirely non-judgemental in their approach. “We have a set system, where everyone — from reception, to nurses to doctors — knows what to do. The nurses are as well-versed as the doctors as to the pros and cons of a particular approach. Patients can have a conversation with a nurse and then follow-up with a doctor. We are used to helping, without being blasé.”

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