Long-Acting Reversible Contraception (LARC) (Nursing)

00:00 Speaking of IUDs, let's look at some other long-acting reversible contraception or LARCs.

00:08 So that's what LARC stands for, long-acting reversible contraception and that just means that we can use it for a long time, it's not a condom, it's not a quick thing, but we can take it out and return to fertility pretty quick. So, LARCs include things like the Mirena which is a type of IUD or the Skyla which is another type of IUD, we call it the baby Mirena and a Paragard. So the Paragard is the copper IUD I just showed you, so that can also be used as a reversible contraceptive method, but easy to take it out and return to fertility.

00:40 Implants can also be used as long-term contraception. So, the Implanon or the Nexplanon can be placed inside the arm and that can stay for 3-4 years. So the Mirena contains levonorgestrel which is a type of progestin and this is what the Mirena looks like. So there is a T-shaped frame, the small reservoir in the middle actually contains the progestin so it releases the levonorgestrel a little bit everyday. And then there is a thread at the bottom.

01:11 So the thread allows the provider to pull it out when it's time for it to come out. It's placed inside the uterus as you can see in this picture and it fills the endometrial cavity. So it has to be placed by a provider and it has to be placed correctly or it doesn't work as well as it should. Now, depending on the type of IUD, it can stay in the uterus up to 3-6 years and that's a wonderful long-term method for someone who doesn't want to get pregnant.

01:37 Now because it doesn't contain estrogen, it can be used by someone who is breastfeeding.

01:43 So that's another benefit. So let's look at the failure rate. So the failure rate is about 0.1 to 0.4%. That's really low. Why do you think it's so low? Exactly. Because we take out the user part. Right? The client doesn't have anything to do with how it's placed or remembering to take it everyday or remembering to use it before you have intercourse or leaving it in for 6 hours. None of that is in play. So it's actually going to be much more effective. It also doesn't contain estrogen so for clients who are breastfeeding, this would be a wonderful choice. Now let's look at the copper IUD. So, this device looks a little bit different and this one does not contain a hormone. The brand name is Paragard. This one is good for up to 10 years. Wow, that's a long time. So you can really set and forget this one. Now, this can be used as an emergency contraceptive device just as the oral contraceptives or the plan B might be used so it would work for that. The Mirena can't use that. But we can use the copper IUD. It has the copper ions, so no hormones. So someone who is averse or just can't have hormones can use this device. Now, one of the things I want you to really think about is what would be the cons of having a copper IUD. It lasts for 10 years, that sounds great. Well, let me tell you what they are. Because it does not contain a hormone, we don't get that cycle control, we don't get that reduction in the lining of the uterus so bleeding sometimes is going to be an issue with the copper IUD. This actually might make the bleeding a little more heavy. So, heavier bleeding can actually be problematic for some clients, so this device may or may not work. That would be part of our discussion. Now let's look at the injection. So, often called the Depo shot, is exactly what it is. This injectable only contains progestin. So again, a method for someone who is breastfeeding or someone who cannot have an estrogen-containing method. It's given intramuscularly every 3 months.

03:52 Usually there is a pregnancy test done before and then we give the injection. Now if someone comes religiously every 3 months and we know they're not pregnant, we may be able to avoid the pregnancy test. Typical failure rate is going to be around 4%. So again, still pretty low and again because we don't have user error, this might be a really good method for someone who might forget or someone who doesn't want to be concerned with the day in and day out of remembering to use a contraceptive device. Let's look at the implant now.

04:23 So, the Nexplanon is the one that's on the market. It's a thin rod that's actually inserted right here, about right here underneath the arm. So it's something you can't really see when you're out and about doing your regular activities during the day. It contains progestin only so it's safe to use for breastfeeding. It's also safe for someone who is estrogen averse and it stays active for about 3 years. Now when we think about the failure rate, it's 0.1, pretty good. So better than the copper IUD and about the same as the Mirena or the Skyla.