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So you and your partner have chosen not to get pregnant, at least for now. If pregnancy is a possibility for you, and if you’re sexually active with people of the opposite sex, your next decision is just as important: How to prevent it? Which methods of birth control are safe, reliable, convenient, and low-cost?

Birth control intrauterine devices and intrauterine systems (IUDs and IUSs)—two methods of long-acting reversible contraception (LARC)—may be for you. (Many health care providers and sources refer to both methods as IUDs.) These are the most reliable forms of birth control because they’re so low maintenance. No need to take a daily pill, replace a weekly patch, and so on. “Students have erratic schedules, so LARC methods could simplify their life,” says Dr. Christine Palmay, spokesperson for Talk With Your Doc, a national initiative that educates women about LARC.

“This is a set-and-forget method. You put it in place, and it’ll be effective for 3–10 years, depending on the type,” says Dr. Wendy Norman, Assistant Professor at the University of British Columbia.

Many students are unfamiliar with LARC, and may not know how suitable these options are for young women and women who have not had children.

In a recent survey by Student Health 101, 52 percent of respondents expressed a lack of confidence in their knowledge about IUDs and IUSs (21 percent felt they didn’t need to know). On the next page, we put your questions to our panel of student-friendly LARC experts.

Long-acting reversible contraception: Your options

Intrauterine device

Intrauterine contraception (IUD and IUS)

This T-shaped device is about the length of a paperclip. A health care provider inserts it into the uterus. A short string hangs down into the vagina, so the device can be easily removed when it is no longer viable or needed. There are two types of intrauterine contraception:

The hormonal intrauterine system (IUS) releases progestin. This thins the lining of the uterus, making it harder for a fertilized egg to implant. It also thickens the cervical mucus, so sperm have less access to the uterus. It may also prevent the ovary from releasing an egg. The hormonal IUS is effective for 3–5 years. Brand names: Jaydess and Mirena.

The copper intrauterine device (IUD) does not contain hormones. The copper IUD works by inhibiting sperm mobility and egg fertilization, and possibly inhibiting implantation of the egg. The copper IUD is effective for 3–10 years. Brand names: Liberté, FlexiT, Mona Lisa, and NovaT.

Implant

Is the birth control shot (injection) a LARC?

Most sexual health organizations say no. That’s because the shot is effective for just a few months, compared to the years of protection provided by the IUD and IUS. That said, the shot works the same way as the hormonal IUS. It is 99 percent effective at preventing pregnancy, and may work for you if you can reliably commit to an appointment every three months. Brand name: Depo-Provera.

LARC methods do not protect against sexually transmitted infections. For STI protection, you still need to use condoms and/or latex dams.

Question

How reliable is LARC at preventing pregnancy?

Answer

“IUDs and IUSs are extremely effective methods of contraception with far less failure compared to the failure rates for typical users of birth control pills.”
—Dr. Ashley Waddington, practicing OB-GYN; Assistant Professor at Queen’s University, Faculty of Medicine, Ontario

Compare LARC methods to condoms and the Pill

“IUDs are extremely effective methods of contraception, with failure rates around 1–2/1,000 users per year. Compared to the failure rates for typical users of birth control pills (8/100 users will become pregnant per year) or condoms (15/100 users will become pregnant per year), IUDs are a way more effective method of preventing pregnancy.”
—Dr. Ashley Waddington, practicing OB-GYN; Assistant Professor at Queen’s University, Faculty of Medicine, Ontario

“IUDs are far more effective than the birth control pill partially because you’re not reliant on user compliance. It’s easy for people to miss pills; they travel, change time zones, and generally have busy schedules.”
—Dr. Christine Palmay, women’s health expert in Toronto, Ontario; spokesperson for Talk With Your Doc, a national initiative designed to educate women about LARC

Students’ stories
“I would recommend getting an IUD to any [woman] who is sexually active. It is a little uncomfortable at first; my cramps lasted about a month. But now I can focus on school for the next few years without having to remember to take the Pill or worry about the risk of getting pregnant. It’s a life changer!”
—First-year undergraduate, Fleming College, Ontario

“I feel comfortable using [LARC]; I am waiting until I complete my education to start a family.”
—Third-year student, University of Regina, Saskatchewan

Question

What are the side effects of LARC methods?

Answer

“Everybody’s body is different, and you should talk with your [health care provider] about whether LARC is suitable for you. For the majority of women, it’s highly suitable. For the first three months, women may experience some cramping and bleeding with an IUD [or IUS], although with IUSs, this will rapidly lessen so that the period becomes lighter than usual for most women. It’s a matter of your body getting used to it.” (The copper IUD can be more disruptive to the menstrual cycle.)
—Dr. Wendy Norman, practicing physician; Chair, Applied Public Health Research at the Canadian Institutes of Health Research; Assistant Professor at the University of British Columbia

Experts and students talk side effects

Non-hormonal IUDs (which contain copper as their active ingredient) can make some women’s periods heavier and/or more crampy.  Most women find it tolerable, but for women who already have heavy or painful periods, they may not always be the best choice. As they do not have hormones in them, they do not tend to have any other side effects.
   
Hormonal IUSs, which are far more popular, tend to make menstrual periods lighter and less crampy. Some women have such light periods that they do not have to use any menstrual products at all. The amount of hormone that gets absorbed into the body from a hormonal IUS is extremely low. However, occasionally I have had patients notice minor side effects like breast tenderness or acne.

“[For both the IUD and IUS] there is a very slight increased risk of pelvic infection in the first three weeks after insertion, but [after that time] the risk goes down to the same as anyone else.”
—Dr. Ashley Waddington, practicing OB-GYN; Assistant Professor at Queen’s University, Faculty of Medicine, Ontario

Students’ stories

“Getting my IUD was one of the best decisions I have made for myself. I know there are many horror stories around them, and I won’t lie, it sucks having it put in. But not having to worry about taking the Pill every day or remembering to change out my ring makes everything so much easier.”
—Second-year undergraduate, Algonquin College, Ontario

“I am a new user of the IUD and the only complaint I have is that it takes a while for your body to get used to it. Don’t freak out if you’re bleeding/cramping for a week. Friends of mine are so happy with this IUD and it has done away with their periods.”
—Third-year undergraduate, University of New Mexico

“I have a copper IUD and it’s great. I’d heard that copper IUDs could make periods worse, but mine hasn’t. I switched to a copper IUD after hormonal birth control made me depressed and irritable and killed my sex drive. Now I feel like a normal human being again. Best decision ever.”
—Third-year graduate student, University of Victoria, British Columbia

“I’m on [the copper IUD] because I can’t have birth control with hormones. The one annoying thing is that my periods have become more frequent.”
—Fourth-year undergraduate, Carleton University, Ontario

Is it painful to get an IUD or IUS?

Is it painful to get an IUD or IUS?
“A lot of people hear stories about IUD insertion being painful or scary. Everybody’s experience is different, and it’s often not as bad as you think it will be. The cramping and scariness go away, but your birth control stays in place. Most patients that I place the IUD in say, ‘Oh, that wasn’t nearly as bad as I thought!’”
—Dr. Colleen Krajewski, practicing OB-GYN; Assistant Professor at the University of Pittsburgh Magee-Women’s Hospital, Pennsylvania; medical advisor to Bedsider.org

“[There was] minor discomfort with insertion but once it’s in you don’t need to worry. After three months of use, I had no more period or bleeding. It’s not even two years later and I still love it.”
—Third-year undergraduate, University of Manitoba

“The IUD was painful to have inserted, but well worth the pain. Very convenient, nothing to think about when it comes to personal contraception.”
—Fourth-year undergraduate, University of New Brunswick

“Getting my IUD inserted was [painful]. I had cramps that lasted a week. The girl in front of me walked out of the clinic and seemed like nothing happened. So your body really does react differently. Many of my friends absolutely love their IUD, and many girls have them so don’t be afraid to ask around.”
—Third-year undergraduate, Kwantlen Polytechnic University, British Columbia

Question

Will a LARC affect my ability to get pregnant later?

Answer

“They’re immediately reversible. So you have the choice, as soon as you’re ready to be pregnant, to take out the IUD or IUS and have a fast return to fertility.”
—Dr. Wendy Norman

Students: LARCs kept my options open

“An IUD is perfect for me right now since I’m very busy with school. In the future I know I want to have a family, so it’s comforting knowing this doesn’t affect any chances of me getting pregnant when I’m ready to start a family.”
—Fourth-year undergraduate, York University, Ontario

“My doctor recommended the Mirena IUD, and I am so happy I decided to try it. I did experience some mild cramping for the first 24 hours, but after that I didn’t even notice it was there. My favourite part is I know I can control when I want to start a family, which is important being a vet student!”
—Second-year graduate student, Ontario Veterinary College, University of Guelph

Question

What makes IUDs and IUSs so convenient?

Answer

“[They] take out the worry of having to remember to take a pill at the same time every day. There are so many situations that we have no control over that may decrease the effectiveness of other methods of birth control, such as forgetting the Pill at your partner’s house. Whereas with [LARC], you don’t have to remember or do anything to protect against pregnancy after it’s been inserted.” (It is a good idea to feel for the strings to check that it’s in place. There is a small risk of your body expelling an IUD or IUS and leaving you unprotected from pregnancy.)
—Dr. Christine Palmay, women’s health expert in Toronto, Ontario; spokesperson for Talk With Your Doc, a national initiative designed to educate women about LARC

Students: Here’s what makes it easy

“The Mirena [IUS] has been a great experience for me; I don’t have to worry at all about pregnancy. Insertion can be painful, but once it’s in, that’s five years of reliable birth control.”
—First-year undergraduate, Nova Scotia Community College

“The copper IUD is cheap and lasts over five years! No daily or monthly fuss.”
—Fourth-year undergraduate, University of Manitoba

“My ex was [using] the shot. We were both really happy with it. Freedom to enjoy ourselves in a monogamous relationship with peace of mind regarding unplanned pregnancy.”
—Fourth-year undergraduate, Lakehead University, Ontario

“Mirena is bae.“
—Third-year undergraduate, University of New Brunswick

Question

How much do IUDs and IUSs cost?

Answer

“LARCs are very cost-effective, and the costs are likely very similar from one province to another because the wholesale price from the manufacturer would be the same. IUDs cost around $75–$90 (for copper IUDs that last 3, 5, or 10 years) or around $300–$400 (for hormonal IUSs that last either 3 or 5 years).  Compared to the cost of an oral birth control pill (about $60–$90 every three months), LARC is far less expensive in the longer term. Even the most expensive IUS ($400) costs about the same as 1½ years of birth control pills. If used for five years, it will cost about a third as much as pills would for the same length of time.”
—Dr. Ashley Waddington

Check out what LARCs cost

LARC costs
“Many drug plans cover the hormonal IUSs, but very few drug plans pay for copper IUDs. This is because the hormonal ones contain a drug, but the copper ones technically do not. One exception would be Quebec where they have a provincial pharmacare program that pays for many Quebec residents’ prescriptions, so they may be able to obtain LARC for a reduced cost or for free.”
—Dr. Ashley Waddington, practicing OB-GYN; Assistant Professor at Queen’s University, Faculty of Medicine, Ontario

Check with your insurance provider for more information on what’s covered and what’s not.

Students’ stories
“My girlfriend got an IUD, which we found out can go from $100 up to [$400] to buy. It was relatively cheap with campus insurance ($80).”
—Second-year undergraduate, Queen’s University, Ontario

“I have an IUD. The cost was totally covered by my student health plan (included in tuition).”
—Second-year undergraduate, University of Guelph, Ontario

“My IUD was around $400, and I had to pay out of pocket because my insurance didn’t cover it. I was terrible at taking the Pill, and this is not only effortless but also gives me peace of mind.”
—Second-year undergraduate, University of New Brunswick

Question

Are there any LARC methods on the market for men?

Answer

“In Canada, the only contraceptive methods that are male-based are vasectomies, which are long lasting but not reversible, or condoms, which have a much higher pregnancy rate.”
—Dr. Wendy Norman

Students: Why we use condoms too

IUDs and IUSs do not protect you against sexually transmitted infections (STIs). To protect your sexual health, you still need to use safer-sex methods, such as condoms and latex dams.

“It’s important to remember that [neither the pill nor IUDs/IUSs] protect against STIs, so be sure to use a condom.”
—Dr. Christine Palmay, women’s health expert in Toronto, Ontario; spokesperson for Talk With Your Doc, an initiative designed to educate women about LARC

“Condoms are [98 percent] effective as [a] form of birth control [with perfect use], and are effective against STIs.” [With typical use, male condoms are 82 percent effective at preventing pregnancy, according to Bedsider.org.]
—Third-year graduate student, university withheld

“Me and my partner use both condoms and birth control. Also, she uses birth control for other non-contraceptive reasons.”
—Fourth-year undergraduate, University of Waterloo, Ontario

Ngia Dinh

Serena Michell: Third-year undergraduate at Wilfrid Laurier University, Ontario, majoring in Criminology; Student Health 101 Student Advisory Board 2015–16.

“This app helps women keep track of their contraceptives. By entering the day that your pack was started and the number of pills per pack, a ‘virtual pack’ will be generated. It allows you to set an alarm and will notify you at the specific time with a message saying, ‘Take a pill.’”

Useful?
“It’s a must-have for the ladies. I rarely forget to take my pill anymore.”
Rating: 5/5 stars

Fun?
“Taking pills is never exciting, but what’s unique is the symbol (a white dot labeled ‘m.P’) that appears on your home screen. It’s low-key for a more discreet reminder.”
Rating: 3/5 stars

Effective?
“It got me into the routine of taking my pill at the same time every day, ultimately helping me feel more confident in my method of contraception.”
Rating: 5/5 stars

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