The pros and cons of long-acting reversible contraceptives: IUD vs. Nexplanon implant

by Anita Del Bianco, MD, FACOG

When it comes to birth control, women have many choices today, including various types of long-acting reversible contraceptives. 

With all those choices can come a lot of confusion about which method of contraception is best. And the answer, as with many things in health care, is that it depends on individual needs and preferences.

Any woman wanting to avoid pregnancy, whether she’s had children or not, is a candidate for long-acting reversible contraceptives, which include intrauterine devices, or IUDs, and the Nexplanon implant. 

The main advantage of long-acting reversible contraceptives is that they are excellent at preventing pregnancy. They are also more cost-effective the longer they are used. 

I personally recommend these forms of contraception for women who want to avoid pregnancy for at least one year. And for women who have trouble remembering to take pills, IUDs and implants have the advantage of working no matter how forgetful we are, because they require no action by the user. 

So when it comes to choosing between an IUD and the Nexplanon implant, which is better?

Again, it depends. One advantage of IUDs is that they last for five to 10 years, depending on which type a patient chooses. They are completely reversible, however, and can be removed anytime a patient likes. 

The Nexplanon implant is good for up to three years. Small, thin and flexible, it is placed under the skin of the underside of the upper arm. The disadvantage of the Nexplanon implant is that it can cause irregular bleeding. This could mean no periods or intermittent spotting and bleeding throughout the three years of use.

An IUD generally does not adversely affect bleeding in the long term but can cause abnormal short-term bleeding and cramping when it is initially inserted. An extra advantage of the hormone-containing IUDs is that they can decrease or stop the menstrual cycle. In fact, they are often used to treat heavy menstrual cycles.

Patients often ask if it hurts to have a long-acting reversible contraceptive placed. The Nexplanon implant is placed after numbing a small area in the arm, and the discomfort is minimal. Placing an IUD can cause some menstrual-type cramping. I recommend that patients use ibuprofen (unless contraindicated) about one hour prior to placing the IUD.

If you have questions about contraceptives, we encourage you to call Premier Women’s Care of Southwest Florida to schedule an appointment with one of our women’s health professionals. You can also book online by clicking on the button above. We’re always happy to talk you through the options as they apply to your individual situation.

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