Last year, the number of women in the centre opting for long-acting, reversible contraception, or LARCs, rose 28% on the previous year (914 in 2012 compared to 716 in 2011). The trend for intrauterine devices (IUDs) and implants occurred across their three Dublin clinics.
The shift is due to two factors, says Dublin Well Woman Centre medical director, Dr Shirley McQuade. LARCs don’t have to be taken daily, and thereby reduce the rate of failure of the pill. While there’s a bigger up-front cost, long-term they’re cheaper than oral contraception.
“All studies on the pill suggest women missing them is very common. Women come in, saying they got bleeding during the three-week phase of the month — when they shouldn’t. When we ask if they missed a pill, they say they forgot it, because they went away for the weekend, or they were on shift work or have an erratic lifestyle. Nurses often want to use LARCs, because their shifts are all over the place, and air-hostesses, too, because of long-haul flights,” Dr McQuade says.
The Irish Family Planning Association is also seeing more women looking for LARCs. “In perfect conditions, the failure rate of the oral contraceptive pill is between 0-1%, but the real-life failure rates are more like 8%. There’s an awful lot of user-failure error,” says medical director, Dr Caitríona Henchion.
“Women on LARCs don’t have to worry about making a mistake, and if they’re taking antibiotics or get the vomiting bug it won’t affect their birth control. All LARCs have failure rates of one in 1,000 or less, so they’re very effective.”
On average, oral contraception costs €10 a month, plus two annual GP visits bring the cost to €240 a year. LARCs cost considerably less. Implanon costs €160 a year, the Mirena coil €90, and the copper coil €30.
LARCs are also reversible. “Fertility’s back to normal one or two cycles after you stop using them. With the pill, it can take three to six months — we occasionally see women who take up to a year for periods to re-establish,” says Dr McQuade.
Being overweight, a smoker, and aged over 35 are concerns if you’re on the pill, but these worries don’t feature with LARCs, says Henchion, “because the implant and Mirena coil contain only small amounts of progesterone, and the copper coil none at all”.
So what’s the downside? Insertion is a procedure with associated discomfort, says McQuade. “We use local anaesthetic when putting in the implant. Removing it, we need to cut the skin. This usually involves a stitch — you end up with a small scar. With IUDs, discomfort varies. The sensation starts like that of a smear test — most women experience a cramping sensation as the womb’s being measured, and as the coil’s going in.”
Henchion says there is a “small risk of perforation” during IUD fitting. Devices can also impact on periods. “In the majority of cases, it’s very minor. With the Mirena or implant, periods, in the long-term, tend to be lighter than before. In the first few months, they can be irregular, but this can be ignored unless they’re heavy, bothering the woman, or not settling down.”
If LARCs are user-friendly and cost-effective, why use the pill? “Women having families, who think they might try getting pregnant again next year, go on the pill — there’s no point outlaying a significant amount of cash or having that settling in period with LARCs,” says Henchion. Some women don’t like having contraceptive devices fitted.