The contraceptive implant Nexplanon® is a highly effective long-acting reversible
contraceptive (LARC) method. Nexplanon® has FDA approval for three years of
use but remains effective for four years. The implant slowly releases a progestin, so
it is also free from the side effects and cardiovascular risks of estrogen-containing
contraceptives, such as combined oral contraceptives (COCs). The implant also
relieves painful menses and endometriosis symptoms, decreases acne, reduces risk
of ectopic pregnancy, and is rapidly reversible. The principal disadvantage of Nexplanon
® is disrupted menstrual bleeding patterns—either by irregular bleeding or
complete cessation of menstrual periods (amenorrhea). Implants may also promote
weight gain and may be associated with an increased incidence of ovarian cysts.
Improperly performed insertions are also a rare cause of contraceptive failure.
Female and male sterilization
The benefits of sterilization include safety, high effectiveness, lack of significant
long-term side effects, no need for continuing motivation or action for use, no need
for supplies, and no need for partner compliance. Female sterilization with various
techniques and male sterilization by vasectomy are permanent methods. They
should be chosen only when no more children are desired. Sterilization is very safe,
but like all surgical procedures, it carries some degree of risk, with mortality rates
from female surgical sterilization in the U.S. estimated at 1 to 4 deaths per 100,000
procedures, and deaths from vasectomy at 0.5 per 100,000 procedures. When the
rare pregnancies after female sterilization occur, about 30% are likely to be outside
the uterus (ectopic) and require medical intervention to avoid serious health consequences.
Intrauterine devices (IUDs)
Intrauterine devices (IUDs), also known as intrauterine contraceptives or IUCs,
have a proven record of very high effectiveness, and suitability for a wide variety
of women. Women who are childless (nulliparous), are in their teens, immediately
post-abortion or postpartum or have had a sexually transmitted infection (STI) are
all appropriate candidates for IUDs, as are women with medical conditions that
might contraindicate the use of combined hormonal contraceptives.28 29
IUDs have important health benefits. The LNG-IUS (Mirena® and Liletta™) that
release a small amount of a progestin hormone usually decreases menstrual blood
loss, improves iron-deficiency anemia, and helps manage heavy menstrual bleeding
(HMB) from various causes. The copper IUD and probably the LNG-IUS provide
protection against endometrial cancer, and they protect against infections causing
pelvic inflammatory disease (PID). The copper T 380A is the most effective emergency
contraceptive method. The long duration of action of each of the IUDs is an
The most prominent problems caused by IUDs are cramping and pain at the time
of insertion disrupted menstrual bleeding patterns and expulsions that occur among
2% to 10% of IUD users. A more serious risk of IUC use is perforation of the uterus
that occurs in 0.03% to 0.06% of IUD insertions. The issue of increased risk
or greater severity of infection among IUD users has been a prominent concern.
However, the pelvic inflammatory disease (PID) rate in IUD users is low, with cases
concentrated in the first 20 days after insertion.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.