CONTRACEPTIVES
LONG-ACTING (HORMONAL) METHODS
Long-acting contraceptives can be either hormonal or non-hormonal. Hormonal long-acting products work similarly to progestin only short-acting hormonal contraceptives, except that they contain greater quantities of hormone which are released over longer periods of time (generally between three to five years). After expiration the products have to be removed from the body (and, if required, replaced). Non-hormonal long-acting contraceptives work on a copper basis and are effective for even longer periods of time (ten to twelve years). Any long-acting contraceptive (hormonal and non-hormonal) must be inserted into and removed from the body by a healthcare provider in a small procedure.
Copper IUD
Copper IUDs (intra-uterine devices) are small (about 3 cm wide and 3.5 cm long) T-shaped plastic devices with exposed copper coil in several locations along the trunk and each arm of the T. They cost up to $1,200 (without insurance) and have an efficiency of as much as 99%. Copper IUDs are a good option for women with contra-indications to hormonal contraception, such as those suffering from cancer. The main side effect of copper IUDs is the potential for stronger menstrual bleeds (menorrhagia). The contraceptive working mechanisms of copper IUDs are not well understood. Copper is believed to act on the reproductive system and prevent pregnancy in the following ways:
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Immune reaction: The ions (Cu2+) emitted by the copper IUD create a toxic environment in the uterus which elicits an inflammatory (immune) response from the body. Once immune cells (leukocytes, i.e. white blood cells) are recruited to the uterus, they eliminate (destroy) all foreign bodies they encounter, including sperm cells.
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Reduced sperm motility: Similarly, large amounts of Cu2+ ions contained in copper also interfere with sperm cells themselves by causing them to become slower (reduced motility) and in some cases even lose their flagella (the tail attached to the sperm cell). Impaired mobility in sperm cells is often considered analogous to decreased fertility, because slow sperm cells are not able to reach and fertilize the ovum. The exact mechanism by which copper reduces sperm motility is sill subject to ongoing research.
Hormonal IUDs
Hormonal IUDs are progestin only products. Like copper IUDs, they are approximately 3 cm wide T-shaped plastic devices which are inserted into the uterus via a small non-surgical procedure. They release regular doses of hormone directly into the uterus, where it is absorbed by the uterine lining. Because administration is so local, very small doses of hormones are sufficient to achieve the desired effects. Depending on the product, hormonal IUDs are good for three to five years. After expiration, they can usually be removed from the uterus in a simple non-surgical procedure, in which a healthcare providers pulls out the IUD on a small string exiting the cervix. Their efficiency is approximately 99%.
Hormonal Arm Implant
The hormonal arm implant ("the stick") is also a progestin only product. It is a match-sized (4 cm long) plastic stick that (similar to hormonal IUDs) contains progestin - which it releases steadily into the body over a period of three (3) years. Because progestin is released into the arm and must travel to the reproductive organs via the blood stream, larger hormone quantities are required compared to hormonal IUDs. The implant is inserted by a medical provider in a small surgical procedure, which places the implant directly under the skin of the (non-dominant) forearm. During the procedure, the area of application is numbed and the implant is guided underneath the skin with a small mouse-shaped applicator. When it is time to remove the implant, a small incision (as small as 2 mm) is made after numbing and the implant is pulled out with a small forceps (tweezers). The efficiency of the implant is also very high at about 99%.
