IUDs (intrauterine device) and LARCs (long acting reversible contraception)
Intrauterine devices have been used since Egyptian times for contraception. Currently they come in the form of hormonal or non hormonal devices that are effective, well tolerated and reversible.
Hormonal IUDs also suppress the thickening of the endometrium and lead to light periods or no periods in the majority of women. This has revolutionized the management of women with heavy or long periods and is licensed as a contraceptive for 5 years from insertion. It is useful for avoiding pregnancy and particularly during the peri-menopausal period when it can help with menopausal symptoms and protect the endometrium if HRT is required. Some women find it helps with PMS symptoms and migraines.
Non hormonal IUDs are also popular with women who choose to avoid hormones because of sensitivity and intolerance to the associated side effects of the pill. It can cause periods to be heavier and longer although this cannot be predicted for an individual and so requires a trial period. Copper IUDs received a reputation for pelvic infection in the 1950-80s. This was related to the lack of screening for sexually transmitted infection at the time of insertion and the lower use of condoms for casual liaisons. These IUDs last 5-10 years for contraception.
IUDs (both hormonal and non hormonal) are best inserted during or just after a period and are checked by ultrasound after insertion to confirm correct positioning.
Long acting reversible contraception is also available as a subcutaneous implant in the inner upper arm providing security of effective contraception for 3 years without the need to take the pill. Condoms however are the most effective way to avoid infection.