Side effects and complications may incite women to file complaints as, for instance, lawsuits in the USA against contraceptive manufacturers are commonplace. Positioning LARC for use in nulliparous and adolescent women can only achieve its goal if the method is continued to be used. It should be realized that, prior to deciding to remove the IUD/IUS, many women have gone through a period of months of cramping pain, trying to endure the method as they have no alternative. 4 However, if the IUD/IUS causes pain and erratic or heavy menstrual bleeding, which are unfortunately common side effects, it will most likely be removed and replaced, often by a less effective method or no method at all. In Europe, IUDs and the LNG-IUS are more popular than implants because of the burden of insertion and surgical removal. 3 The most frequently reported reasons for liking the IUD (only one copper IUD is available in the USA) are ease of use and reliability, and for the levonorgestrel intrauterine system (LNG-IUS), lighter menstrual cycles. 2 Among LARCs, the IUD, (the denomination is used to indicate both copper and hormone-releasing intrauterine systems (IUSs), or only to indicate copper IUDs) is by far preferred by young US women. LARC is vigorously promoted by societies such as the American College of Obstetricians and Gynecologists (ACOG), the US-based Association of Reproductive Health Professionals, the World Health Organization (WHO), the European Society of Contraception and Reproductive Health Care, the UK Faculty of Sexual and Reproductive Healthcare, and other organizations, as these methods are thought to be the solution for the global problem of unintended pregnancy.
For this reason, long-acting reversible contraceptive (LARC) methods (eg, intrauterine devices and implants) are advocated.
1 Side effects and noncompliance are the main causes for these high failure rates. The latest figures published by Trussell and his team show that the pill, the contraceptive patch, and the vaginal ring have a typical 1-year pregnancy rate of 9%. The primary objective of any contraceptive is to avoid unintended pregnancy.
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