Long-acting reversible contraception (LARC)

You are the gynaecology registrar at a 15-minute contraception counselling appointment. Your patient is a 22-year-old nulliparous woman in a long-term relationship, on the pill and missing it three to four times a month, asking what is "safer than the pill." She has heard the implant makes you bleed and that the IUD is not for people who have not had children. She has class II obesity and a faint family history of thrombosis on her mother's side. You have twenty minutes to take a contraceptive history, choose a method, address her fears and leave her with the right one. This topic is the script for that consultation and every LARC question it generates.^[6]

Overview and definition

LARC is the umbrella term for contraceptive methods that require a single administration by a clinician, last years, and work for as long as they are in place — without any daily, weekly or per-coital action by the user. The three marketed methods fall into two mechanical families. ^[6]

• Subdermal etonogestrel implant — a 4-cm radiopaque rod containing 68 mg etonogestrel, inserted under the skin of the medial upper arm. Releases ENG over up to 5 years (FDA label updated January 2026).^[6]
• Levonorgestrel-releasing intrauterine system (LNG-IUS) — a T-shaped polyethylene frame with a hormone reservoir on the vertical stem; the 52 mg device (Mirena in many jurisdictions) is the highest dose and is approved for up to 8 years of contraception; 19.5 mg and 13.5 mg devices are approved for shorter durations.^[3][6]
• Copper IUD (Cu-IUD) — a T-shaped polyethylene frame with 380 mm² of copper wound around the vertical stem; non-hormonal, labelled for use up to 10 years in UK and Australian practice, depending on the device label, and used for emergency contraception when inserted within 5 days of unprotected intercourse.^[6][8]

The cleanest single-sentence definition used by the U.S. Selected Practice Recommendations is that LARC methods are reversible, user-independent and have "fewer than one user in 100" pregnant in the first year with typical use — a property no short-acting method can match. ^[6]

References21ShowHide

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2. [2]McNicholas C, Madden T, Secura G, Peipert JF The contraceptive CHOICE project round up: what we did and what we learned Clin Obstet Gynecol, 2014.PMID 25286295
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