Long-acting contraception: pros, cons, and what to expect on insertion

A few years ago I got tired of calendar math. I kept counting pills, setting alarms, and promising myself I wouldn’t forget this time. That’s when I started reading about long-acting reversible contraception (LARC)—IUDs and the implant—and I realized the best part wasn’t just effectiveness. It was mental quiet. I wanted to capture what I learned and what the actual insertion day was like so you can picture it in your own life without the hype.

The moment it clicked for me

Here’s the short version that finally made sense: LARC is “set it and mostly forget it.” Once an intrauterine device (IUD) or the small arm implant is in place, you don’t have to remember anything daily or weekly. Typical-use effectiveness is extremely high because there’s nothing to miss. That doesn’t make these methods perfect for everyone—no method is—but the high protection with low daily effort was the aha moment that pushed me to look closer. LARC also does not protect against STIs, so condoms still matter when STI protection is needed.

• What I valued most: fewer decisions. Fewer decisions = fewer opportunities to drift from a plan.
• What I accepted: every method has side effects; the question is which trade-offs fit my life.
• A gentle caveat: anatomy, health history, and personal preferences matter. One size never fits all.

What I kept open in my browser while researching

I’m putting these up front because they shaped how I framed pros/cons and the insertion experience. They’re neutral, non-commercial resources you can skim now and revisit later:

• CDC U.S. Selected Practice Recommendations 2024
• ACOG LARC FAQ
• FDA Birth Control Chart 2024
• WHO Contraception Fact Sheet 2025
• HHS Title X Clinic Finder

How I compared my main options without spiraling

When I felt overwhelmed, I stepped back and wrote three columns—“how it works,” “what I might feel,” and “what I need to do.” That cut through a lot of noise.

• Hormonal IUD (levonorgestrel) — Releases a small, local dose of progestin in the uterus. Many people see lighter periods over time; some become very light or stop. Early months can bring irregular spotting or cramping as the body adjusts. No daily upkeep beyond a quick “string check” if you want to do it.
• Copper IUD — Hormone-free. Copper affects sperm movement and fertilization. It can make periods heavier or crampier at first, which may or may not settle. Some people love the simplicity; others don’t like the bleeding changes.
• Implant (etonogestrel) — A matchstick-sized rod placed under the skin of the upper arm. It quietly releases progestin. The biggest “con” people mention is unpredictable spotting (light but irregular). The “pro” is the ease—no strings, no pelvic procedure, and removal is quick when you’re ready.

All three are reversible. If you decide to stop, a clinician removes the device and most people see a speedy return to their baseline fertility (more on that below).

Pros and cons I wrote in my notebook

• Pros I appreciated
  • Among the most effective reversible methods with essentially no daily effort.
  • Discrete—there’s nothing to remember around travel, time zones, or busy seasons.
  • Long duration—several years depending on the specific device and local guidance.
  • For hormonal IUDs, many people see easier periods; for copper IUD, no hormones at all.
• Cons I took seriously
  • Insertion is a procedure (pelvic for IUD; small arm procedure for implant).
  • Bleeding changes are common early on (lighter, heavier, or just different depending on the method).
  • Rare but important risks with IUDs include device expulsion or, very rarely, uterine perforation; for the implant, placement and removal need trained hands.
  • No STI protection—condoms still matter when that’s a goal.

What insertion day looked like for me

I asked for the first appointment of the day so I wouldn’t rush. I wore comfy clothes, ate a normal breakfast, packed a water bottle and a pad, and jotted down three questions in my notes app. Here’s the general flow many clinics follow for IUD insertion:

• Check-in and a quick pregnancy check if needed. Some clinics also offer STI testing—good to ask if you’re due.
• Consent and a review of pros/cons. This is your chance to confirm it matches your goals.
• Pelvic exam with a speculum. The cervix is cleaned; a small instrument may hold it steady (brief pinch).
• The uterus is measured (a few seconds of crampy pressure), then the IUD is placed through a thin tube. Strings are trimmed.
• Afterward, I sat for a minute, drank water, and that was it. Mild cramping was the headline for the day; a heating pad helped later.

For the implant insertion, the vibe was even more low-key:

• They cleansed and numbed a spot on the inner upper arm.
• The applicator slid the rod under the skin in seconds. I felt pressure, not pain, thanks to the local anesthetic.
• A small bandage and a snug wrap went on to minimize bruising. I could feel the rod with my fingertips afterward (a good safety check).

Before I left, my clinician walked me through what to expect in the first weeks and when to reach out. I scheduled a quick check-in on my calendar—not mandatory everywhere, but I liked having it on the books.

Will I need pain medication

Most clinics suggest over-the-counter pain relief and a heating pad. Some also offer numbing options for the cervix during IUD insertion. If you’re anxious about discomfort, say so in advance so you can talk through the clinic’s approach. The goal is not to “tough it out” but to plan realistically.

What happens after it’s in

This part depends on the method and when you start it in your cycle. Copper IUDs protect right away. Hormonal IUDs and the implant can be effective immediately if placed at specific times; otherwise, you may be advised to use a backup method briefly. Your clinic will tailor this based on your timing and history. I set a calendar reminder to check IUD strings occasionally (you don’t have to, but it can be reassuring), and I kept notes on bleeding patterns for the first few months to see the trend rather than judging a single day.

Bleeding changes and other effects I watched for

• Hormonal IUD — Early spotting is common. Over time, many people see lighter periods or none at all. Cramping typically eases after the first weeks.
• Copper IUD — Periods can be heavier or crampier at first. This sometimes improves after a few cycles; sometimes it doesn’t. Writing down what I noticed helped me decide if it was tolerable or not.
• Implant — The pattern is often the weirdest: light but unpredictable spotting. Some people don’t mind; others really do. For me, setting expectations made it less frustrating.

Other possible effects include headaches, breast tenderness, acne or skin changes, or mood shifts. These vary and don’t predict your future fertility. If something feels off, that’s a good reason to check in with your clinician, not “just live with it.”

Rare but important risks I wanted plain language for

• Expulsion (IUD) — The device can partially or fully come out, especially early. A clue is strings that feel much longer or you can feel plastic at the cervix. If that happens, use backup protection and call your clinic.
• Perforation (IUD) — Very rare. If severe pain or unusual symptoms occur after insertion, that’s not something to ignore.
• Infection — The overall risk of pelvic infection isn’t raised long-term by having an IUD, but having an undiagnosed STI at insertion can increase short-term risk. Good STI screening practice is to test when indicated and treat promptly.
• Wrong depth or migration (implant) — Also uncommon when placed and removed by trained clinicians. If you can’t feel the rod or if the site looks unusual, get it checked.

Can I use LARC if I haven’t had children

Yes. Major guidelines support offering IUDs and implants to adolescents and to people who have never been pregnant, with the same attention to preferences, STI screening when indicated, and informed consent. The key is person-centered counseling, not gatekeeping.

Cost, coverage, and finding a clinic

Costs vary by device and by insurance. In the U.S., many plans cover contraception without cost sharing; public clinics supported by the Title X program offer sliding-scale services regardless of insurance status. If navigating coverage sounds like a maze, you’re not alone—I found it helpful to call a clinic first and ask, “Can you help me check benefits and total costs before I book?”

• Ask your insurer to confirm the specific device, insertion, and follow-up visit coverage.
• Ask the clinic whether they stock the device or need to order it (this affects scheduling).
• Use a Title X–funded clinic search if you prefer a sliding-scale option near you.

When removal or switching was on my mind

You can remove an IUD or implant any time—there’s no minimum “commitment window.” Most people’s fertility returns quickly after removal. If you’re switching methods, your clinician can help you avoid gaps in protection (for example, by overlapping or using a short period of backup). I liked planning a “what if I hate it?” exit strategy on day one; it made the decision feel safer.

Red and amber flags that tell me to slow down

• Call soon if you have severe or worsening pelvic pain, fever, unusually heavy bleeding, foul-smelling discharge, or you can feel the hard part of an IUD at the cervix.
• Check in if spotting is persistent and disruptive, if headaches or mood symptoms feel new and severe, or if you can’t feel an implant and you used to.
• Don’t wait to test for pregnancy if you have symptoms or missed periods with an IUD in place; although pregnancy is uncommon on LARC, prompt evaluation matters.

Health conditions I asked about in advance

This is not a diagnosis list, just examples of situations where personalized guidance matters: current breast cancer (for progestin methods), certain uterine shapes or fibroids (for IUD placement), copper allergy or Wilson disease (for copper IUD), and recent pelvic infection or postpartum infections. The takeaway is simple—your health history should shape your choice, not disqualify you from options without discussion.

My tiny decision framework when I felt stuck

• Step 1 Name my top priority right now: lowest maintenance, bleeding control, hormone-free, or fastest start.
• Step 2 Match likely trade-offs: lighter periods (hormonal IUD), hormone-free (copper), no pelvic procedure (implant).
• Step 3 Reality check with a clinician: timing, backup method needs, and any health factors that change the plan.

What I’m keeping and what I’m letting go

I’m keeping the idea that “easier” can be a legitimate health goal. It’s okay to choose a method because it frees brainspace. I’m letting go of the myth that insertion must be awful; with good preparation, pain management, and a clinician who talks through each step, it can be very manageable. I’m also bookmarking a few principles:

• Plan the day—transportation, comfort items, and questions ready.
• Expect a settling-in period—judge the pattern over weeks, not one day.
• Own your preferences—it’s your body; convenience and comfort count as legitimate reasons.

FAQ

1) Does insertion hurt
Answer: Sensations range from pressure to crampy pain for an IUD and pressure with numbing for the implant. Asking about numbing options and bringing a heating pad or pain reliever plan helps many people.

2) How soon does it work
Answer: Copper IUDs protect right away. Hormonal IUDs and the implant may protect immediately depending on timing; otherwise, a short backup period is often advised. Your clinician will tailor this to your cycle and recent sexual activity.

3) Will it affect my future fertility
Answer: These methods are reversible. Most people return to their baseline fertility quickly after removal. If pregnancy doesn’t happen on your expected timeline later, that’s a reason for a standard fertility evaluation, not a sign that LARC caused a delay.

4) Can I get an IUD or implant if I’ve never been pregnant
Answer: Yes. Major guidelines support offering LARC regardless of prior pregnancy, with the same attention to comfort, screening when indicated, and informed consent.

5) What should I watch for after insertion
Answer: Increasing pain, fever, very heavy bleeding, foul discharge, or a device that feels out of place are reasons to contact your clinic. For milder cramping or spotting, track the pattern and check in if it’s disruptive or not improving over time.

Sources & References

• CDC — U.S. Selected Practice Recommendations (2024)
• ACOG — LARC FAQ
• FDA — Birth Control Overview (2024)
• WHO — Contraception Fact Sheet (2025)
• HHS OPA — Title X Service Grants

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).