All About Long-Term Birth Control

Many people start using birth control at an early age and stay on it for years. The average age that a person begins taking an oral contraceptive (also known as "the pill") is roughly 16. The age that people stop taking the pill differs because of personal preferences about sexual health as well as the desire to have children.

There are many forms of birth control, and using any of them over a long period of time is generally considered safe. However, there are some possible side effects from long-term usage, such as an increased risk of blood clots and breast cancer.

The effects, though, are not all negative: Long-term use of birth control has also been associated with a reduced risk of developing ovarian, endometrial, and colorectal cancers.

Types of Long-Term Birth Control

The various forms of birth control have different shelf lives—that is, how long they will keep working once they're started. Some of the long-term options offer people protection from an unintended pregnancy without the need for daily reminders (for example, to take a pill). One of their major benefits is that out of all the reversible options, they are the most effective at preventing pregnancy. The typical failure rate is less than 1%.

Paragard IUD

Paragard is an intrauterine device (IUD). It is a T-shaped device made of copper. It is placed in the uterus by a doctor. Once inserted, the IUD can protect against pregnancy for up to 10 years. Some family planning organizations recommended keeping the IUD inserted for up to 12 years before removing it.

Unlike other IUDs, the Paragard device does not use hormones to prevent pregnancy. It prevents sperm from reaching an egg by hindering their mobility and blocking the activation of certain enzymes that help the sperm break through the egg wall to fertilize it.

The typical failure rate is 0.8%, which means that out of 100 people using this method for a year, fewer than one will get pregnant.

Hormonal (Progesterone) IUD

There are four brands of progesterone IUDs approved for use in the United States: Mirena, Kyleena, Liletta, and Skyla. They are similar to the Paragard IUD in that they are placed in the uterus and are T-shaped; however, they work differently.

Progesterone IUDs release a synthetic version of the hormone progesterone (progestin). The hormone is what usually plays a role in regulating the menstrual cycle and preparing the body for pregnancy. 

To prevent pregnancy, the hormones in a progesterone IUD keep the sperm from being able to reach an egg by thickening the mucus in the cervix, thinning the lining of the uterus, and suppressing ovulation.

The typical use failure rate is 0.1% to 0.4%, which means that out of 100 people using this method for a year, fewer than one will get pregnant.

Hormonal Contraceptive Implant

A hormonal contraceptive implant is a small plastic, rod-shaped device that is implanted under the skin of the arm. Like a hormonal IUD, the implant releases progestin to prevent pregnancy.

The typical use failure rate is 0.1%. This means that out of 100 people using this method for a year, fewer than one will get pregnant.

Nexplanon is the name of the implant that is approved by the Food and Drug Administration (FDA) in the United States.

Other Types of Birth Control

There are different types of birth control that you can choose from depending on your needs and preferences. The methods can be categorized into those that are reversible and those that are permanent.

Reversible Options

IUDs and the Nexplanon implant are considered long-acting reversible contraception (LARC), but there are also short-term options.

If you want a contraceptive method that will leave you with the potential to conceive in the future, you need a method that is not permanent. You have a few options for short-acting reversible birth control:

• Short-acting hormonal contraception: Short-acting contraceptives have a shorter shelf life than implanted devices. These include the birth control pill, the patch, Depo-Provera (injection), and the Nuvaring. Typical use failure rate of these options is 7%, and 4% for Depo-Provera. This means that if 100 people use one of these methods for a year, seven will get pregnant (or four with Depo-Provera).
• Barrier contraception: Diaphragms and cervical caps create a barrier to prevent sperm from getting to the uterus. They can be cleaned and reused. Spermicide is also typically used to help prevent pregnancy. Typical use failure rate is 17%, which means that if 100 people use this method for a year, 17 will get pregnant.
• One-time barrier contraception: Some barrier methods, like contraceptive sponges and external condoms, are meant to be used only one time. They also create a barrier that prevents sperm from reaching the uterus. Sponges contain spermicide, and spermicide can also be used with external condoms to improve how well they work. Typical use failure rate for the sponge is 14% for those who have never had a baby and 27% for those who have had a baby. For external condoms, the rate is 13%.

Permanent Options

Permanent contraception is an irreversible method of birth control. People who are certain they do not want the option of having children in the future may choose a permanent method of contraception.

One example of permanent contraception is a tubal ligation. This procedure makes it impossible for the eggs to get through the tubes that would carry them from the ovaries to the uterus (fallopian tubes). Typical use failure rate is 0.5%.

For people with a penis, a vasectomy is a procedure that cuts and blocks the tubes that sperm travel down. A vasectomy makes it impossible for sperm to be released during ejaculation.

Typical use failure rate is 0.15%. This means that for both of these methods, fewer than one person out of 100 will get pregnant during a year.

Side Effects and Risks

While birth control is typically safe to use over a long period of time, there are some side effects. Some of them are harmful, while others can actually be beneficial.

IUDs  

Hormonal and non-hormonal IUDs have different risks and benefits. There are some benefits of using hormonal IUDs long-term besides preventing pregnancy, including:

• People who have average or heavy periods might experience lighter monthly bleeding if they use a hormonal IUD.
• Improved red blood cell levels in people with anemia (not having enough healthy red blood cells, which restricts the transfer of oxygen throughout the body)
• Less severe menstrual cramps over time
• Less severe endometriosis-driven pelvic pain

Copper IUDs, on the other hand, do not cause shorter periods and do not improve anemia. In fact, they can increase bleeding, do not relieve severe menstrual cramps, and have not been shown to improve endometriosis symptoms.

Using an IUD also comes with a slight risk that the device will migrate from where it is placed in the uterus to somewhere else in the reproductive tract, which can cause complications.

In very rare instances, an IUD has broken through the wall of the uterus and made its way into the body cavity between the abdominal wall and organs (uterus perforation). It is a potentially fatal complication and is a medical emergency.

Research has shown that people who use IUDs may have heavier menstrual periods. This can be a typical occurrence while the body adjusts to the new form of birth control, but in some cases, the heavy bleeding can continue.

Risks of Other Forms of Birth Control

Birth control pills and other forms of birth control are generally considered safe to use long-term but do carry risks that everyone taking them should know.

• Increased risk of blood clots, stroke, and heart attack: People who take birth control pills are at a higher risk of developing blood clots or having a stroke or heart attack. Pills with higher doses of estrogen are considered to raise the risk even more.
• Increased risk of some cancers: Some studies have shown that people taking birth control are almost twice as likely to develop breast cancer as people who do not take it. The risk of developing cervical cancer also appears to be higher among people taking birth control pills.
• High blood pressure: Increased blood pressure (hypertension) can occur in people taking birth control pills. Although the increase is typically mild, there have been rare cases where a person's blood pressure rose to dangerously high levels while they were taking birth control.
• Increased risk of gallbladder disease: Research has shown that taking birth control pills for a long time may increase a person's risk of developing gallbladder disease by 36%. Taking birth control pills may also increase a person's risk of developing gallstones.
• Lowered libido: Some research has suggested that people taking birth control may have a lowered libido, though the results of several studies have been conflicting. More research is needed to determine how long-term birth control use affects a person's sex drive.

Permanent contraceptive methods such as tubal ligation can also have long-term side effects. In rare cases, people who had tubal ligations have experienced an ectopic pregnancy, a potentially life-threatening medical emergency that happens when the fertilized egg implants in the fallopian tube instead of the uterus.  

There are some potentially negative effects of using other forms of birth control for a long time (specifically the birth control pill). However, according to the National Cancer Institute, doing so may also reduce your risk of developing both ovarian and uterine cancers.

Summary

People who are looking for a long-term birth control option should rest assured that most options are considered safe to use for a long time. For example, IUDs can be used up until a person reaches menopause.

There are potential risks associated with many forms of long-term birth control, but it's worth discussing your options with your doctor. For many people, the benefits of using birth control long-term outweigh the risks.

There are differences in how well the various methods work, with IUDs and the implant being the most effective reversible methods. The effectiveness may factor into your decision, too.

A Word From Verywell

Not all forms of birth control will be right for everyone, and some people may find that long-term options are not the best choice. That's why it's important to speak with your doctor about your current health status and fertility goals to find the birth control method that will be the safest and most effective for you.