Dear Dr. Vanessa, What Are My Semi-Permanent Birth Control Options?

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Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

Dear Dr. Vanessa,

I don’t want any more kids, but I really don’t want my tubes tied and my husband doesn’t want the snip either. What are our other permanent or semi-permanent birth control options? I really don’t want to have to remember a daily pill anymore.

— Sorta-Commital

Dear S.C.,

There are a few options for long-lasting reversible birth control that work as well as or better than some forms of permanent birth control. One is a contraceptive implant called Implanon, which can be worn for three years. Another is an intrauterine contraceptive (Editors’ note: IUC, or the birth control formerly known as an IUD): Mirena contains hormone and can be worn for five years; Paragard contains copper and can be worn for 12 years. There’s also the Depo Provera shot. Here are some of their pros and cons:

1. Implanon: If you choose Implanon, your clinician will put a small implant under the skin of your upper arm.  It will constantly release small amounts of a progestin, the hormone called etonogestrel, which will prevent the ovaries from releasing an egg (ovulation) and also thicken cervical mucus to prevent sperm from joining an egg (fertilization).

Implanon is more than 99.9 percent effective — more effective than some forms of permanent birth control.  The advantages to Implanon are that it can be used by women who can’t take estrogen, there is no pill to take daily, it provides long-lasting birth control but is not permanent, and the ability to become pregnant returns quickly when use is stopped.

The possible disadvantages of the implant include irregular bleeding patterns; headache; change in sex drive; discoloring or scarring of the skin over the implants; soreness, bruising, or swelling for a few days; rarely, a woman may need medication for infection or pain, and rarely, a woman may have pain at insertion site for longer than a few days. Other possible side effects include nausea and sore breasts, but usually for only the first two or three months of use.

The cost for three years of protection with the implant ranges between $400 and $800.  It costs $75 to $125 to have the implants removed.

2. IUCs: If you choose an intrauterine contraceptive (IUC), your clinician will put a small plastic device in your uterus. The IUC contains either copper (ParaGard) or the hormone levonorgestrel (Mirena) that will keep sperm from joining the egg. IUCs are more than 99 percent effective against unintended pregnancy — better than some forms of permanent birth control.  The advantages of IUCs include not having to put anything in place before intercourse, not having to take a pill every day, and the ability to become pregnant returns quickly when the IUC is removed. The Mirena may help reduce menstrual cramps. The ParaGard can be used during breastfeeding.

The possible disadvantages of IUC use include spotting between periods. Use of the ParaGard may increase cramps and heavier and longer periods. Rarely, insertion of an IUC can lead to infection, which, if left untreated, could lead to infertility. And rarely, the wall of uterus is punctured during insertion. Pregnancies, which rarely occur with IUC use, are more likely to be ectopic (not in the uterus). The cost of five to 12 years of protection with IUCs is between $175 and $650.

3. Depo-Provera: Some people include contraceptive injections in the category of long-acting reversible contraceptives. The most common brand of injection is Depo-Provera. Each injection of the hormone progestin provides three months protection against unintended pregnancy. It is between 97 and 99 percent effective. Its advantages and disadvantages are similar to those of the implant. The cost is from $35 to $75 dollars an injection plus the cost of the doctor visits.

So there are many great alternatives for long-lasting reversible contraception for you to consider. For more information, you can visit Planned Parenthood.

In the meantime, best wishes for your good sexual health,

Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.


  1. Please also add that some implants are similar to the Pill in that they can be counteracted by certain medications, so you still have to check with your doctor when you take a new medication. A friend of mine sadly found this out the hard way, and I’d hate others to have to.

    And, slightly off topic, I just can’t believe that women have to pay for birth control in the States – makes the current attacks on Planned Parenthood seem all the more unbelievable.

  2. Please add a side note about Depo Provera having a “black box” warning and how it is recommended that a person not be on it longer than 2 years. I have severe osteoporosis from being on it for 8 years and I am only 32. Also, it causes progressive weight gain.

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