LARC (IUDs and Implants): A Complete Guide for Indian Women

• LARC = copper IUD, hormonal IUS (Mirena/Eloira/Kyleena) and the arm implant — all are over 99% effective because there's no daily action to forget.
• The copper IUD is hormone-free and lasts about 10 years; it usually makes periods heavier. The hormonal IUS lasts 5–7 years and usually makes periods lighter or stops them.
• The arm implant lasts 3 years and is one of the most effective methods ever made; unpredictable spotting in the first months is the main downside.
• WHO, FOGSI and ACOG now confirm IUDs are appropriate for women who have never had children, including teenagers — the old 'only after a baby' rule is retired.
• Fertility returns within days to weeks of removal — LARC does not harm your future ability to conceive.
• In India the copper IUD is free at government health centres (PHCs); the hormonal IUS and implant are mostly private-pay.

LARC stands for long-acting reversible contraception. The label exists to draw a clear line between methods that need consistent user action — a daily pill, a weekly patch, a condom every time — and methods that quietly protect you for years from one procedure. The usual cut-off is three or more years of protection per insertion.

By that definition, three methods are true LARC in India:

• Copper IUD — a non-hormonal device in the uterus, effective for about 10 years.
• Hormonal IUS — a levonorgestrel-releasing device in the uterus (Mirena 5–7 years, Eloira 5 years, Kyleena 5 years, Jaydess 3 years).
• Etonogestrel implant — a small rod under the skin of the upper arm, effective for 3 years.

The copper IUD has been the backbone of India's family-planning programme for decades and is the most widely used reversible method in the country after condoms. The standard device, Cu-T 380A, is a small T-shaped frame about 3 cm wide wrapped with 380 sq mm of copper. Multiload Cu-375 is an anchored alternative often preferred in private clinics. Both are licensed for roughly 10 years.

It works without any hormones. Copper ions released into the uterus impair sperm movement and survival, and the body's mild reaction to the device creates an environment that is hostile to sperm and to implantation. It is one of the most effective methods available, with fewer than 1 pregnancy per 100 women per year — yet it is also the cheapest LARC.

In the public system the Cu-T 380A is given free at primary and community health centres, district hospitals and ASHA-supported camps in every state. It can also be placed within 48 hours of delivery (the postpartum IUCD or PPIUCD programme), free at most government delivery centres. In private gynaecology practice the device costs around Rs 500–1,500, with insertion fees of Rs 500–3,000.

The main trade-off is your period. Menstrual flow typically increases by around half in the first few cycles and stays somewhat heavier than before, and cramps can be stronger early on, often easing over time. Occasional spotting between periods can happen at first. The device slips out (expulsion) in about 2–5% of users in the first year — more common in women who haven't had children and after postpartum insertion — so it's worth knowing the signs of an IUD that has moved or come out. Perforation of the uterine wall at insertion is rare (about 1 in 1,000). For the full picture, see our deep dive on the copper IUD.

The levonorgestrel-releasing intrauterine system is the hormonal cousin of the copper IUD, and it gives a very different period experience. Mirena (52 mg levonorgestrel, licensed 5–7 years) is the original. Eloira, made in India by Pregna International, carries the same 52 mg dose at a lower price — roughly Rs 8,000–15,000 against Mirena's Rs 13,000–18,000. Kyleena has a smaller frame and lower dose and is available at select metro centres. All are licensed for and routinely used in women who have never had children.

The IUS releases a tiny, steady amount of progestin (about 20 mcg a day) directly into the uterus. This thickens cervical mucus so sperm can't get through and thins the uterine lining. Because almost all the hormone stays local, the amount reaching the bloodstream is very low — so systemic effects like breast tenderness, mood changes or weight gain are less common than with the pill, the implant or the injection.

The effect women notice most is dramatically lighter bleeding. By six months, around 1 in 5 Mirena users have no periods at all; by five years that rises to about 4 in 10, and the rest have very light, infrequent bleeds. This is why FOGSI recommends the hormonal IUS as a first-line treatment for heavy menstrual bleeding in women who also want contraception — one device treats both.

Insertion is the same quick outpatient procedure as the copper IUD. The catch is the first 3–6 months, when irregular spotting is common as the lining settles — this is the most frequent reason for early removal, and knowing it's expected and temporary helps women stay with the method. Fertility returns within a cycle or two of removal. For a side-by-side comparison, see copper versus hormonal IUD in India.

The etonogestrel implant is a flexible rod about the size of a matchstick, placed just under the skin of the upper arm. It is among the most effective contraceptives ever developed — fewer than 1 pregnancy per 1,000 women per year. The brands you'll see are Implanon NXT and Nexplanon (the same device; Nexplanon adds a marker visible on X-ray). In India it's stocked mainly at larger private and corporate hospitals at around Rs 15,000–25,000 for the device plus Rs 1,000–3,000 to insert.

Insertion takes about five minutes under local anaesthetic: the clinician numbs a spot on your non-dominant upper arm, slides the rod in with a pre-loaded applicator, and covers the site with a small dressing. You can feel the rod under the skin afterwards, and you're taught to check for it. Removal at three years (or sooner) is a slightly longer procedure through a tiny incision.

Unlike the IUDs, the implant works mainly by stopping ovulation altogether, with thickened cervical mucus as back-up. No egg is released in over 99% of cycles in the first two years.

The main thing to expect is an unpredictable bleeding pattern in the first 3–6 months. By one year, roughly 1 in 5 women have no periods, others have light or infrequent bleeding, and a minority have prolonged or frequent bleeding. This unpredictability is the most common reason women have it removed early, so honest counselling beforehand matters. Fertility returns fast — ovulation usually resumes within three weeks of removal, and pregnancy in the first month is entirely possible. For more, see our guides to the birth control implant and the implant in the Indian context.

For years, Indian counselling wrongly restricted IUDs to women who had already had a child, based on outdated fears about insertion and infection. That restriction has been formally retired for over a decade. The WHO Medical Eligibility Criteria now classify both the copper IUD and the hormonal IUS as appropriate (Category 2) for women who have never been pregnant, and FOGSI has aligned with this. ACOG goes further, naming LARC the recommended first-line method for adolescents who choose contraception — because real-world pill adherence is hardest in this group, and switching to LARC sharply cuts unplanned pregnancy.

The implant has never had a parity restriction and suits women without children, including teens.

Breastfeeding women can use all three methods. The progestin-only IUS and implant do not affect milk supply, and the copper IUD has no hormones at all — see contraception while breastfeeding. It's the estrogen-containing combined pill, not LARC, that carries the breastfeeding caution.

Women spacing pregnancies are ideal candidates, because fertility returns the same cycle after removal. Women who have completed their family but don't want surgery often find that one copper IUD or hormonal IUS carries them through to perimenopause.

Key contraindications. The copper IUD should be avoided with active pelvic infection, unexplained vaginal bleeding, certain uterine-shape problems, known pregnancy, or Wilson's disease. The hormonal IUS and implant share the bleeding caution and also shouldn't be used with current or recent breast cancer or severe liver disease. Your clinician will check the WHO criteria for any borderline situation.

IUD and hormonal IUS insertion is a 5–15 minute outpatient procedure. You'll lie back as for a routine pelvic exam. The clinician examines your uterus, places a speculum, cleans the cervix, measures the depth of the uterine cavity, then passes the loaded device through the cervix to sit at the top of the uterus. The threads are trimmed to about 3 cm so you can later feel them on a self-check. The speculum comes out and you're done.

Pain varies. Many women feel a sharp cramp as the device is placed, fading to a dull ache over the next hour; some feel very little, and a few find it genuinely painful. Taking ibuprofen 400–600 mg with food about an hour beforehand helps, and a local anaesthetic block at the cervix is an option if you expect severe pain. Misoprostol to "soften" the cervix is no longer routinely advised, as trials show it doesn't reduce pain. Discuss pain-relief options with your doctor in advance.

Implant insertion is gentler: a quick numbing injection in the upper arm, then the rod is slid in through a tiny puncture in about five minutes. Bruising for a week or two is common.

Postpartum IUCD insertion happens within about 10 minutes of delivering the placenta for women who chose it antenatally. The expulsion rate is a bit higher than for an interval insertion, but having contraception in place before you go home is a real convenience — more in our guide to starting contraception after birth.

After insertion, plan for 30–60 minutes at the clinic, bring a sanitary pad, and take it easy for the rest of the day. Cramping usually fades over a few hours, and the first period afterwards is often heavier. A follow-up at 4–6 weeks confirms the device is correctly placed.

Every LARC method has an adjustment phase in the first 3–6 months. Knowing what's normal — and what isn't — prevents needless worry and premature removal.

Copper IUD: expect heavier, crampier periods at first. Flow rises by around half on average, usually settling into a predictable but heavier-than-before cycle by six months. If your periods were already heavy, iron-deficiency anaemia is a real risk, so iron supplementation may be advised. Flow heavy enough to disrupt daily life needs medical review.

Hormonal IUS: expect irregular light spotting in the first months as the lining adjusts, then a shift to very light or absent periods by six months. The light-or-no-bleeding outcome is exactly why many women choose it.

Implant: expect an unpredictable mix — some months light, some prolonged, some none. The pattern in the first three months doesn't reliably predict the long-term one, so it's worth waiting it out. If bleeding stays intolerable, removal and a switch is a perfectly reasonable choice.

The feature that sets LARC apart from sterilisation is how quickly and completely it reverses. When you're ready to stop — to conceive, to switch, or because you no longer need contraception — the device comes out at a clinic visit and fertility returns almost at once.

IUD and IUS removal takes 1–2 minutes: the clinician grasps the threads and gently withdraws the device, with mild cramping. If the threads aren't visible, a small instrument retrieves them. Ovulation usually returns the same or next cycle, and conception studies show outcomes identical to women who never used contraception.

Implant removal takes 5–10 minutes through a tiny incision under local anaesthetic. Ovulation typically resumes within three weeks.

A crucial reassurance: LARC does not harm future fertility. It does not use up your eggs, permanently alter your ovaries, or affect the uterus once removed. The fertility you have when you stop is the fertility you'd have had at that age anyway — our guide on what happens after stopping birth control explains this in detail.

The one exception is not a true LARC: the DMPA injection keeps releasing drug for months after the last shot, so the average time to pregnancy after stopping is around 10 months. That delay is unique to DMPA — the copper IUD, hormonal IUS and implant all return fertility quickly.

Access to LARC in India is shaped by a free public supply of the copper IUD, a limited supply of the hormonal IUS, and an entirely private market for the implant.

• Copper IUD: free at every PHC, community health centre and district hospital, including free postpartum insertion at government delivery centres. In private practice, Rs 500–1,500 for the device plus Rs 500–3,000 to insert. Over 10 years, the per-year cost is tiny.
• Hormonal IUS: Mirena Rs 13,000–18,000 and Eloira Rs 8,000–15,000 for the device, plus Rs 1,500–5,000 insertion, at private and corporate hospitals. Government supply is still limited. Over 5–7 years this works out to roughly Rs 1,500–3,500 per year for the device.
• Implant: Rs 15,000–25,000 plus Rs 1,000–3,000 insertion at private and corporate hospitals, with essentially no government supply. Over three years, the highest per-year cost of the three.

There is no single best LARC — the right one depends on your priorities, your periods, your access and your comfort with hormones. FOGSI, WHO, ACOG and RCOG all stress shared decision-making over a one-size-fits-all prescription.

Lean toward the copper IUD if you want a hormone-free method, the longest duration (about 10 years), the lowest cost, or you have reasons to avoid estrogen — and you can accept somewhat heavier, crampier periods.

Lean toward the hormonal IUS if you want much lighter or absent periods, you have heavy menstrual bleeding you'd like treated at the same time, and you're comfortable with a low-dose hormonal method.

Lean toward the implant if you want IUD-level effectiveness without a device in the uterus, or anatomical reasons make an IUD difficult, and you can tolerate an unpredictable bleeding pattern.

A non-LARC method may suit you better if you want more day-to-day control, haven't decided on long-term contraception, or want something you can stop yourself without a clinic visit — such as pills or barrier methods.

And remember: switching is always possible. Because LARC reverses quickly, you're never locked in. The right method is the one you can use consistently and feel comfortable with — and that choice may change at different stages of your life. If you're approaching your 40s, our guide to contraception in perimenopause covers what changes then.

• Severe or worsening lower abdominal or pelvic pain that doesn't settle.
• Fever, chills, or foul-smelling vaginal discharge (possible pelvic infection).
• You can no longer feel your IUD threads on self-check, or you feel the hard plastic of the device at the cervix.
• You can see or feel that the IUD has partly or fully come out.
• Bleeding far heavier or longer than the expected adjustment pattern, or bleeding with large clots.
• Symptoms of pregnancy (a missed period plus nausea or breast tenderness) while using any LARC.
• For the implant: you can no longer feel the rod under your skin, or the insertion site becomes red, hot or increasingly painful.

• WHO — Medical Eligibility Criteria for Contraceptive Use (5th edition)
• WHO — Family planning / contraception methods fact sheet
• ACOG — Long-Acting Reversible Contraception (IUD and Implant)
• NHS — Intrauterine device (IUD) and contraceptive implant
• Ministry of Health & Family Welfare, India — Family Planning (PPIUCD / IUCD guidance)
• FOGSI — The Federation of Obstetric and Gynaecological Societies of India