control patch, or the vaginal ring require daily, weekly, or monthly action by the user. While the perfect use failure rates of those methods may equal LARC methods, the typical use failure rates are significantly higher. Even methods such as the DMPA injection require users to return to their provider every 12 weeks for the intramuscular shot or every 4 weeks for the subcutaneous shot. So, DMPA typical use failure rates are also higher than perfect use failure rates as more than 40% of women discontinue DMPA in the first year. In both effectiveness and continuation, LARC methods are considered the first-line option for contraception. Side effects Contraceptive implants may cause irregular bleeding which some women find unacceptable as a side effect ("Irregular bleeding and spotting common in first 6 months" associated with IUS; similar to side effects observed with IUD, injection or implant. "Changes in bleeding pattern which are likely to remain irregular") or a complete cessation of menstrual flow (amenorrhea). Side effects that are observed less often may include emotional lability, weight gain, headache, and acne. Side effects for LARC are mostly similar to combined and progesterone only oral contraceptives, with a possibility of a small change in mood or libido observed in IUD and IUS use. The risk of acne vulgaris may be higher in IUS users, but is an uncommon reason for stopping use. Weight gain has been observed with depot medroxyprogesterone acetate (Depo-Provera). IUDs present a slight risk of infection at the time of insertion but have a low risk of pelvic inflammatory disease (<1% for women at low risk of STIs), and uterine perforation (<1 in 1000). If a person becomes pregnant while they have an IUD inserted then the IUD should be removed within the first 12 weeks of gestation. In such a case, the mother has low risk of ectopic pregnancy – approximately 1 in 20. Women who cease using depot medroxyprogesterone acetate can find that they have a delay of up to a year before being able to get pregnant, while there is no evidence of a delay in IUD, IUS or implant users. Society and culture Cost and benefit LARC methods traditionally have a higher up-front cost, between $800 and $900 in the United States, than methods such as pills, patches and vaginal rings, but are more cost-effective in the long run. Like all contraceptive methods, access to LARC methods