Long acting reversible contraceptives

Clearinghouse Connector – October 2015

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Long acting reversible contraceptives (LARC) are methods of contraception that require administration less than once per month, can be removed or ‘reversed’, and should not affect long-term fertility. The term LARC usually refers to contraceptive implants (in Australia available as Implanon NXT®) which are inserted under the skin and provide contraceptive coverage for up to 3 years, and copper and hormonal intrauterine devices (IUDs) inserted into the uterus, which can be effective for up to 5-10 years.

LARC methods have few contraindications, are cost effective over time, and are generally appropriate for use by women of all ages. IUDs and implants are among the most effective forms of reversible contraception available.

Other benefits are associated with the use of LARC, especially for young women and those experiencing sexual and/or reproductive coercion. These include that following insertion, it is harder (though not impossible) for someone else to tell if you are using LARC methods. In addition, these contraceptives can be inserted immediately after an abortion or miscarriage, or while breastfeeding. The copper IUD is also extremely effective as emergency contraception. However, no form of contraception is 100 per cent effective or free from side-effects. While LARC methods are extremely effective in preventing pregnancy, unlike condoms they do not prevent sexually transmissible infections (STIs).

Despite the benefits of LARC methods compared with other forms of contraception, current uptake in Australia remains low (with recent studies indicating that less than 10 per cent of women in Australia use LARC methods). A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Doctors may be reluctant to prescribe these types of contraceptives because of uncertainty about their suitability, or due to a lack of training on insertion. Additional barriers for women accessing LARC methods include concerns around possible side-effects, and the initial cost. Greater understanding by GPs of the attitudes, experiences and concerns of women in relation to LARC methods could lead to more effective contraceptive use and more meaningful choice for women.

Additional research is required relating to the uptake and experiences of LARC methods by women with disabilities and Aboriginal women, acknowledging that contraceptive interventions occur within a social and historical context which has included state-sanctioned reproductive coercion, including forced contraception. Strategies for increasing LARC access should ensure that options for specific populations are not restricted, and that reproductive choice for all women is promoted.

Overview of different types of LARC

Your contraception choices The Royal Women’s Hospital (available in a number of languages), 2015

Contraception: It’s your choice Family Planning Victoria, 2015

Long-acting reversible contraception (LARC): IUD and implant American College of Obstetricians and Gynecologists, 2014

Uptake and barriers

Few Australian women use long-acting contraceptives, despite their advantages The Conversation, 2015

Victorian Rural Women’s Access To Family Planning Services Survey report Project of the Rural Services of the Women’s Health Association of Victoria, 2012

Factors predicting uptake of long-acting reversible methods of contraception among women presenting for abortion The Medical Journal of Australia, 2014

Menstrual manipulation for adolescents with disabilities American College of Obstetricians and Gynecologists, 2009

Common threads : the sexual and reproductive health experiences of immigrant and refugee women in Australia Multicultural Centre for Women’s Health (MCWH), 2012

Long acting reversible contraception, young women and social norms Centre for Public Health, Liverpool John Moores University, 2014

Leveling the playing field : the promise of long-acting reversible contraceptives for adolescents Guttmacher Policy Review, 2013

Victorian context

Victorian GPs being trained to discuss with women long term contraceptive implants The Age, January 2015

Contraception and substance use : practical advice for women The Royal Women’s Hospital, 2014

Long acting reversible contraception position statement Family Planning Alliance Australia, 2014

Use by young women

Long-acting reversible contraception for adolescents Current Opinions in Obstetrics and Gynecology, 2015

Factors associated with contraceptive satisfaction in adolescent women using the IUD Journal of Pediatric and Adolescent Gynecology, 2015

Understanding the low uptake of long-acting reversible contraception by young women in Australia : a qualitative study BioMed Central Women’s Health, 2015

Resources for health professionals

Long acting reversible contraception The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2014

Effectiveness of long acting reversible contraception New England Journal of Medicine 2012

Game change in Colorado : widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women Perspectives on Sexual and Reproductive Health, 2014

The impact on women’s health of climatic and economic disaster : position paper Australian Women’s Health Network (AWHN), 2014

Women or LARC first? : reproductive autonomy and the promotion of long-acting reversible contraceptive methods Perspectives on Sexual and Reproductive Health, 2014

Common threads, common practice : working with immigrant and refugee women in sexual and reproductive health : best practice guide Multicultural Centre for Women’s Health, 2012

Current contraceptive management in Australian general practice : an analysis of BEACH data The Medical Journal of Australia, 2012

The efficacy of intrauterine devices for emergency contraception : a systematic review of 35 years of experience Human Reproduction, 2012

Contraception : common issues and practical suggestions Australian Family Physician, 2012

Promoting the use of long-acting reversible contraceptives Austin Journal of Obstetrics and Gynecology, 2014

International studies

Who is using long-acting reversible contraceptive methods? : findings from nine low-fertility countries Perspectives on Sexual and Reproductive Health, 2014

Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand Contraception, 2010

Injectable contraception provided by community-based health workers : one important step toward meeting unmet need Global Health, Science and Practice, 2013

Trends in long-acting reversible contraception use among U.S. women aged 15-44 National Centre for Health, 2015

The continuation rates of long-acting reversible contraceptives in UK general practice using data from The Health Improvement Network Pharmacoepidemiology and Drug Safety, 2015

RISUG: an intravasal injectable male contraceptive The Indian Journal of Medical Research, 2014

Statement of Policy, Global Women’s Health and Rights, American Congress of Obstetricians and Gynaecologists Reaffirmed 2015

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