Efficacy and Safety of Long-Acting Reversible Contraception

Abstract

Long-acting reversible contraception (LARC) includes intrauterine devices (IUDs) and the subdermal implant. These methods are the most effective reversible methods of contraception, and have the additional advantages of being long-lasting, convenient, well liked by users and cost effective. Compared with other user-dependent methods that increase the risk of noncompliance-related method failure, LARC methods can bring ‘typical use’ failure rates more in line with ‘perfect use’ failure rates. LARC methods are ‘forgettable’; they are not dependent on compliance with a pill-taking regimen, remembering to change a patch or ring, or coming back to the clinician for an injection. LARC method failure rates rival that of tubal sterilization at <1% for IUDs and the subdermal implant. For these reasons, we believe that IUDs and implants should be offered as first-line contraception for most women. This article provides a review of the LARC methods that are currently available in the US, including their effectiveness, advantages, disadvantages and contraindications. Additionally, we dispel myths and misconceptions regarding IUDs, and address the barriers to LARC use.

The Use of ACOG Guidelines: Perceived Contraindications to IUD and Implant Use Among Family Planning Providers

“…Numerous studies have also documented the efficacy and safety of LARC (Bhathena and Guillebaud 2008;Brito et al 2012;Stoddard et al 2011). While there were previous fears about the suitability of LARC for adolescents, for immediate post-partum, and post-abortion insertions, ACOG guidelines now note that existing evidence does not substantiate these fears.…”

“…Immediate post-partum insertions among adolescents have been shown to be safe and to significantly reduce rapid repeat pregnancies (Tocce et al 2012). Another advantage of LARC methods is high patient satisfaction, high continuation rates, and low levels of contraceptive failure (Cheng 2000;Doyle et al 2008;Stoddard et al 2011;Tocce et al 2012).…”

Vulnerable birth mothers and repeat losses of infants to public care: is targeted reproductive health care ethically defensible?

“…Thus, controversy that raged about Norplant has given way to more mainstream medical concerns with 23 effectiveness and uptake of contraception (Stoddard et al, 2011;Baldwin and Edelman, 2013., Russo et al, 2013). Consensus in medical opinion is that the risks of rapid repeat pregnancy need to be balanced with and mostly outweigh risks associated with the prescription of LARC (Baldwin and Edelman, 2013).…”

Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices

“…Contraceptive failure rates for both copper intrauterine devices (IUDs) and levonorgestrel-releasing intrauterine systems (LNG IUSs) are among the lowest for reversible methods of contraception [1,2], with studies of various types showing rates of around 0.1-2.2 per 100 WY for copper IUDs and 0.1-0.6 per 100 WY for LNG IUSs [3][4][5][6][7][8][9][10]. The respective ectopic pregnancy rates range from 0.02-0.2 in LNG IUS users and from 0.1-0.8 in copper IUD users [3,4,8,11].…”