Feature Article

An update on contraception. Part 2: rings, implants and injections

Kathleen McNamee, Caroline Harvey

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Abstract

Long-acting reversible hormonal contraceptives are less prone to issues with compliance than the more commonly used combined pill and have great potential to reduce unplanned pregnancies. It is important to include a discussion of their use in routine contraceptive counselling and encourage uptake, particularly in women who are at high risk of unplanned pregnancies.

Key Points

  • A woman’s choice between the different contraceptive methods will be directed by a variety of factors including age, personal preference, cost, availability, fear of injections, tolerance of irregular bleeding, privacy needs, drug interactions and lactation.
  • Long-acting reversible contraceptives (LARCs) are underused in Australia. They are less prone to issues with compliance than the more commonly used combined pill and have great potential to reduce unplanned pregnancies.
  • LARCs such as the vaginal ring, etonogestrel implant and depot medroxyprogesterone acetate (DMPA) injection can be administered any time in a woman’s menstrual cycle as long as pregnancy has been excluded. They are immediately effective if initiated on day one to five of a normal cycle.
  • The vaginal ring, implant and DMPA injection have the advantage of a low user input once initiated, and all three methods can be used to treat dysmenorrhoea.
  • It is important to include a discussion of LARCs use in routine contraceptive counselling and encourage uptake, particularly in women who are at high risk of unplanned pregnancies.