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Feature Article

An updated guide to contraception Part 2: Long-acting reversible methods

Caroline Harvey, Kathleen McNamee, Deborah Bateson, Mary Stewart

Figures

© image point fr/shutterstock
© image point fr/shutterstock

Abstract

This second article in an updated three-part series on contraception covers long-acting reversible methods – hormonal and copper-bearing intrauterine devices and the contraceptive implant – which are associated with a lower risk of unintended pregnancy than shorter-acting contraceptive methods. The contraceptive injection is no longer considered a long-acting reversible method, but it continues to play an important role for some women and is included in this article.

 

Key Points

  • Long-acting reversible contraception (LARC) methods are highly acceptable and offer cost-effective, efficacious contraception.
  • The contraceptive implant and intrauterine devices (IUDs) have similar high efficacies in both typical and perfect use.
  • There are few absolute or relative contraindications to LARC methods and few serious risks associated with their use.
  • Use of LARC has not been shown to have a long-term effect on fertility once the method has been stopped.
  • The depot medroxyprogesterone acetate (DMPA) injection is no longer considered a LARC method, because of its lower typical-use efficacy and lack of immediate reversibility, but it continues to play an important role for some women.
  • The efficacy of IUDs and the DMPA injection is not affected by the concurrent use of medications that induce liver enzymes.
  • The benefits of LARC methods should be discussed with women who present for renewal of oral contraceptive pill or vaginal ring prescriptions.

Figures

© image point fr/shutterstock
© image point fr/shutterstock