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Feature Article Obstetrics and gynaecology
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A practical guide to contraception. Part 2: Long-acting reversible methods

Caroline Harvey, Kathleen McNamee, Mary Stewart
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Abstract
Women using long-acting reversible methods of contraception – the contraceptive implant, copper and hormonal intrauterine devices and the contraceptive injection – have a lower risk of unintended pregnancy compared with those using oral contraceptive pills, the vaginal ring or barrier methods.
Key Points
  • Long-acting reversible methods of contraception (LARCs) are acceptable to women and can offer cost-effective ‘fit and forget’ contraception.
  • The longest acting LARCs, the contraceptive implant and intrauterine devices (IUDs), have very similar efficacies in typical and perfect use.
  • There are few absolute orrelatively strong contraindications to LARCs, and few serious risks associated with their use.
  • The efficacies of depot medroxyprogesterone acetate injections and IUDs are not affected by the concurrent use of medications that induce liver enzymes.
  • Use of LARCs has not been shown to have a long-term effect on fertility once the method has been stopped.
  • Include a discussion of the benefits of LARCs when women present for renewal of oral contraceptive pill or vaginal ring scripts.
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