Long-acting reversible contraceptives
Long-acting reversible contraceptives (LARC) | |
---|---|
Background | |
Type | Various (includes hormonal and non-hormonal options) |
First use | ? |
Pregnancy rates (first year) | |
Perfect use | ? |
Typical use | ? |
Usage | |
Reversibility | Yes |
User reminders | ? |
Advantages and disadvantages | |
STI protection | No |
Long-acting reversible contraceptives (LARC) are methods of
LARCs are convenient, enjoyable and cost effective.
LARCs are recommended to
Methods
LARC methods include IUDs and the subdermal implant:[7]
- Mirena and others, also known as IUC and IUS)[8]
- Nonhormonal ParaGardand others)
- Subdermal Norplant/Jadelle)
Some shorter-acting methods are sometimes considered LARC:
- Progestogen-only injectable contraceptive[8]
- Combined injectable contraceptive
Medical use
The effectiveness of LARC methods has been shown to be superior to other types of birth control.[9][10] A study in 2012, with the largest cohort of IUD and implant users to date, found that the risk of contraceptive failure for those using oral contraceptive pills, the birth control patch, or the vaginal ring was 17 to 20 times higher than the risk for those using long-acting reversible contraception.[10] For those under 21, who typically have lower adherence to drug regimens, the risk is twice as high as the risk among older participants.[10] A statistically significant association has been observed in England between a decrease in teenage conception and increased LARC usage.[11]
The discrepancy between LARC methods and other forms of birth control lies in the difference between "perfect use" and "typical use". Perfect use indicates complete adherence to medication schedules and guidelines. Typical use describes effectiveness in real-world conditions, where patients may not fully adhere to medication regimens. LARC methods require little to no user action after insertion; therefore, LARC perfect use failure rates are the same as their typical use failure rates.[12] LARC failure rates rival that of sterilization, but unlike sterilization LARC methods are reversible.[12] Other reversible methods, such as oral contraceptive pills, the birth control patch, or the vaginal ring require daily, weekly, or monthly action by the user. While the perfect use failure rates of those methods may equal LARC methods, the typical use failure rates are significantly higher.[13] Even methods such as the DMPA injection require users to return to their provider every 12 weeks for the intramuscular shot or every 4 weeks for the subcutaneous shot. So, DMPA typical use failure rates are also higher than perfect use failure rates as more than 40% of women discontinue DMPA in the first year.[14] In both effectiveness and continuation, LARC methods are considered the first-line option for contraception.[10]
Side effects
Contraceptive implants may cause irregular bleeding which some women find unacceptable as a side effect[15] ("Irregular bleeding and spotting common in first 6 months" associated with IUS; similar to side effects observed with IUD, injection or implant. "Changes in bleeding pattern which are likely to remain irregular")[16] or a complete cessation of menstrual flow (amenorrhea). Side effects that are observed less often may include emotional lability, weight gain, headache, and acne.[17]
Side effects for LARC are mostly similar to
Society and culture
Cost and benefit
LARC methods traditionally have a higher up-front cost, between $800 and $900 in the United States,
The Colorado Family Planning Initiative (CPFI), a six-year $23 million privately funded program to expand access to LARCs, decreased unplanned adolescent pregnancies in the state by about 40% and returned $5.85 in savings for each dollar spent. There was a similar decline of unplanned pregnancies in unmarried women under 25 who have not finished high school, another at risk group. Use of LARC methods by children of child-bearing age in the state increased to 20% during the 2009–2014 period.[19] A 2017 study found that CPFI "reduced the teen birth rate in counties with clinics receiving funding by 6.4 percent over five years. These effects were concentrated in the second through fifth years of the program and in counties with relatively high poverty rates."[26]
Promotion
LARC usage[27] | |
---|---|
Russia | 32% |
France | 27% |
Austria | 23% |
Georgia | 23% |
Bulgaria | 18% |
Germany | 11% |
Romania | 10% |
United States | 10% |
Australia | 7% |
The United Kingdom Department of Health has actively promoted LARC use since 2008, particularly for young people;
The use of long-acting reversible contraceptives in the United States has increased nearly fivefold from 1.5% in 2002 to 7.2% in 2011–2013.[31] Increasing access to long-acting reversible contraceptives was listed by the Centers for Disease Control and Prevention as one of the top public health priorities for reducing teen pregnancy and unintended pregnancy in the United States.[32] One study of female family planning providers showed that they were significantly more likely to use LARCs than the general population (41.7% compared to 12.0%) suggesting that the general population has less information or access to LARCs.[33]
Guidelines released in 2009 by the
References
- ^ PMID 21668037.
- ^ "Contraception | Reproductive Health | CDC". Centers for Disease Control and Prevention. 22 April 2020. Retrieved 5 May 2020.
- ^ PMID 20634208.
- ^ PMID 25266430.
LARC methods should be considered first-line contraceptive choices for adolescents.
- PMID 22764557.
- PMID 19641264.
- ^ "Overview | Long-acting reversible contraception | Guidance | NICE". nice.org.uk. July 2019. Retrieved 24 November 2019.
- ^ a b c d Your guide to long-acting reversible contraception (LARC) Archived 28 October 2020 at the Wayback Machine. www.fpa.org.uk. Public Health England.
- PMID 18372257, archived from the originalon 2 December 2008
- ^ S2CID 16812353
- PMID 25473316.
- ^ a b Trussel, J (2007), ""Effectiveness of Long-Acting Reversible Contraception" In:Hatcher, RA; Nelson, TJ; Guest, F; Kowal, D.", Contraceptive Technology (19th ed.), New York: Ardent Media
- PMID 18082661
- PMID 21508749
- ^ "Managing Clinical Complexities of Long-Term Contraception". Medscape. Retrieved 27 February 2016.
- ^ a b c d e f "UKMi Guidance: Long-acting reversible contraception (update)" (PDF). NHS. Retrieved 23 November 2014.
- ^ PMID 25266435. Retrieved 7 July 2015.)
For adolescents who need highly effective contraception that is user- and coitus-independent, the implant is an outstanding choice.
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: CS1 maint: multiple names: authors list (link - PMID 19913155.
- ^ a b Sabrina Tavernise (5 July 2015). "Colorado's Effort Against Teenage Pregnancies Is a Startling Success". The New York Times. Retrieved 7 July 2015.
The state health department estimated that every dollar spent on the long-acting birth control initiative saved $5.85 for the state's Medicaid program, which covers more than three-quarters of teenage pregnancies and births.
- ^ PMID 21506736
- PMID 24576791.
- PMID 17963860
- PMID 20541171
- PMID 25271604.
- ^ Udeh, B; Losch, M; Spies, E (2009), The Cost of Unintended Pregnancy in Iowa: A Benefit-Cost Analysis of Public Funded Family Planning Services, The University of Iowa Public Policy Center
- ISSN 1945-7731.
- PMID 25040454.
- ^ "Increasing use of long-acting reversible contraception". Nursing Times.net. 21 October 2008. Retrieved 19 June 2009.
- ^ "CG30 Long-acting reversible contraception: quick reference guide" (PDF). National Institute for Health and Clinical Excellence. Archived from the original (PDF) on 20 September 2009. Retrieved 19 June 2009.
- ^ "Sexual Health Ruleset" (PDF). New GMS Contract Quality and Outcome Framework – Implementation Dataset and Business Rules. Primary Care Commissioning. 1 May 2009. Retrieved 19 June 2009.
Summarised at
* "Contraception – Management QOF indicators". NHS Clinical Knowledge Summaries. NHS Institute for Innovation and Improvement. Archived from the original on 9 July 2012. Retrieved 19 June 2009. - PMID 25714042.
- ^ "Public Health Priorities". Centers for Disease Control and Prevention. 20 September 2011.
- PMID 25722074.
- ^ ACOG Committee Opinion 450 (December 2009). "Increasing the Use of Contraceptive Implants and Intrauterine Devices To Reduce Unintended Pregnancy". American Congress of Obstetricians and Gynecologists. Archived from the original on 2 May 2012. Retrieved 28 June 2012.
{{cite web}}
: CS1 maint: numeric names: authors list (link) - ^ "U.S. Medical Eligibility Criteria for Contraceptive Use, 2010" (PDF). Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. 28 May 2010.
External links
- UK National Health Service Long-acting Reversible Contraception Guidelines
- Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception[permanent dead link]
- Increasing Use of Contraceptive Implants and Intrauterine Devices To Reduce Unintended Pregnancy from the American Congress of Obstetricians and Gynecologists