LARC!

CLINICAL GUIDANCE FROM ACOG!

  • 2017: Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. 
  • 2012: Long-acting reversible contraceptives (LARC) have higher efficacy, higher continuation rates, and higher satisfaction rates compared with short-acting contraceptives among adolescents who choose to use them. 

EFFICACY, DURATION, and CONTINUATION!

The etonogestrel implant (Nexplanon) appears to be effective up to 5 years and the levonorgestrel IUD (Mirena) up to 7 years.

The LARC discontinuation rate is ~15% with the most common reason for discontinuation being heavy bleeding.

  • What can be done?
    • Anticipatory guidance
    • Trial of ibuprofen 800mg TID (extrapolated from studies on celecoxib)
    • Trial of OCP 

Contraceptive continuation rates are higher with LARC (vs non-LARC methods) after 3 years of use. In a study of 4700+ women, after 3 years of use, continuation was 67.2% among LARC users and 31.0% among non-LARC users (see Kaplan Meier Survival Curve below and article for further discussion!)

 

Rates of continuation and satisfaction are also higher for LARC (vs non-LARC methods) after 12 months of use. In a study of 5000+ women, LARC users had higher 12-month continuation rates (86%) than OCP users (55%). Satisfaction mirrored continuation: more than 80% of users were satisfied with the IUD compared with 54% satisfied with OCPs.

When doctors pick their own birth control, IUDs are the most popular option. In fact, one study showed that 40% of 300+ female family planning providers used LARC methods (vs 12% of the general population!)


 

Non-contraceptive benefits of progestin IUD:

  • improves menorrhagia 
  • helps endometriosis
  • associated with ⅓ decreased risk of cervical cancer

Rare complications: 

  • expulsion (5%)
  • ectopic pregnancy
  • perforation / wandering IUD
  • procedural pain

TAKE-HOME POINTS!

  • LARCs are effective and have high satisfaction rates
  • After Nexplanon: anticipatory guidance, NSAIDs, and maybe OCPs
  • IUDs have ringing endorsement of clinicians
  • Progestin IUDs may reduce menorrhagia and risk of cervical cancer
  • 5, 7, 10: Nexplanon, Mirena, Paragard

*Blog post based on Med-Peds Forum talk by Justin Berk, MP Core Faculty