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