Promoting the Use of Long-Acting Reversible Contraceptives

Special Issue Article: Female Contraception: Types, Effectiveness and Side Effects

Austin J Obstet Gynecol. 2014;1(6): 6.

Promoting the Use of Long-Acting Reversible Contraceptives

Edith Weisberg1,2,*

1Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Australia

1Sydney Centre for Reproductive Health Research, FPNSW, Australia

*Corresponding author: Edith Weisberg, Sydney Centre for Reproductive Health Research, FPNSW, 228-236 Liverpool Road, Ashfield 2131, Sydney 2131, Australia

Received: August 19, 2014; Accepted: October 04, 2014; Published: October 09, 2014


Long-acting reversible contraceptives (LARC) have the advantage of high efficacy associated with long duration of action. They include progestogen-only sub-dermal implants, intrauterine systems and copper releasing intra-uterine devices. Although LARC have obvious benefits both for women and the community it is apparent that there is a general lack of knowledge about these methods. In order to increase the use of LARC it is important that both women and health providers have accurate information about these methods. Ensuring clinicians have adequate training in the use of, counselling and insertion of both implants and IUD/IUS through ongoing education will improve access. Availability of same day insertion for women requesting this and encouraging insertion immediately post-abortion or early in the post-partum will also improve access.

However, it is important that women's autonomy to decide about which method of contraception to use is respected despite the emphasis being placed on increasing the use of LARC.

This manuscript will provide information about LARC and discuss barriers to their use and strategies for increasing use.

Keywords: Long-acting contraception; Implants; Intrauterine system; Intrauterine device; Efficacy; lifespan; Barriers; Promotion


LARC: Long-acting Reversible Contraceptives; LNG: Levonorgestrel; ENG: etonogestrel; IUS: Intrauterine System; IUD: Intrauterine Device; Cu: Copper; μg: microgram; COC: Combined Oral Contraceptive;ACOG: American College of Obstetricians and Gynecologists; PID: Pelvic Inflammatory Disease


An ideal contraceptive method would be: 100% effective, readily reversible, easy to use, not interfere with sexual pleasure, cheap, readily available, without side effects and have additional health benefits. Although many of these attributes have been achieved with the range of methods now available there is no contraceptive which is 100% effective and has no side effects.

Long-acting reversible contraceptives (LARC), which include transdermal implants and intra-uterine systems (IUS) and devices (IUD) come close to the ideal in being almost 100% effective, readily reversible with rapid return of fertility. They require no action on the part of the user once inserted, do not interfere with sexual pleasure and alsohave some health benefits.Despite these obvious advantages LARC worldwide are underutilised [1,2] although they are being promoted as first-line contraceptives [3,4].

The development of these new delivery systems, transdermal, and intrauterine was prompted by the high unintended pregnancy rates in users of COCs (2-6%) [5], mainly due to the difficulties busy women have in adhering to a daily intake schedule.The implants and the IUS are progestogen-only methods which were developed to avoid the risk of VTE associated with oestrogen use and to improve compliance.Once inserted, they have lifespans between 3-5 years and require no further action on the part of the user. These newer hormonal methods use technology with a steady release rate over 24 hours, enabling lower doses to be used and providing more stable blood levels than the daily fluctuations produced by COCs [6]. The steady release rates mean that lower doses are required which still provide efficacy rates equivalent to sterilisation. They are suitable for women in whom estrogen is contraindicated (Table 1). The major disadvantage is that all progestogen-only methods cause changes to the menstrual cycle including poor cycle control so that women require careful counselling prior to use [7].