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Efficacy and Safety of Long-Acting Reversible Contraception

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Abstract

Long-acting reversible contraception (LARC) includes intrauterine devices (IUDs) and the subdermal implant. These methods are the most effective reversible methods of contraception, and have the additional advantages of being long-lasting, convenient, well liked by users and cost effective. Compared with other user-dependent methods that increase the risk of noncompliance-related method failure, LARC methods can bring ‘typical use’ failure rates more in line with ‘perfect use’ failure rates. LARC methods are ‘forgettable’; they are not dependent on compliance with a pill-taking regimen, remembering to change a patch or ring, or coming back to the clinician for an injection. LARC method failure rates rival that of tubal sterilization at <1% for IUDs and the subdermal implant. For these reasons, we believe that IUDs and implants should be offered as first-line contraception for most women. This article provides a review of the LARC methods that are currently available in the US, including their effectiveness, advantages, disadvantages and contraindications. Additionally, we dispel myths and misconceptions regarding IUDs, and address the barriers to LARC use.

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References

  1. Hatcher RA, Trussell J, Nelson AL, et al., editors. Contraceptive technology. 19th rev. ed. New York: Ardent Media, 2007: 120, 148–9, 759, 874

    Google Scholar 

  2. World Health Organization (WHO). Comparing typical effectiveness of contraceptive methods. Geneva: World Health Organization; 2006

    Google Scholar 

  3. Mosher WD, Jones J. Use of contraception in the United States: 1982–2008. Vital Health Stat 2010; 23(29): 1–44

    Google Scholar 

  4. Darney P, Patel A, Rosen K, et al. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril 2009; 91(5): 1646–53

    Article  PubMed  Google Scholar 

  5. Wenzl R, van Beek A, Schnabel P, et al. Pharmacokinetics of etonogestrel released from the contraceptive implant Implanon. Contraception 1998; 58(5): 283–8

    Article  PubMed  CAS  Google Scholar 

  6. Kiriwat O, Patanayindee A, Koetsawang S, et al. A 4-year pilot study on the efficacy and safety of Implanon, a single-rod hormonal contraceptive implant, in healthy women in Thailand. Eur J Contracept Reprod Health Care 1998; 3(2): 85–91

    Article  PubMed  CAS  Google Scholar 

  7. Affandi B, Korver T, Geurts TB, et al. A pilot efficacy study with a single-rod contraceptive implant (Implanon) in 200 Indonesian women treated for < or=4 years. Contraception, 1999; 59(3): 167–74

    Article  PubMed  CAS  Google Scholar 

  8. Van den Bosch T, Donders GG, Riphagen I, et al. Ultrasonographic features of the endometrium and the ovaries in women on etonogestrel implant. Ultrasound Obstet Gynecol 2002; 20(4): 377–80

    Article  PubMed  Google Scholar 

  9. Mäkäräinen L, van Beek A, Tuomivaara L, et al. Ovarian function during the use of a single contraceptive implant: Implanon compared with Norplant. Fertil Steril 1998; 69(4): 714–21

    Article  PubMed  Google Scholar 

  10. Funk S, Miller MM, Mishell Jr DR, et al. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception 2005; 71(5): 319–26

    Article  PubMed  CAS  Google Scholar 

  11. Ponpuckdee J, Taneepanichskul S. The effects of implanon in the symptomatic treatment of endometriosis. J Med Assoc Thai 2005; 88 Suppl. 2: S7–10

    PubMed  Google Scholar 

  12. Mansour D, Korver T, Marintcheva-Petrova M, et al. The effects of Implanon on menstrual bleeding patterns. Eur J Contracept Reprod Health Care 2008; 13 Suppl. 1: 13–28

    Article  PubMed  CAS  Google Scholar 

  13. Chikamata DM, Miller S. Health services at the clinic level and implantable contraceptives for women. Contraception 2002; 65(1): 97–106

    Article  PubMed  Google Scholar 

  14. Brache V, Faundes A, Alvarez F, et al. Nonmenstrual adverse events during use of implantable contraceptives for women: data from clinical trials. Contraception 2002; 65(1): 63–74

    Article  PubMed  CAS  Google Scholar 

  15. Harrison-Woolrych M, Hill R. Unintended pregnancies with the etonogestrel implant (Implanon): a case series from postmarketing experience in Australia. Contraception 2005; 71(4): 306–8

    Article  PubMed  Google Scholar 

  16. World Health Organization. Medical eligibility criteria for contraceptive use. 3rd ed. Geneva: S.W.H.O., Reproductive Health and Research, 2004

  17. Levine JP, Sinofsky FE, Christ MF. Assessment of Implanon insertion and removal. Contraception 2008; 78(5): 409–17

    Article  PubMed  Google Scholar 

  18. Association of Reproductive Health Professionals. Clinical proceedings: new developments in intrauterine contraception. Washington DC: Association of Reproductive Health Professionals, 2004

    Google Scholar 

  19. Mosher W, Jones J. Use of contraception in the United States: 1982–2008. National Center for Health Statistics. Vital Health Stat 2010; 23(29): 1–44

    Google Scholar 

  20. Sonfield A. Popularity disparity: attitudes about the IUD in Europe and the United States. Guttmacher Policy Rev 2007; 10: 19–24

    Google Scholar 

  21. Wang D. Contraceptive failure in China. Contraception 2002; 66(3): 173–8

    Article  PubMed  Google Scholar 

  22. Harper CC, Blum M, de Bocanegra HT, et al. Challenges in translating evidence to practice: the provision of intrauterine contraception. Obstet Gynecol 2008; 111(6): 1359–69

    Article  PubMed  Google Scholar 

  23. Tatum HJ, Schmidt FH, Phillips DM, et al. The Dalkon shield controversy: structural and bacteriologic studies of IUD tails. JAMA 1975; 231(7): 711–7

    Article  PubMed  CAS  Google Scholar 

  24. Svensson L, Westrom L, Mardh PA. Contraceptives and acute salpingitis. JAMA 1984; 251(19): 2553–5

    Article  PubMed  CAS  Google Scholar 

  25. Hubacher D, Lara-Ricale R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med 2001; 345(8): 561–7

    Article  PubMed  CAS  Google Scholar 

  26. Ory HW. Ectopic pregnancy and intrauterine contraceptive devices: new perspectives. The Women’s Health Study. Obstet Gynecol 1981; 57(2): 137–44

    CAS  Google Scholar 

  27. Pakarinen P, Toivonen J, Luukkainen T. Therapeutic use of the LNG IUS, and counseling. Semin Reprod Med 2001; 19(4): 365–72

    Article  PubMed  CAS  Google Scholar 

  28. ACOG Committee Opinion No. 392, December 2007. Intrauterine device and adolescents. Obstet Gynecol 2007; 110(6): 1493–5

    Google Scholar 

  29. McNaught J. Adolescents and IUCDs: not a contraindication. J Pediatr Adolesc Gynecol 2006; 19(4): 303–5

    Article  PubMed  Google Scholar 

  30. Brockmeyer A, Kishen M, Webb A. Experience of IUD/IUS insertions and clinical performance in nulliparous women: a pilot study. Eur J Contracept Reprod Health Care 2008; 13(3): 248–54

    Article  PubMed  Google Scholar 

  31. Peipert JF, Zhao Q, Allsworth JE, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol 2011; 117(5): 1105–13

    Article  PubMed  Google Scholar 

  32. Nilsson CG, Haukkamaa M, Vierola H, et al. Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD. Clinical Endocrinol 1982; 17: 529–36

    Article  CAS  Google Scholar 

  33. Sivin I, Stern J, Coutinho E, et al. Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS. Contraception 1991; 44(5): 473–80

    Article  PubMed  CAS  Google Scholar 

  34. Bengtson MB, Solberg IC, Aamodt G, et al. Relationships between inflammatory bowel disease and perinatal factors: both maternal and paternal disease are related to preterm birth of offspring. Inflamm Bowel Dis 2010; 16(5): 847–55

    Article  PubMed  Google Scholar 

  35. CDC. U S medical eligibility criteria for contraceptive use, 2010 [online]. Available from URL: http://www.cdc.gov [Accessed 2010 Oct 12]

  36. Andersson JK, Rybo G. Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia. Br J Obstet Gynaecol 1990; 97(8): 690–4

    Article  PubMed  CAS  Google Scholar 

  37. Baldaszti E, Wimmer-Puchinger B, Loschke K. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003; 67(2): 87–91

    Article  PubMed  CAS  Google Scholar 

  38. Hidalgo M, Bahamondes L, Perrotti M, et al. Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Contraception 2002; 65(2): 129–32

    Article  PubMed  CAS  Google Scholar 

  39. Jindabanjerd K, Taneepanichskul S. The use of levonorgestrel-IUD in the treatment of uterine myoma in Thai women. J Med Assoc Thai 2006; 89 Suppl. 4: S147–51

    PubMed  Google Scholar 

  40. Zapata LB, Whiteman MK, Tepper NK, et al. Intrauterine device use among women with uterine fibroids: a systematic review. Contraception 2010; 82(1): 41–55

    Article  PubMed  Google Scholar 

  41. ACOG Practice Bulletin: No. 110. Noncontraceptive uses of hormonal contraceptives. Obstet Gynecol 2010; 115 (1): 206–18

  42. Bahamondes L, Ribeiro-Huguet P, de Andrade KC, et al. Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Acta Obstet Gynecol Scand 2003; 82(6): 580–2

    PubMed  Google Scholar 

  43. Mechanism of action, safety and efficacy of intrauterine devices. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser 1987; 753: 1–91

    Google Scholar 

  44. Adoni A, Ben Chetrit A. The management of intrauterine devices following uterine perforation. Contraception 1991; 43(1): 77–81

    Article  PubMed  CAS  Google Scholar 

  45. ACOG Practice Bulletin No. 59, January 2005. Clinical management guidelines for obstetrician-gynecologists: intrauterine device. Obstet Gynecol 2005; 105 (1): 223–32

    Google Scholar 

  46. Walsh T, Grimes D, Frezieres R, et al. Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet 1998; 351(9108): 1005–8

    CAS  Google Scholar 

  47. Teisala K. Removal of an intrauterine device and the treatment of acute pelvic inflammatory disease. Ann Med 1989; 21(1): 63–5

    Article  PubMed  CAS  Google Scholar 

  48. Soderberg G, Lindgren S. Influence of an intrauterine device on the course of an acute salpingitis. Contraception 1981; 24(2): 137–43

    Article  PubMed  CAS  Google Scholar 

  49. Penney G, Brechin S, de Souza A, et al. FFPRHC guidance (January 2004). The copper intrauterine device as long-term contraception. J Fam Plann Reprod Health Care 2004; 30(1): 29–41; quiz 42

    Google Scholar 

  50. Zhou L, Xiao B. Emergency contraception with Multiload Cu-375 SL IUD: a multicenter clinical trial. Contraception, 2001; 64(2): 107–12

    Article  PubMed  CAS  Google Scholar 

  51. Alvarez F, Brache V, Fernandez E, et al. New insights on the mode of action of intrauterine contraceptive devices in women. Fertil Steril 1988; 49(5): 768–73

    PubMed  CAS  Google Scholar 

  52. United Nations Development Programme. Long-term reversible contraception: twelve years of experience with the TCu380A and TCu220C. Contraception 1997; 56(6): 341–52

    Google Scholar 

  53. Sivin I, Stern J, Diaz S, et al. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices. Am J Obstet Gynecol 1992; 166(4): 1208–13

    PubMed  CAS  Google Scholar 

  54. Vessey MP, Lawless M, McPherson K, et al. Fertility after stopping use of intrauterine contraceptive device [letter]. Br Med J (Clin Res Ed), 1983; 286(6359): 106

    Article  CAS  Google Scholar 

  55. Hubacher D, Grimes DA. Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv 2002; 57(2): 120–8

    Article  PubMed  Google Scholar 

  56. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception 2009; 79(5): 356–62

    Article  PubMed  CAS  Google Scholar 

  57. National Centre for Research Resources [online]. Available from URL: http://www.ncrr.nih.gov [Accessed 2011 Apr 12]

  58. National Institutes of Health [online]. Available from URL: http://nihroadmap.nih.gov [Accessed 2011 Apr 12]

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Acknowledgements

This work was supported in part by a Midcareer Investigator Award in Women’s Health Research (K24 HD01298) and by a Clinical and Translational Science Award (UL1RR024992) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.[57,58] The authors have no conflicts of interest that are directly relevant to the content of this review.

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Correspondence to Jeffrey F. Peipert.

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Stoddard, A., McNicholas, C. & Peipert, J.F. Efficacy and Safety of Long-Acting Reversible Contraception. Drugs 71, 969–980 (2011). https://doi.org/10.2165/11591290-000000000-00000

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  • DOI: https://doi.org/10.2165/11591290-000000000-00000

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