LARC and Reproductive Choice

October 24, 2017

Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) today issued an updated Practice Bulletin, “Long-Acting Reversible Contraception: Implants and Intrauterine Devicesoutlining new key data on the safety of long-acting reversible contraception (LARC), the most effective, reversible contraceptive methods available. ACOG’s guidance aligns with the Centers for Disease Control and Prevention’s Medical Eligibility Criteria Categories for Hormonal Contraceptives and Intrauterine Devices and the American Academy of Pediatrics’ recommendations for adolescent patients.

Today, patients can choose from five different intrauterine devices (IUDs), the non-hormonal copper IUD or four different levonorgestrel containing IUDs, each with varying levels of hormone. The Practice Bulletin reviews evidence on the safety and efficacy of each of the devices, how they function to prevent pregnancy and their duration of effectiveness. Like all other FDA-approved contraceptive methods, the document notes that IUDs are not abortifacients and do not disrupt pregnancy.

More options make it easier for patients to find an IUD or implant suited to their needs. A discussion of the full range of LARC methods available should be a part of any contraceptive counseling with eligible patients, including adolescents and women who have never given birth. For many patients, LARC presents an advantage by eliminating the need for daily medication, frequent pharmacy visits and ongoing attention to preventing unintended pregnancy.

 “We have many more contraception options for women of all ages and life stages, especially in the realm of LARC” said Practice Bulletin author, Eve Espey, M.D. “Many patients may not know they’re a good fit for an IUD or implant, or that IUDs now come in varying sizes and hormone levels.  Counseling will help women to align their contraceptive choice with other health care priorities, whether that’s preventing pregnancy during adolescence or making a plan for contraceptive use following pregnancy.”

Ob-gyns should also be aware that new data supports extended use for some methods of LARC. Copper IUDs have been shown to be effective for up to 12 years. Likewise, studies concluded that some hormonal IUDs and the contraceptive implant are effective beyond their initial FDA-approved labeling.

The Practice Bulletin provides detailed guidance about the best timing for initiating LARC, and in what circumstances a patient should be advised to use backup contraception. Appropriate opportunities to complete LARC insertions may be immediately postpartum or following induced abortion or early pregnancy loss. By coordinating placement of an IUD or implant on the same day as another procedure or birth, patients can prevent unintended pregnancies and avoid the problems associated with barriers to returning for a follow-up contraceptive care visit, including travel, time off work, securing child care and/or additional costs. 

The Practice Bulletin and other ACOG guidance identify contraception as an essential part of women’s health care based on scientific research and clinical expertise. LARC remains among the safest and most effective contraceptive methods available to women.

“It’s vital that we continue to provide the most up-to-date scientifically-based information about the safety and efficacy of LARC and other contraceptive methods,” said Espey. “ACOG remains committed to ensuring every woman can access high quality, comprehensive contraceptive care.”

Practice Bulletin #186, “Long-Acting Reversible Contraception: Implants and Intrauterine Devices" will appear in the November issue of Obstetrics & Gynecology.

For more information on ACOG’s LARC program, please visit: www.acog.org/larc

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The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org