features of the LARC (long acting reversible contraception) methods to discuss with women
Last reviewed 01/2018
Features of the LARC methods to discuss with women
| Copper IUCD | IUS | Progestogen-only injection | Implant | |
| How it works | By preventing fertilisation and inhibiting implantation | Mainly by preventing implantation; sometimes by preventing fertilisation | Primarily by preventing ovulation | Primarily by preventing ovulation |
| Duration of use | 5-10 years for IUDs with 380 mm2 copper, depending on type Until contraception no longer needed if woman 40 years or more at time of insertion | 5 years Until contraception no longer needed if woman 45 years or more at time of insertion and does not have periods with IUS in place | Repeat injections needed every 12 weeks (DPMA) or 8 weeks (NET-EN) | 3 years |
| Failure rate | Fewer than 2 in 100 women over 5 years, for IUDs with at least 380 mm2 copper Expulsion occurs in fewer than 1 in 20 women in 5 years | Fewer than 1 in 100 women over 5 years Expulsion occurs in fewer than 1 in 20 women in 5 years | Fewer than 0.4 in 100 over 2 years; pregnancy rates lower for DPMA than NET-EN | Fewer than 1 pregnancy in 1000 implants fitted over 3 years |
| Effects on periods | Heavier bleeding and/or dysmenorrhoea likely | Irregular bleeding and spotting common in first 6 months Oligomenorrhoea or amenorrhoea likely by end of first year | Amenorrhoea common, and is more likely with DMPA than NET-EN, and with longer use; not harmful Persistent bleeding may occur | Bleeding patterns are likely to change during implant use. Bleeding may stop, become more or less frequent, or be prolonged. Dysmenorrhoea may be reduced |
| Other risks |
Up to 50% of women stop using IUDs within 5 years; most common reasons are unacceptable vaginal bleeding and pain Ectopic pregnancy: overall rates lower than with no contraception But if a woman becomes pregnant with IUD in situ, risk is about 1 in 20 so she should seek advice to exclude it Pelvic inflammatory disease: less than 1% for women at low risk of STI Uterine perforation: less than 1 in 1000 Change in mood or libido: may be a small effect, similar for IUD and IUS No evidence of effect on: Weight gain |
Up to 60% of women stop using the IUS within 5 years; most common reasons are unacceptable vaginal bleeding and pain, less common reason is hormonal (non-bleeding) problems Ectopic pregnancy: overall rates lower than with no contraception But if a woman becomes pregnant with IUS in situ, risk is about 1 in 20 so she should seek advice to exclude it Pelvic inflammatory disease: less than 1% for women at low risk of STI Uterine perforation: less than 1 in 1000 Change in mood or libido: may be a small effect, similar for IUD and IUS Acne: risk may be increased, but is an uncommon reason for stopping use No evidence of effect on: Weight gain |
Up to 50% of women stop using DMPA by 1 year; the most common reason is an altered bleeding pattern, such as persistent bleeding Weight gain: may be up to 2-3 kg over a year on DMPA Bone mineral density: DMPA use is associated with small loss; largely recovered when DMPA is stopped No evidence that fracture risk is increased No evidence of effect of DMPA on: Depression Acne Headaches |
Complications with insertion and removal are uncommon. Refer to the summary of product characteristics for a full list of risks |
| Return to fertility | No evidence of delay | No evidence of delay | Can take up to a year But women who do not want to get pregnant should start a different contraceptive as soon as they stop injections | No evidence of delay |
| Advice at time of fitting |
There may be pain and discomfort for a few hours and light bleeding for a few days Watch for symptoms of uterine perforation Follow-up visit after first menses or 3-6 weeks after insertion Return at any time if problems or to change method Check for threads regularly |
There may be pain and discomfort for a few hours and light bleeding for a few days Watch for symptoms of uterine perforation Follow-up visit after first menses or 3-6 weeks after insertion Return at any time if problems or to change method Check for threads regularly |
Return for next injection, or if problems | Refer to the summary of product characteristics |
Reference:
progestogen only implant (contraceptive)