Long-Acting Contraceptives

Research Review CPD-Accredited E-Learning Module

Begin

Long-Acting Contraceptives

This Research Review E-Learning Module is intended for New Zealand midwives and covers the benefits and management considerations relating to LARCs currently available in NZ. It is based on the Research Review Educational Series publication of the same name.


Before starting the module please read the Research Review Educational Series publication, accessed through the link below:

Long-Acting Contraceptives

The PDF can be viewed on screen, saved and printed through the link above.

This E-Learning Module covers:

  • Benefits of LARCs
  • LARC funding and use in New Zealand
  • Patient-centred contraceptive counselling
  • Levonorgestrel-releasing intrauterine systems
  • Copper intrauterine devices
  • Levonorgestrel implants
  • LARCs in specific patient populations

Learning outcomes

After completing this module, you should have an improved understanding of:

  • The benefits of LARCs
  • LARC funding and use in New Zealand
  • Patient-centred contraceptive counselling
  • Levonorgestrel-releasing intrauterine systems
  • Copper intrauterine devices
  • Levonorgestrel implants
  • LARCs in specific patient populations

Contributing experts

Expert commentary has been provided by consultant gynaecologist and Honorary Associate Professor Helen Roberts.

Module questions have been developed by Dr Chris Tofield who works part time in General Practice in Tauranga, New Zealand, is involved in clinical research and is a clinical advisor to the Bay of Plenty District Health Board.

Accreditation

“Long-Acting Contraceptives” E-Learning module is approved as continuing midwifery education by the Te Tatau o te Whare Kahu Midwifery Council.
Approval number: 2021CME005E

References

  1. Committee on Practice Bulletins-Gynecology Long-Acting Reversible Contraception Work Group. Practice Bulletin No. 186: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2017;130:e251-e69.
  2. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Long-acting reversible contraception. 2017. http://www.ranzcog.edu.au/college-statements-guidelines.html Accessed April 17, 2020.
  3. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83:397-404.
  4. Best Practice Advocacy Centre. Long-acting contraceptives: implants and IUDs. 2019. https://bpac.org.nz/2019/contraception/docs/long-acting.pdf Accessed April 17, 2020.
  5. McNicholas C, Madden T, Secura G, et al. The contraceptive CHOICE project round up: what we did and what we learned. Clin Obstet Gynecol. 2014;57:635-43.
  6. Peipert JF, Zhao Q, Allsworth JE, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011;117:1105-13.
  7. Birgisson NE, Zhao Q, Secura GM, et al. Preventing unintended pregnancy: the contraceptive CHOICE project in review. J Womens Health (Larchmt). 2015;24:349-53.
  8. Hubacher D, Spector H, Monteith C, et al. Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trial. Am J Obstet Gynecol. 2017;216:101-9.
  9. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility-follow-up after participation in a randomized clinical trial. Contraception. 2007;75:88-92.
  10. Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018;3:9.
  11. Bayer New Zealand Limited. MIRENA® 52 mg intrauterine contraceptive device: Data sheet. 2018. https://www.medsafe.govt.nz/profs/Datasheet/m/Mirenaius.pdf Accessed June 17, 2020.
  12. Bayer New Zealand Limited. JAYDESS® 13.5 mg intrauterine contraceptive device: Data sheet. 2018. https://www.medsafe.govt.nz/profs/Datasheet/j/jaydessIVD.pdf Accessed June 17, 2020.
  13. Bayer New Zealand Limited. JADELLE® subcutaneous implants levonorgestrel: Data sheet 2019. https://www.medsafe.govt.nz/profs/datasheet/j/Jadelleimplant.pdf Accessed June 17, 2020.
  14. Family Planning Alliance Australia. Long Acting Reversible Contraceptive (LARC): position statement. 2019. http://familyplanningallianceaustralia.org.au/larc/ Accessed Oct 18, 2019.
  15. Family Planning 2020. Global consensus statement for expanding contraceptive choice for adolescents and youth to include long-acting reversible contraception. 2019. https://www.familyplanning2020.org/sites/default/files/Global%20Consensus%20Statement%20-%20Expanding%20Contraceptive%20Choice.pdf Accessed Oct 18,2019.
  16. Australian Healthcare and Hospitals Association. Consensus statement: reducing unintended pregnancy for Australian women through increased access to long-acting reversible contraceptive methods. 2017. https://ahha.asn.au/sites/default/files/docs/policy-issue/larc_consensus_statement.pdf Accessed May 28, 2020.
  17. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 186 Summary: Long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2017;130:1173-5.
  18. Faculty of Sexual and Reproductive Healthcare. UK medical eligibility criteria for contraceptive use. 2019. https://www.fsrh.org/standards-and-guidance/uk-medical-eligibility-criteria-for-contraceptive-use-ukmec/ Accessed April 17, 2020.
  19. Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010;203:115 e1-7.
  20. National Institute for Health and Care Excellence. Long-acting reversible contraception: clinical guideline. 2019. www.nice.org.uk/guidance/cg30 Accessed April 17, 2020.
  21. Angelini K. A lower-cost option for intrauterine contraception. Nurs Womens Health. 2016;20:197-202.
  22. Matytsina-Quinlan LA. Jaydess audit standards and benefits. BMJ Sex Reprod Health. 2019.
  23. Trussell J, Hassan F, Henry N, et al. Cost-effectiveness analysis of levonorgestrel-releasing intrauterine system (LNG-IUS) 13.5 mg in contraception. Contraception. 2014;89:451-9.
  24. World Health Organization. Reproductive health and research - medical eligibility criteria for contraceptive use. 4th ed. Geneva: WHO; 2009.
  25. Faculty of Sexual and Reproductive Healthcare. Contraceptive choices for young people. 2019. https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-young-people-mar-2010/ Accessed April 30, 2020.
  26. Baldwin MK, Edelman AB. The effect of long-acting reversible contraception on rapid repeat pregnancy in adolescents: a review. J Adolesc Health. 2013;52:S47-53.
  27. Whitley CE, Rose SB, Sim D, et al. Association between women’s use of long-acting reversible contraception and declining abortion rates in New Zealand. J Womens Health (Larchmt). 2020;29:21-8.
  28. PHARMAC. Decision to widen access to levonorgestrel intrauterine (LIUS) systems (Mirena and Jaydess). 2019. https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/decision-to-widen-access-to-levonorgestrel-intrauterine-lius-systems-mirena-and-jaydess/ Accessed April 17, 2020.
  29. New Zealand Formulary. Copper intra-uterine device. 2020. https://nzf.org.nz/nzf_4233 Accessed April 17, 2020.
  30. Mazza D, Watson CJ, Taft A, et al. Increasing long-acting reversible contraceptives: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomized trial. Am J Obstet Gynecol. 2020;222:S921.e1-S.e13.
  31. Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil Steril. 2012;97:616-22 e1-3.
  32. Faculty of Sexual and Reproductive Healthcare. New product review from the clinical effectiveness unit: Jaydess® levonorgestrel intrauterine system (LNG-IUS). 2014. https://www.fsrh.org/standards-and-guidance/documents/new-product-review-levosert-intrauterine-delivery-system-april/ Accessed April 20, 2020.
  33. Lewis RA, Taylor D, Natavio MF, et al. Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. Contraception. 2010;82:491–6.
  34. Seeber B, Ziehr SC, Gschlieber A, et al. Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system. Contraception. 2012;86:345–9.
  35. French RS, Cowan FM, Mansour DJ, et al. Implantable contraceptives (subdermal implants and hormonally impregnated intrauterine systems) versus other forms of reversible contraceptives: two systematic reviews to assess relative effectiveness, acceptability, tolerability and cost-effectiveness. Health Technol Assess. 2000;4:i-vi, 1-107.
  36. PHARMAC. 2019. Decision to widen access to levonorgestrel intrauterine (LIUS) systems (Mirena and Jaydess). 2019. https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/decision-to-widen-access-to-levonorgestrel-intrauterine-lius-systems-mirena-and-jaydess/ Accessed June 23, June 2020.
  37. Abraham M, Zhao Q, Peipert JF. Young age, nulliparity, and continuation of long-acting reversible contraceptive methods. Obstet Gynecol. 2015;126:823-9.
  38. Faculty of Sexual and Reproductive Healthcare. FSRH clinical guideline: intrauterine contraception. 2019. https://www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception/ Accessed April 29, 2020.
  39. Faculty of Sexual and Reproductive Healthcare. UKMEC - Summary table hormonal and intrauterine contraception. 2019. https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets Accessed June 15, 2020.
  40. Holland MK, White IG. Heavy metals and human spermatozoa. III. The toxicity of copper ions for spermatozoa. Contraception. 1988;38:685-95.
  41. Hsia JK, Creinin MD. Intrauterine contraception. Semin Reprod Med. 2016;34:175-82.
  42. Goodfellow Unit. Intrauterine contraceptive devices. Auckland: University of Auckland; 2019.
  43. Sanders JN, Adkins DE, Kaur S, et al. Bleeding, cramping, and satisfaction among new copper IUD users: A prospective study. PLoS One. 2018;13:e0199724.
  44. Diedrich JT, Desai S, Zhao Q, et al. Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction. Am J Obstet Gynecol. 2015;212:50.e1-8.
  45. Barnett C, Moehner S, Do Minh T, et al. Perforation risk and intra-uterine devices: results of the EURAS-IUD 5-year extension study. Eur J Contracept Reprod Health Care. 2017;22:424-8.
  46. Heinemann K, Reed S, Moehner S, et al. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015;91:274-9.
  47. Kaislasuo J, Suhonen S, Gissler M, et al. Uterine perforation caused by intrauterine devices: clinical course and treatment. Hum Reprod. 2013;28:1546-51.
  48. Planning F. IUD insertion training. 2020. https://www.familyplanning.org.nz/courses/course?id=12 Accessed June 15, 2020.
  49. Wan LS, Stiber A, Lam LY. The levonorgestrel two-rod implant for long-acting contraception: 10 years of clinical experience. Obstet Gynecol. 2003;102:24-6.
  50. Bayer New Zealand Limited. JADELLE® 75 mg: Data sheet. 2019.
  51. Faculty of Sexual and Reproductive Healthcare. FSRH clinical guidance: progestogen-only implants. 2014. www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-implants-feb-2014 Accessed April 21, 2020.
  52. Croxatto HB. Mechanisms that explain the contraceptive action of progestin implants for women. Contraception. 2002;65:21-7.
  53. Roke C, Roberts H, Whitehead A. New Zealand women’s experience during their first year of Jadelle® contraceptive implant. J Prim Health Care. 2016;8:13-9.
  54. Sivin I. Risks and benefits, advantages and disadvantages of levonorgestrel-releasing contraceptive implants. Drug Saf. 2003;26:303-35.
  55. O’Neil-Callahan M, Peipert JF, Zhao Q, et al. Twenty-four-month continuation of reversible contraception. Obstet Gynecol. 2013;122:1083-91.
  56. National Institute of Demographic and Economic Analysis. Current trends for teenage births in New Zealand. Hamilton: University of Waikato; 2015.
  57. Sandle M, Tuohy P. ‘Everyone’s talking Jadelle’: the experiences and attitudes of service providers regarding the use of the contraceptive implant, Jadelle in young people in New Zealand. N Z Med J. 2017;130:40-6.
  58. Black K, Lotke P, Buhling KJ, et al. A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women. Eur J Contracept Reprod Health Care. 2012;17:340-50.
  59. Teal SB, Romer SE, Goldthwaite LM, et al. Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications. Am J Obstet Gynecol. 2015;213:515.e1-5.
  60. Ritter T, Dore A, McGeechan K. Contraceptive knowledge and attitudes among 14-24-year-olds in New South Wales, Australia. Aust N Z J Public Health. 2015;39:267-9.
  61. Bracken J, Graham CA. Young women’s attitudes towards, and experiences of, long-acting reversible contraceptives. Eur J Contracept Reprod Health Care. 2014;19:276-84.
  62. Jaccard J, Levitz N. Counseling adolescents about contraception: towards the development of an evidence-based protocol for contraceptive counselors. J Adolesc Health. 2013;52:S6-13.
  63. Australian Commission on Safety and Quality in Health Care. Heavy Menstrual Bleeding Clinical Care Standard. ACSQHC2017.
  64. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. 2018. www.nice.org.uk/guidance/ng88 Accessed April 23, 2020.
  65. Health Quality Ontario. Levonorgestrel-releasing intrauterine system (52 mg) for idiopathic heavy menstrual bleeding: A health technology assessment. Ont Health Technol Assess Ser. 2016;16:1-119.
  66. Jusko WJ. Clarification of contraceptive drug pharmacokinetics in obesity. Contraception. 2017;95:10-6.
  67. Merki-Feld GS, Skouby S, Serfaty D, et al. European society of contraception statement on contraception in obese women. Eur J Contracept Reprod Health Care. 2015;20:19-28.
  68. Lopez LM, Bernholc A, Chen M, et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev. 2016:CD008452.
  69. Faculty of Sexual and Reproductive Healthcare. Overweight, obesity and contraception England No. 28042132019.
  70. Gemzell-Danielsson K, Apter D, Hauck B, et al. The effect of age, parity and body mass index on the efficacy, safety, placement and user satisfaction associated with two low-dose levonorgestrel intrauterine contraceptive systems: subgroup analyses of data from a phase III trial. PLoS One. 2015;10:e0135309.
  71. Xu H, Wade JA, Peipert JF, et al. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women. Obstet Gynecol. 2012;120:21-6.
  72. Faculty of Sexual and Reproductive Healthcare. Contraceptive choices for women with cardiac disease 2014. https://www.fsrh.org/standards-and-guidance/documents/ceu-guidance-contraceptive-choices-for-women-with-cardiac/ Accessed April 30, 2020.
  73. Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart. 2006;92:1520-5.
  74. Roos-Hesselink JW, Cornette J, Sliwa K, et al. Contraception and cardiovascular disease. Eur Heart J. 2015;36:1728-34, 34a-34b.
  75. Practice Committee of the American Society for Reproductive Medicine. Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertil Steril. 2017;107:43-51.
  76. Committee on Gynecologic Practice. ACOG Committee Opinion Number 540: Risk of venous thromboembolism among users of drospirenone-containing oral contraceptive pills. Obstet Gynecol. 2012;120:1239.
  77. Faculty of Sexual and Reproductive Healthcare. FSRH guideline: contraception after pregnancy 2017. https://www.fsrh.org/news/new-fsrh-guideline--contraception-after-pregnancy/ Accessed April 30, 2020.
  78. American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 670: immediate postpartum long-acting reversible contraception. Obstet Gynecol. 2016;128:e32-e7.
  79. Bayer New Zealand Limited. POSTINOR-1: New Zealand data sheet. 2017. https://www.medsafe.govt.nz/profs/datasheet/p/Postinor-1tab.pdf Accessed April 24, 2020.
  80. Faculty of Sexual and Reproductive Healthcare. FSRH guideline: emergency contraception 2017. https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-emergency-contraception-march-2017/ Accessed April 30, 2020.
  81. Shen J, Che Y, Showell E, et al. Interventions for emergency contraception. Cochrane Database Syst Rev. 2017;8:Cd001324.