Long-acting Reversible Contraception: The Effective and Appropriate Use of Long-acting Reversible Contraception

This guideline has been developed with the aim of providing guidance on LARC. The effectiveness of barrier and oral contraceptive pills is dependent on their correct and consistent use. In contrast, long-acting reversible methods have effectiveness that does not depend on daily adherence. Currently, there is a very low uptake of LARC (around 8 per cent of contraceptive usage in 2003/04). A number of factors contribute to this. Issues for providers include the initial cost, which may be thought of as too high, particularly if the methods may not be used or required for the intended duration, the need for specific clinical skills (including awareness of current best practice, insertion practice and ability to give information or advice on the methods available) and facilities. Expert clinical opinion is that LARC methods may have a wider role and an increase in their use could help to reduce unintended pregnancy. The current very low uptake suggests that healthcare professionals need better guidance and training so that they can help women to make an informed choice from a full range of contraceptive methods. Enabling women to make an informed choice about LARC and addressing consumer preferences is an important objective of this guideline.

Table of Contents:
Chapter 1 Introduction 1.1 Aim of the guideline 1.2 Areas outside the remit of the guideline 1.3 For whom is the guideline intended? 1.4 Who has developed the guideline? 1.5 Other relevant documents 1.6 Guideline development methodology Chapter 2 Summary of recommendations and practice algorithm 2.1 Summary of recommendations 2.2 Future research recommendations 2.3 LARC selection algorithm Chapter 3 Contraceptive use and principles of care 3.1 Normal fertility 3.2 Contraceptive provision 3.3 Contraceptive prevalence 3.4 Efficacy and effectiveness of contraception 3.5 Provision of information and informed choice 3.6 Contraceptive prescribing 3.7 Health benefits of contraception 3.8 Acceptability 3.9 Adherence 3.10 Discontinuation 3.11 Contraception and sexually transmitted infection 3.12 User autonomy and consent 3.13 Contraception for special groups 3.14 Training of healthcare professionals in contraceptive care 3.15 Cost effectiveness of LARC methods versus other reversible contraceptive methods 3.16 Brief overview of features common to progestogen-only methods Chapter 4 Copper intrauterine devices (IUDs) 4.1 Introduction 4.2 Effectiveness 4.3 Expulsion 4.4 Discontinuation and reasons for discontinuation 4.5 Adverse effects 4.6 Common concerns and symptoms 4.7 Risks 4.8 Return to fertility 4.9 Details of method use 4.10 Training of healthcare professionals 4.11 Specific groups 4.12 Medical conditions and contraindications 4.13 Drug interactions 4.14 Follow-up Chapter 5 Intrauterine system (IUS) 5.1 Introduction 5.2 Effectiveness 5.3 Expulsion 5.4 Discontinuation and reasons for discontinuation 5.5 Adverse effects 5.6 Common concerns and symptoms 5.7 Risks 5.8 Return to fertility 5.9 Details of method use 5.10 Training of healthcare professionals 5.11 Specific groups 5.12 Medical conditions and contraindications 5.13 Drug interactions 5.14 Follow-up Chapter 6 Progestogen-only injectable contraceptives (POICs) 6.1 Introduction 6.2 Effectiveness 6.3 Discontinuation and reasons for discontinuation 6.4 Adverse effects 6.5 Common concerns and symptoms 6.6 Risks 6.7 Return to fertility 6.8 Details of method use 6.9 Training of healthcare professionals 6.10 Specific groups 6.11 Medical conditions and contraindications 6.12 Drug interactions 6.13 Follow-up Chapter 7 Progestogen-only subdermal implants (POSDIs) 7.1 Introduction 7.2 Effectiveness 7.3 Discontinuation and reasons for discontinuation 7.4 Adverse effects 7.5 Common concerns and symptoms 7.6 Risks 7.7 Return to fertility 7.8 Details of method use 7.9 Training of healthcare professionals 7.10 Specific groups 7.11 Medical conditions and contraindications 7.12 Drug interactions 7.13 Follow-up Chapter 8 Economic evaluation 8.1 Introduction - the role of health economics in the LARC guideline 8.2 Literature review 8.3 Development of a model for the economic evaluation of LARC methods 8.4 Results of the economic analysis 8.5 Limitations of the economic analysis - further considerations Chapter 9 Auditable standards Appendix A Summary of changes after stakeholders consultation Appendix B Schematic structure of the decision-analytic model used in the economic analysis Appendix C Results of cost effectiveness analysis in the form of graphs Appendix D Results of the sensitivity analysis References Index Evidence tables CD-ROM