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Long Acting Reversible Contraception LARC

Long Acting Reversible Contraception LARC. Sarah Wallage NE Sexual Health Update 25/9/8. LARC methods. Depot progestogen injection ( depoprovera R ) Progestogen only implant ( implanon R ) Copper IUD ( banded devices , Nova T 380 ) Levonorgestrel IUS ( Mirena R )

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Long Acting Reversible Contraception LARC

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  1. Long Acting Reversible ContraceptionLARC Sarah Wallage NE Sexual Health Update 25/9/8

  2. LARC methods • Depot progestogen injection ( depoproveraR) • Progestogen only implant ( implanonR) • Copper IUD ( banded devices , Nova T 380 ) • Levonorgestrel IUS ( Mirena R) • Combined Vaginal ring ( NuvaringR) ? 08

  3. Effective Contraception Pregnancies / 100 women in first year of use Actual use Perfect Use Condoms 5-20 2 COC / POP 4-8 <1 IUD/IUS 1-2 1-2 Implant <1 <1 Depoprovera 1-2 <1

  4. Contraception ‘in use’ by women seen at Aberdeen TOP clinic

  5. Common clinical questions • Weight change • Affected by enzyme inducers? • Bone mineral density • Return of fertility • Bleeding patterns • Will it help premenstrual symptoms

  6. Weight change • Depoprovera 60% gain 2-3kg in first year • No causal association for implanon IUS IUD

  7. Enzyme Inducers Enzyme inducers do not affect IUD IUS depoprovera Implanon effectiveness is reduced Advise alternative method ( or condoms too)

  8. Bone mineral density • IUS IUD implanon No effect on BMD some ovarian function even if amenorrhoea • Depoprovera possible reduction BMD studies : opposing results NO osteoporosis NO clinical fracture reversible after discontinue

  9. Bone mineral density and depoprovera • Assess risks for osteoporosis before use and after 2 years • Care with under 18yr ( peak BMD) • Care with over 40 yr ( menopause) • Grampian DEXA scan 5 yrs • Any woman can choose to start and continue depoproveraafter discussion of her risk/benefit balance

  10. Fertility after Discontinue LARC • IUD IUS implanon Rapid return to baseline fertility • Depoprovera mean 6 months until first ovulation No permanent effect on fertility

  11. Bleeding patterns • IUD natural cycle but heavier in 50% • IUS erratic first 3-6 months then likely light, infrequent or absent • Depoprovera erratic first 1-3 doses majority amenorrhoeic • Implanon majority light/infrequent pattern may change throughout duration

  12. Ovulation ? • Implanon depoprovera - anovulant • IUD not affect ovulation • IUS 60% women still ovulate even if amenorrhoeic Premenstrual symptoms

  13. LARC Discontinuation Rates Depoprovera 40% discontinue at 1 yr Implanon 43% discontinue at 3 yr IUD IUS 50-60% discontinue by 5yr COC 30% discontinue 1 yr Condoms 50% discontinue 1 yr • Cost effective v COC after 2 yrs

  14. When to Fit LARC ? • First 5 days of cycle effective immediately • Can start at any time of cycle if reasonably certain not pregnant + condoms if sex in next 7 days + pregnancy test after 4 weeks

  15. How to Fit LARC • All women wishing contraception should be offered LARC • Pathway for referral if not available at practice ( NICE) • FSRH and RCN training local proformas local practical training ‘our place or yours’

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