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4yr
Considerations for initiating long-acting, reversible contraceptives

Unintended pregnancies pose a significant public health risk and account for 45% of all pregnancies in the US, with 41% caused by inconsistent use of contraceptives. This highlights the current need for modern contraception with enhanced compliance. The Practice Bulletin from the American College of Obstetricians and Gynecologists indicates long-acting reversible contraceptives (LARC) are the most effective reversible contraceptive methods because women can have long-term effective contraception with a single intervention. Yet, fewer than 15% of women choose a traditional LARC and 20-30% of women have their IUD or implant removed within one year.



1. For patients that are hesitant or decline traditional LARCs, what additional/alternative birth control options could be considered?

2. What are the reasons why some patients are more likely to switch to a long-lasting alternative birth control?



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Guttmacher Institute. Contraceptive Use in the United States Fact Sheet, July 2018.



ACOG Practice Bulletin: Long-Acting Reversible Contraception: Implants and Intrauterine Devices, Number 186 (https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices)



CDC US Selected Practice Recommendations (US SPR) for Contraceptive Use, 2016 (https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/summary.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fcontraception%2Fusspr.htm)



Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(RR-3):1–103. (Level III) Kavanaugh ML, et al. F&S Reports, 2020, 1(2):83-93, https://www.fertstertreports.org/article/S2666-3341(20)30038-6/fulltext.



Diedrich JT, Zhao Q, Madden T, et al. Three-year continuation of reversible contraception. Am J Obstet Gynecol, 2015;213:662.e1-8.


  • 4yr
    I prescribe quite a bit of isotretinoin for acne and in my opinion the LARC's are the safest for young women to prevent pregnancy. Especially for younger women. I am too concerned that oral contraceptives might be missed. I feel confident with LARC in place.
  • 4yr
    For patients hesitant to use IUDs due to either ectopics or menorhhagia, I would recommend Nexplanon as a good alternative, followed by Annovera
  • 4yr
    LARC especially the non-hormone containing LARC has become the most popular form of birth control among the women that I see, over the last few years, increasingly women are selecting this form. women who experience heavy bleeding are also trending towards Liletta/Mirena. That said, if the woman does not desire a 'uterine' LARC, I offer the Nexplanon as a good alternative or if they decline this, then Annovera is a good option too -- of course no contraindications to hormones should exist. Some women prefer the convenience of DMPA -- subcutaneous or intramuscular.
  • 4yr
    Long-acting reversible contraceptives have few contraindications and should be offered routinely as safe and effective contraceptive options for most women. Concern about IUD complications, including pelvic inflammatory disease, intolerance of adverse effects, or pain and difficulty with insertion, continues to limit obstetrician–gynecologists’ or other health care providers’ willingness to recommend IUDs to adolescents and nulliparous women.
  • 4yr
    For patients hesitant to use LARCs because of concern about side effects or infertility I have found Noacetol to be an effective alternative.
  • 4yr
    Patients are being increasingly fearful that LARCs cause permanent infertility. This is a barrier that limits the increased usage of LARCs, directing pts to traditional OCPs and condoms. However when a pt with a history of ectopic pregnancy or complications of IUD comes, LARCs become very popular and this is the pt population I’ve had most success with.
  • 4yr
    Some fear the invasive procedure of iud or implant, but others will choose them for convenience; individual choice.
  • 4yr
    LARCs are an excellent option for birth control but some have side effects and some are worried they may cause infertility. For them OCPs and barrier methods are an option.
  • 4yr
    1. go monthly to primary care or GYN for birth control in form of injectble 2. long acting improves compliance
  • 4yr
    I would perform thorough history taking and physical exam. Consider any risk factors that the patient may have and find out what their goals are. Do they want to try to be pregnant in 3 yrs, 5 yrs, 10 yrs, never? What conceptive methods have they used before? How successful was it? It is important to discuss why patient is reluctant or hesitant to use LARCs and address any misconceptions that they may have. Other options are calendar method, abstinence, condoms, OCPs. Discuss advantages, potential side effects and success rates. Depending on each case, it is also reasonable to discuss vasectomy for the male partner. An office visit about LARCs will not be complete without stressing importance of use of back up method, STD prevention/evaluation and availability of emergency contraception if needed.,

    Some reasons why patients prefer LARCs- they are effective, reversible, and convenient, no need to track the calendar and menstrual period. Although some LARCs typically need an office visit for a minor procedure such as inserting an IUD or the implant.
  • 4yr
    For women who decline LARC's, there are many other birth control options. These include OCP's, the minipill, sterilization, depo-provera, vaginal rings, the use of barrier methods such as cervical caps/diaphragms or male/female condoms. Barriers to using LARC's include the upfront cost, the procedure itself and concerns for pain with insertion, and also lack of familiarity with the different birth control options that are available. Some women choose to pursue LARC methods as they may struggling with remembering daily pills and do not want to have to worry about it. Other women may choose it for the potential effect that it may decrease or eliminate periods overtime.
  • 4yr
    Patients are being increasingly fearful that LARCs cause permanent infertility. This is a barrier that limits the increased usage of LARCs, directing pts to traditional OCPs and condoms. However when a pt with a history of ectopic pregnancy or complications of IUD comes, LARCs become very popular and this is the pt population I’ve had most success with.
  • 4yr
    Patients may switch to a larc for convenience so as to not have to remember to dose daily; alternatively, iud or barrier methods could be chosen.

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