Long-acting reversible contraception--highly efficacious, safe, and underutilized

Expanding access to long-acting reversible contraception (LARC) is an important policy move that promises to lower the U.S. rate of unplanned pregnancies, according to a clinical update. The University of Michigan authors report that greater use is impeded by potentially steep out-of-pocket costs, safety myths, and insufficient counseling.

Expanding access to long-acting reversible contraception (LARC) is an important policy move that promises to lower the U.S. rate of unplanned pregnancies, according to a clinical update. The University of Michigan authors report that greater use is impeded by potentially steep out-of-pocket costs, safety myths, and insufficient counseling. What women should know, they explain, is that LARC has an efficacy rate of 99%, boasts high continuation rates, and even offers a number of benefits beyond pregnancy prevention. Contrary to some concerns, it can be safely used by adolescent, unmarried, or nulliparous females without escalating their risk for pelvic inflammatory disease or infertility. The risk of ectopic pregnancy is actually lower, not higher, among IUD users, they point out; and the probability of devices shifting out of place is slim. Moreover, LARC is known to alleviate menstrual-related disorders and symptoms, among other noncontraceptive benefits. It also is an appropriate option for patients who should avoid estrogen-based contraceptives, including smokers or users with uncontrolled diabetes or hypertension. The paper identifies six FDA-approved LARC devices: one copper IUD, four levonorgestrel-containing IUDs, and one subdermal progestin implant. The choice should be based on shared decision-making between patients and their providers after discussing the patient's values and preferences, the authors conclude.