Long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and the etonogestrel implant, are some of the most effective contraceptive methods. In BRAZIL we currently have:
- MIRENA (levonorgestrel IUD 52mg, initially approved for 5 years)*
- KYLEENA (levonorgestrel IUD 19.5 mg, initially approved for 5 years)*
- COPPER IUD 380A (initially approved for 10 years)*
- IMPLANON (68mg etonogestrel subdermal implant (initially approved for 3 years) *
***Initial approvals have either been updated or are in the process of being updated, please see recommendations below.
Conclusions and Recommendations, the following recommendations are based primarily on good quality scientific evidence:
- Patients should be informed that the effectiveness of the MIRENA IUD is maintained for 8 years.
- Patients should be informed that the effectiveness of the COPPER 380A IUD is maintained for 10 to 12 years.
- Patients should be informed that the efficacy of IMPLANON is maintained for 5 years.
- Patients should be informed that the efficacy of long-term IUDs and IMPLANON is independent of weight (BMI). However, data are limited in patients with class 3 obesity and above (BMI > 40), therefore shared decision-making is necessary to carefully weigh the risks and benefits.
The following recommendations are based primarily on consensus and expert opinion:
- For patients over 35 years of age, the COPPER 380A IUD can be used for extended periods until menopause.
- Adolescents may use LARCs for a long time.
- Patients taking CYP3A4-inducing drugs may have prolonged use of IUDs, but their efficacy may be reduced with extended use of IMPLANON; therefore, shared decision-making is necessary to carefully weigh the risks and benefits.
The MIRENA IUD is the only LARC method that is also FDA-approved for the treatment of heavy menstrual bleeding, approved for 5 years for this indication. Evidence also supports the benefits of IMPLANON for the treatment of endometriosis and adenomyosis, although it is not FDA-approved for this indication.
There are many advantages to extending the use of LARCs for both contraceptive and non-contraceptive benefits. Some patients may face barriers to accessing family planning services (cost, lack of provision in the primary care setting, and desire to reduce in-person office visits). It is also important to consider that there may be medical comorbidities that make removal and replacement difficult.
Extended use of LARCs may provide individual and public health benefits. Several approaches have already been extended beyond their original FDA approval dates, demonstrating that extended use is already a proven concept for LARCs.
