Introduction

Introduction

NICE clinical guideline 30, long-acting reversible contraception (LARC), defined LARC as contraceptive methods that need administration less than once per cycle or month, including copper intrauterine devices (IUDs), progestogen-only intrauterine systems (IUS), progestogen-only injectable contraceptives and progestogen-only subdermal implants. Contraceptive vaginal rings were not included in the guideline because they were not licensed for use in the UK at the time of publication.

The NICE guideline states that increased use of LARC methods could help reduce rates of unintended pregnancy. In contrast to the oral contraceptive pill, LARC methods do not depend on daily concordance and have been shown to be a more cost-effective option. Intrauterine devices and implants were shown to be more cost effective than injectable contraceptives.

The NICE guideline estimated that about 30% of pregnancies are unplanned. The Department of Health's Abortion statistics for 2012 indicate that age-standardised rate for legal abortions per 1000 female residents aged 15–44 years in England and Wales was 16.5, the lowest rate for 16 years. The rate of abortion was highest among women aged 21 years (31 per 1000).

The Health and Social Care Information Centre reported information on NHS community contraceptive clinics in England in 2012/13 (family planning clinics and clinics run by voluntary organisations such as Brook Advisory Centres; data on contraception obtained from GP practices or outpatient clinics were not reported). Use of LARC accounted for the primary methods of contraception among 30% of women who attended NHS community contraceptive clinics in England in 2012/13, of whom 30% chose injectable contraceptives (9% of all women attending).

The percentage of women choosing LARC as a primary method of contraception increased with age, from 18% of those under 15 years to 43% of women aged 35 years and over. However, injectable contraceptives were most popular among women aged 16–24 years (chosen by 10–11% of women attending clinics); this option was chosen by fewer women aged under 15 years (6%) and 35 years and over (8%). The oral contraceptive pill was the most popular choice of contraception with 47% of women attending NHS community contraceptive clinics selecting this option; 20% of women reported using the male condom.

A formulation of DMPA for intramuscular administration (Depo-Provera) has been in use in the UK since 1991. This evidence summary describes Sayana Press, a new formulation of DMPA for subcutaneous administration.