Appendix A: Features of the LARC methods to discuss with women

Appendix A: Features of the LARC methods to discuss with women

Copper IUD

IUS

Progestogen-only injection

Implant

How it works

By preventing fertilisation and inhibiting implantation

Mainly by preventing implantation; sometimes by preventing fertilisation

Primarily by preventing ovulation

Primarily by preventing ovulation

Duration of use

5–10 years for IUDs with 380 mm2 copper, depending on type

Until contraception no longer needed if woman 40 years or more at time of insertion[a]

5 years

Until contraception no longer needed if woman 45 years or more at time of insertion and does not have periods with IUS in place[a]

Repeat injections needed every 12 weeks (DPMA) or 8 weeks (NET‑EN)[b]

3 years

Failure rate

Fewer than 2 in 100 women over 5 years, for IUDs with at least 380 mm2 copper

Expulsion occurs in fewer than 1 in 20 women in 5 years

Fewer than 1 in 100 women over 5 years

Expulsion occurs in fewer than 1 in 20 women in 5 years

Fewer than 0.4 in 100 over 2 years; pregnancy rates lower for DPMA than NET‑EN

Fewer than 1 pregnancy in 1000 implants fitted over 3 years

Effects on periods

Heavier bleeding and/or dysmenorrhoea likely

Irregular bleeding and spotting common in first 6 months

Oligomenorrhoea or amenorrhoea likely by end of first year

Amenorrhoea common, and is more likely with DMPA than NET‑EN, and with longer use; not harmful

Persistent bleeding may occur

Bleeding patterns are likely to change during implant use. Bleeding may stop, become more or less frequent, or be prolonged. Dysmenorrhoea may be reduced.

Other risks

Up to 50% of women stop using IUDs within 5 years; most common reasons are unacceptable vaginal bleeding and pain

Ectopic pregnancy: overall rates lower than with no contraception But if a woman becomes pregnant with IUD in situ, risk is about 1 in 20 so she should seek advice to exclude it

Pelvic inflammatory disease: less than 1% for women at low risk of STI

Uterine perforation: less than 1 in 1000

Change in mood or libido: may be a small effect, similar for IUD and IUS

No evidence of effect on:

Weight gain

Up to 60% of women stop using the IUS within 5 years; most common reasons are unacceptable vaginal bleeding and pain, less common reason is hormonal (non‑bleeding) problems

Ectopic pregnancy: overall rates lower than with no contraception But if a woman becomes pregnant with IUS in situ, risk is about 1 in 20 so she should seek advice to exclude it

Pelvic inflammatory disease: less than 1% for women at low risk of STI

Uterine perforation: less than 1 in 1000

Change in mood or libido: may be a small effect, similar for IUD and IUS

Acne: risk may be increased, but is an uncommon reason for stopping use

No evidence of effect on:

Weight gain

Up to 50% of women stop using DMPA by 1 year; the most common reason is an altered bleeding pattern, such as persistent bleeding

Weight gain: may be up to 2–3 kg over a year on DMPA

Bone mineral density: DMPA use is associated with small loss; largely recovered when DMPA is stopped

No evidence that fracture risk is increased

No evidence of effect of DMPA on:

Depression

Acne

Headaches

Complications with insertion and removal are uncommon. Refer to the summary of product characteristics for a full list of risks

Return to fertility

No evidence of delay

No evidence of delay

Can take up to a year

But women who do not want to get pregnant should start a different contraceptive as soon as they stop injections

No evidence of delay

Advice at time of fitting

There may be pain and discomfort for a few hours and light bleeding for a few days

Watch for symptoms of uterine perforation

Follow‑up visit after first menses or 3–6 weeks after insertion

Return at any time if problems or to change method

Check for threads regularly

There may be pain and discomfort for a few hours and light bleeding for a few days

Watch for symptoms of uterine perforation

Follow‑up visit after first menses or 3–6 weeks after insertion

Return at any time if problems or to change method

Check for threads regularly

Return for next injection, or if problems

Refer to the summary of product characteristics

[a] Check Summary of Product Characteristics for current licensed indications; if using outside licensed indications, discuss, obtain informed consent and document this is the notes.

[b] At time of publication, NET-EN is licensed for short-term use (two injections); if using outside licensed indications, discuss, obtain informed consent and document this is the notes.