Draft Scope: Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception


Draft Scope


1   Guideline title:
Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception
1.1   Short title
Long-acting reversible contraception


2   Background
  The National Institute for Clinical Excellence ('NICE' or 'the Institute') has commissioned the National Collaborating Centre for Women and Children's Health to develop a clinical guideline on Long-acting reversible contraception for women for use in the NHS in England and Wales. This follows referral of the topic by the Department of Health and Welsh Assembly Government (see Appendix). The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.
  The Institute's clinical guidelines will support the implementation of National Service Frameworks (NSFs) in those aspects of care where a Framework has been published. The statements in each NSF reflect the evidence that was used at the time the Framework was prepared. The clinical guidelines and technology appraisals published by the Institute after an NSF has been issued will have the effect of updating the Framework.

3     Clinical need for the guideline
One of the key aims of the NHS sexual health and HIV strategy is to reduce rates of unintended pregnancy. Improving access to contraception, and the range of methods available, is an essential element of achieving this aim.
  Clinical opinion is that non-user dependent methods could have a wider role in contraception and an increase in their use could help to reduce unintended pregnancy in the highest risk group, most notably in teenagers and younger women.
The effectiveness of barrier and oral contraceptive pills is dependent on their correct and consistent use. By contrast long acting reversible methods have high effectiveness which is not dependent on daily compliance and which maybe associated with greater contraceptive effectiveness.
  Currently there is very low uptake of these methods (around 5% of contraceptive usage). A number of factors contribute to this; the high initial costs of these methods may put providers off if they think they will not be used for the intended duration; the need for specific clinical skills (including current scientific information, insertion practice and information/advice giving techniques) and facilities. Industry marketing frequently drives current provision of the most recently introduced long-acting methods of contraception, with the support of local clinical champions and of professional organisations.
  The resulting variation suggests that health professionals need additional guidance and training so that they can enable women to make an informed choice from a full range of contraceptive methods. There are no current formal professional or NHS guidelines covering this topic.


  The guideline
The guideline development process is described in detail in three booklets that are available from the NICE website (see 'Further information'). The Guideline Development Process - Information for Stakeholders describes how organisations can become involved in the development of a guideline.
  This document is the scope. It defines exactly what this guideline will (and will not) examine, and what the guideline developers will consider. The scope is based on the referral from the Department of Health and Welsh Assembly Government (see Appendix).
The guideline will take into account the results of any related technology appraisals being carried out by the Institute.
  The areas that will be addressed by the guideline are described in the following sections.
  Groups that will be covered

The guideline will offer best practice advice for women of reproductive age who wish to regulate their fertility through the use of long acting reversible contraceptive methods.

  The guideline will identify the groups most likely to benefit from these contraceptive methods
  The guideline will address specific issues for the use of these methods in women during the menarche and before the menopause.
  Groups that will not be covered
  Male contraception as there are currently no methods.
  Women outside reproductive age.
  Healthcare setting
  The guideline will cover the necessary elements of clinical care for provision of reversible long-acting methods in general practice, community contraceptive clinics and hospital services.
  Clinical management
  The guideline will cover the benefits, side effects and contra-indications to the use of the following methods:
  hormonal methods for women
  • Intrauterine systems and implants
  • Injections
  • Sub dermal implants
  • Vaginal ring
  non-hormonal methods

  • Intrauterine device
Advice on treatment options will be based on the best evidence available to the development group. When referring to pharmacological treatments, the guideline will normally make recommendations within the licensed indications. Exceptionally, and only where the evidence supports it, the guideline may recommend use outside the licensed indications. The guideline will assume that prescribers will use the Summary of Product Characteristics to inform their prescribing decisions for individual patients.
  Guidance on the information that should be available to enable patients to make informed decisions about the contraceptive method to use.
  Guidance on any preliminary assessment required before using the method of contraception.
  Guidance on skills and facilities required by health professionals in the use of these technologies
  Advice on when long-acting reversible contraceptive methods may be less effective and when additional precautions may be required (e.g. when commencing or changing between contraceptive methods)
  The guideline will not cover the following areas
  Methods of contraception which are intended to result in permanent sterilisation
  Contraceptive methods which are related to coitus or which require frequent (more than once per month for women) repeat administration e.g. combined oral contraceptive pill or progesterone only pills
  Post coital or emergency contraceptive methods.
  Use of the technologies for other non-contraceptive reasons (e.g. menorrhagia)
  Use of the technologies in women after the menopause e.g. for hormone replacement therapy


Audit support within guideline
The guideline will incorporate review criteria and audit advice.

The audit should complement other existing and proposed work of relevance, including the Sexual health strategy.
This is the first draft of the scope for consultation.
The development of the guideline recommendations will begin in January 2003.

Further information
Information on the guideline development process is provided in:
  • The Guideline Development Process - Information for the Public and the NHS
  • The Guideline Development Process - Information for Stakeholders
  • The Guideline Development Process - Information for National Collaborating Centres and Guideline Development Groups
These booklets are available as PDF files from the NICE website. Information on the progress of the guideline will also be available from the website.
Appendix - Referral from the Department of Health and Welsh Assembly Government
To prepare clinical guidelines for the NHS in England and Wales on the effective and appropriate use of long-acting reversible contraception, including intra-uterine devices and sub-dermal implants.







This page was last updated: 30 March 2010