Long-acting reversible contraception

Long-acting reversible contraception: implementation resource summary

Since publication of the NICE guideline on long-acting reversible contraception (LARC) in October 2005, many new LARC products have become available.  This implementation resource provides links to up to date, relevant and valid information to support this guideline.  

What is LARC?

LARC is defined as contraceptive methods that require administration less than once per cycle or month. Included in the category of LARC are:

• Copper intrauterine devices
• Progestogen-only intrauterine systems (The MHRA issued a Drug Safety Update in January 2016 highlighting that levonorgestrel-releasing intrauterine systems should always be prescribed by brand name because products have different indications, durations of use, and introducers)
• Progestogen-only injectable contraceptives
• Progestogen-only subdermal implants.

Where will I find up to date useful information on LARC?

Up to date information on LARC products is contained in the relevant summaries of product characteristics (SPCs), as well as the British national formulary (BNF) and the MHRA websites.  

Evidence based guidelines on contraceptive choices have also been produced by the faculty of sexual and reproductive healthcare of the Royal College of Obstetricians and Gynaecologists (FSRH). The FSRH guidelines are accredited by NICE.

The family planning association (FPA) have produced a variety of resources to aid shared decision making about contraceptive choices.

Where will I find the FSRH guidance on LARC?

The clinical effectiveness unit of the FSRH have published a variety of evidence based guidelines on contraceptive choices along with a guide to using their guidelines. Their guidance includes the following:

Method specific guidance, including guidance on:

• intrauterine contraception
• progestogen-only implants
• progestogen-only injectable contraception.

Contraception for specific populations, including guidance on:

• contraception for women aged over 40 years
• contraceptive choices for women with cardiac disease
• sexual and reproductive health for women with inflammatory bowel disease
• contraception after pregnancy
• contraceptive choices for young people.

How can I support shared decision-making on the choice of LARC?

The NICE guideline recommends that women requiring contraception should be given information about and offered a choice of all contraceptive methods, including LARC. Further, women should be provided with the method of contraception that is most acceptable to them, unless it is contraindicated. The NICE guideline recommends that women considering LARC methods should receive detailed information – both verbal and written – that will enable them to choose a method and use it effectively. This information should take into consideration their individual needs and should include a discussion on:

• contraceptive efficacy
• duration of use
• risks and possible side effects
• non-contraceptive benefits
• the procedure for initiation and removal/discontinuation
• when to seek help while using the method.

The FPA have produced a variety of information sources and decision aids on contraceptive choices, including a Contraception at a Glance tool (endorsed by NICE). Downloadable resources, leaflets and posters for healthcare professionals are also available.