Extended Use of Long-Acting Reversible Contraception
Publication Date: June 15, 2022
Last Updated: July 25, 2022
Summary of Recommendations
Patients should be counseled that the contraceptive effectiveness of the levonorgestrel 52 mg IUD is maintained beyond the current FDA-approved duration of 7 to 8 years. (1, B)
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Patients should be counseled that the contraceptive effectiveness of the copper 380 mm2 IUD is maintained beyond the current FDA-approved duration of 10 to 12 years. (1, B)
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Patients should be counseled that the contraceptive effectiveness of the etonogestrel 68 mg implant is maintained beyond the current FDA-approved duration of 3 to 5 years. (1, A)
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Patients should be counseled that the contraceptive effectiveness with extended use of IUDs and implants is independent of BMI. (1, B)
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Patients should be counseled that the contraceptive effectiveness with extended use of IUDs is independent of BMI. (1, B)
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Extended use of the implant may be offered in patients of any BMI. However, given data is limited in patients with class 3 obesity and above (BMI > .40), shared decision making and careful weighing of risks and benefits is warranted. (2, B)
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For patients over age 30 at time of insertion of the copper 380 mm2 IUD, extended use beyond 12 to 20 years or to menopause, can be considered as a form of reversible, permanent contraception. (1, C)
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Adolescents may be counseled regarding extended use of LARC. (1, C)
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Effectiveness may be reduced with extended implant use in patients taking medications that are CYP3A4 inducers; use of shared decision making and careful weighing of risks and benefits in these situations is warranted. (2, C)
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Patients taking CYP3A4 inducing medications may be offered extended use of IUDs. (1, C)
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Patient autonomy and preference are important and valid reasons for offering extended LARC use. (1, C)
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Title
Extended Use of Long-Acting Reversible Contraception
Authoring Organization
Society of Family Planning
Publication Month/Year
June 15, 2022
Last Updated Month/Year
February 13, 2024
Country of Publication
US
Document Objectives
In this clinical recommendation, we review the evidence supporting the use of the copper intrauterine device, levonorgestrel intrauterine devices and etonogestrel subdermal implant beyond the Food and Drug Administration approved duration of use for contraception (extended use). Clinicians should discuss effectiveness as well as other clinical considerations with patients to allow them to make contraceptive decisions that support their reproductive goals and clinical needs. Extended use of long acting reversible contraception may be a safe, effective and desirable option for many patients.
Inclusion Criteria
Female, Adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Prevention
Diseases/Conditions (MeSH)
D003267 - Contraception, D003270 - Contraceptive Agents, D003273 - Contraceptive Devices, D000075523 - Long-Acting Reversible Contraception
Keywords
contraception, long-acting contraception
Source Citation
Dethier D, Qasba N, Kaneshiro B. Society of Family Planning clinical recommendation: Extended use of long-acting reversible contraception. Contraception. 2022 Jun 15:S0010-7824(22)00162-7. doi: 10.1016/j.contraception.2022.06.003. Epub ahead of print. PMID: 35716806.