Long Acting Reversible Contraceptives (LARC)

Copper IUD (ParaGard)

Nonhormonal, prevents fertilization efficacy >99%, does not impact ovulation
-Uterus should sound to a depth of 6-9cm
-Long acting: 10 years (FDA-approved), efficacy up to 12 years
-Emergency Contraception up to 5 days after unprotected intercourse
-Reduced risk of cervical cancer, endometrial, and ovarian cancers

ADR: can make menses heavier, longer, more painful (treat with NSAIDS, most symptoms improve after 6 months)

Contraindications:
-Pregnancy
-Wilson’s disease/bleeding disorders
-Active pelvic/cervical infection
-unexplained abnormal uterine bleeding (AUB, determine cause before placing)
-Copper allergy
-Significant distortion of uterine cavity

MRI compatible, notify technician

Levonorgestrel IUD

-LNg 52mg (Mirena): sound uterus 6-10 cm; higher dose of hormones for heavy menstrual bleeding
-LNg 52mg (Liletta): sound uterus >5.5cm
both are FDA approved up to 8 years

no uterine sound depth specified for:
-LNg 19.5mg (Kyleena): FDA approved up to 5 years
-LNg 13.5mg (Skyla): FDA approved up to 3 years
both contain lower dose of progestin = lower rate of amenorrhea

Levonorgestrel IUD

Efficacy >99%
ADR: reduced volume of bleeding, prolonged bleeding, unscheduled bleeding, amenorrhea, and spotting (bleeding patterns can vary by patient)
• Intermittent spotting improves for most users by 6 months of use
• Acne and breast tenderness

Contraindications:
Absolute:
Pregnancy
significant distortion of uterine cavity
active pelvic/cervical infection
unexplained abnormal uterine bleeding
progestin-sensitive cancer
Relative: active liver disease

IUD Risks

- Uterine perforation
- Migration of IUD
- Expulsion
- Infection from insertion
- Pain
-Higher rate of miscarriage and slightly higher rate of ectopic pregnancy if it fails to prevent pregnancy

Etongestrel implant (Nexplanon)

Most effective contraception available >99%, semi-rigid plastic with 68mg of etongestrel, FDA approved 3 years, efficacy up to 5 years
MOA: preventing fertilization by thickening of cervical mucus (changes tubal motility that is unfavorable to sperm migration)

ADR:
Local: implant site reactions including erythema, hematoma, bruising, pain, swelling Systemic: unscheduled, or irregular, uterine bleeding, longer or shorter duration of menstrual bleeding, amenorrhea, Headaches, weight gain, acne, breast tenderness, emotional lability, abdominal pain

Risks: Nerve injury, infection, pain, migration, difficult removal

Bleeding Symptoms:
- Infrequent (33.6%)
- Amenorrhea (22.2%)
- Prolonged (17.7%)
- Frequent (6.7%)