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Latebreakers

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

The Short and Long of IUD Use Duration
December 2018

 

So what exactly is the expert consensus on how long someone can use an IUD? There are two branches to that question. First, when is it appropriate to place an IUD when a patient wants only short-term contraception? And second, how effective is the IUD beyond the time period listed in the labeling? Regarding the first question, experts are advising that clinicians reframe the concept of ‘early’ removal. Understandably, clinicians are mindful of the high up-front cost of IUDs borne by their patients. And they have been educated to focus on contraceptive method continuation rates, which can reflect patients’ satisfaction or dissatisfaction with their methods. But that focus on continuation rates, along with the name “long-acting” reversible contraception, can dissuade clinicians and patients from using an IUD for a only a short time, such as 9 months rather than for the several year limit listed in the labeling.[1] According to Contraceptive Technology editor and author Patty Cason, while IUDs have limits duration of use, there is no limit on a minimal time for use.

Cason acknowledges that providers may feel reluctant to remove a device in a timeframe they consider “early.” When patients are considering use of one of a method requiring placement, many wonder whether there will be a provider willing and able to remove the device on demand and whether they will have coverage for the cost of the removal. When discussing the IUD, writes Cason, consider using following phrasing: “This [IUD or implant] is good for up to X years (fill in information for the particular method), but if you want to get pregnant before then or you would like it removed for any reason, come in, we will take it out.” The up to phrase emphasizes that they are not expected to use it for any particular length of time.[2]

The fact that an implant or an IUD is good for “up to” 3 to 20 years is an added advantage but not always relevant, according to Cason. The emphasis is better placed on the phrase “up to” than on the number of years, because the amount of time is relevant only if the patient is seeking contraception for that length of time. Otherwise, other features of the method may be more important. A key feature is that IUDs (and implants) are highly effective, which makes them excellent choices for the short-term, too.

What about the flip side to the issue of duration of IUD use? How protective is the IUD when extended beyond time indicated in the labeling?

  • The TCu380A is labeled for 10 years of use, although data indicate high effectiveness for 12 years.[3]
  • The efficacy of the 52 mg IUDs may last as long as 15 years.[4]
  • Liletta is approved for extended use up to 4 years. The LNG content at 5 years supports continued efficacy at least until 5 years and likely 7.[5]
  • Mirena is approved for up to 5 years. Data show that it is highly effective for at least 2 additional years of use: 6th year failure rate 0.25 and 7th year failure rate 0.43 (n=496).[6]

Cason suggests that healthcare professionals, policy makers, and stakeholders could take advantage of the present information to decide to maintain the same device at least up to 7 years.  She notes, too, that amenorrhea could be a good indicator of contraceptive effect from LNG IUDs. Some notable points to keep in mind when considering extending use:

  • Extended use is off-label. Obtain informed consent.
  • How important is it to the patient to prevent pregnancy?
  • Does the patient have affordable and timely access to another IUD or implant?
  • What is your clinical judgment?
  • How do the patient’s age, weight, pregnancy history, and comorbidities influence the shared decision about extending use?
  • Is placement of a new device challenging due to body habitus or comorbidities?
  • If you remove the IUD, will she adopt a less effective method and be at a higher risk for an unintended pregnancy?

[1] Amico JR, Bennett AH, Karasz A, Gold M. “She just told me to leave it”: Women’s experiences discussing early elective IUD removal. Contraception. 2016;94:357-361.

[2] Cason P, Aiken ARA. Engaging with unintended pregnancy through patient-centered reproductive goals and contraceptive counseling. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.

[3] Long-term reversible contraception. Twelve years of experience with the TCu380A and TCu220C. Contraception 1997;56:341–52.

[4] Bahamondes, L., Fernandes, A., Bahamondes, M. V., Juliato, C. T., Ali, M., & Monteiro, I. Pregnancy outcomes associated with extended use of the 52-mg 20 mug/day levonorgestrel-releasing intrauterine system beyond 60 months: A chart review of 776 women in Brazil. Contraception 2017.

[5] Creinin MD, Jansen R, Starr RM, Gobburu J, Gopalakrishnan M, Olariu A. Levonorgestrel release rates over 5 years with the Liletta(R) 52-mg intrauterine system. Contraception 2016;94:353–6.

[6] McNicholas, C., Swor, E., Wan, L., & Peipert, J. F. (2017). Prolonged use of the etonogestrel implant and levonorgestrel intrauterine device: 2 years beyond Food and Drug Administration-approved duration. Am J Obstet Gynecol, 216(6), 586.e581-586.e586.