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CPD: Key questions on LARC


contraceptive


Learning Objectives

This module will bring you the latest on long-acting reversible contraception, including:

  • Choosing between a copper IUD and an IUS
  • Counselling women on the benefits of LARC
  • Mental health considerations with LARC
  • LARC in older women

Author

Dr Priyanka Patel is a specialty trainee in community sexual and reproductive health at Homerton University Hospital. Dr Tracey Masters is a consultant in sexual and reproductive health at Homerton University Hospital.

In what circumstances would you choose a copper IUD (Cu-IUD)over the IUS? Are there any contraindications to an IUS that would not apply to a Cu-IUD?

Supporting a woman in making her choice between a Cu-IUD and an IUS will be based on weighing up the advantages and disadvantages for each individual patient. For example, are her periods heavy or painful, how does she feel about hormonal side-effects, does she mind having light erratic bleeding or no menses or does she want regular periods?

There are some circumstances where the Cu-IUD would be preferable to the IUS1:

  • The woman does not feel comfortable with the possibility of no menses or erratic menses.
  • If the woman is seeking emergency contraception, when the IUS cannot be used and the Cu-IUD may be retained for future contraception.
  • Non-hormonal contraception is most appropriate for women with a history of breast cancer. In women with current breast cancer, UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)advises that the IUS represents an ‘unacceptable health risk’ (UKMEC 4). For those with a past history and no recurrence in past five years, UKMEC advises that risks of using the LNG-IUS generally outweigh the advantages (UKMEC 3). Any consideration of the IUS should involve the woman’s cancer specialist. 
  • Severe liver disease, such as decompensated cirrhosis, hepatocellular adenoma or hepatocellular carcinoma are all also contraindications (UKMEC 3) to the IUS. Progestogen-only contraception is metabolised by the liver and its use may adversely affect women whose liver function is compromised. Combined oral contraception (COC) use is associated with growth of hepatocellular adenoma, but it is still unknown whether other hormonal contraceptives have similar effects.

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