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Long-Acting Reversible Contraception With Contraceptive Implants and Intrauterine Devices

To identify the key insights or developments described in this article
1 Credit CME

Long-acting reversible contraception (LARC), including contraceptive implants and intrauterine devices (IUDs), is highly effective, with typical-use failure rates of less than 1 pregnancy per 100 person-years of use.1 Fertility returns rapidly after discontinuation of LARC.2

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Article Information

Corresponding Author: Sarah Averbach, MD, MAS, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Family Planning, University of California, San Diego School of Medicine, 9300 Campus Point Dr, #7433, La Jolla, CA 92037 (saverbach@health.ucsd.edu).

Published Online: May 6, 2022. doi:10.1001/jama.2022.5448

Conflict of Interest Disclosures: Dr Averbach reports grants from National Institutes of Health and Society of Family Planning Research Fund outside the submitted work and serving as an advisor to Bayer on insertion technique for immediate postpartum intrauterine device placement. No other disclosures were reported.

Additional Contributions: We thank Eve Espey, MD, MPH (University of New Mexico), for her assistance in reviewing the manuscript.

References
1.
Curtis  KM , Jatlaoui  TC , Tepper  NK ,  et al.  US selected practice recommendations for contraceptive use, 2016.   MMWR Recomm Rep. 2016;65(4):1-66. doi:10.15585/mmwr.rr6504a1PubMedGoogle ScholarCrossref
2.
Committee on Practice Bulletins-Gynecology, Long-Acting Reversible Contraception Work Group.  Practice Bulletin No. 186: long-acting reversible contraception.   Obstet Gynecol. 2017;130(5):e251-e269. PubMedGoogle Scholar
3.
Curtis  KM , Tepper  NK , Jatlaoui  TC ,  et al.  US medical eligibility criteria for contraceptive use, 2016.   MMWR Recomm Rep. 2016;65(3):1-103.PubMedGoogle ScholarCrossref
4.
Richards  M , Teal  SB , Sheeder  J .  Risk of luteal phase pregnancy with any-cycle-day initiation of subdermal contraceptive implants.   Contraception. 2017;95(4):364-370.PubMedGoogle ScholarCrossref
5.
Turok  DK , Gero  A , Simmons  RG ,  et al.  Levonorgestrel vs. copper intrauterine devices for emergency contraception.   N Engl J Med. 2021;384(4):335-344. PubMedGoogle ScholarCrossref
6.
Stanton  TA , Blumenthal  PD .  Postpartum hormonal contraception in breastfeeding women.   Curr Opin Obstet Gynecol. 2019;31(6):441-446. PubMedGoogle ScholarCrossref
7.
Averbach  SH , Ermias  Y , Jeng  G ,  et al.  Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type.   Am J Obstet Gynecol. 2020;223(2):177-188. PubMedGoogle ScholarCrossref
8.
Armstrong  MA , Raine-Bennett  T , Reed  SD ,  et al.  Association of the timing of postpartum intrauterine device insertion and breastfeeding with risks of intrauterine device expulsion.   JAMA Netw Open. 2022;5(2):e2148474.PubMedGoogle Scholar
9.
Mody  SK , Farala  JP , Jimenez  B ,  et al.  Paracervical block for intrauterine device placement among nulliparous women.   Obstet Gynecol. 2018;132(3):575-582. PubMedGoogle ScholarCrossref
10.
Teal  SB , Turok  DK , Chen  BA ,  et al.  Five-year contraceptive efficacy and safety of a levonorgestrel 52-mg intrauterine system.   Obstet Gynecol. 2019;133(1):63-70. PubMedGoogle ScholarCrossref
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