Long-acting Reversible Contraception (LARC)

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1 Long-acting Reversible Contraception (LARC) Patient Information Leaflets

2 What is long-acting reversible contraception? There are many different contraceptives available, however, long acting contraceptives are ones that you do not have to think about every day or each time you have sex, such as the pill or condoms. This leaflet shows you the different methods available, how they work, how effective they are and the main advantages and disadvantages. These methods include: Contraceptive injections, which work up to 12 weeks and can be repeated. Devices that are fitted inside your womb intrauterine devices (IUDs) and intrauterine system (IUS), which last between 5-10 years, and can be replaced after this time. Implants placed under your skin, which last for 3 years and can be replaced after this. Injections, IUDs, IUS and implants are called long acting reversible contraceptives because you can stop using them if you decide you want to get pregnant or change to an alternative method. These methods are for women. There are currently no long-acting reversible contraceptives for men. Contraception needs to be used until menopause.

3 Intrauterine device (IUD) What is it? A small plastic or copper device that is inserted in the womb. How does it work? Can work by preventing sperm from fertilizing an egg, or by stopping a fertilized egg from implanting in the womb. How long does it last? Between 5-10 years for the most effective types of IUD. If you are 40 or older when an IUD is fitted, it may stay in place until you no longer need contraception after the menopause. How effective is it? Fewer than 20 of every 1000 women who have an IUD for 5 years get pregnant. Can it affect my chance of getting pregnant in the future? No. How might it affect periods? Periods might become heavier or more painful. What unwanted effects does it have? Overall, the risk of ectopic pregnancy is lower in women using IUDs than in women using no contraception. In women who become pregnant while using IUD the risk is higher. An ectopic pregnancy is a pregnancy that implants itself outside of the womb (uterus) and this is the wrong place for a pregnancy. If you become pregnant while using IUD, you need a check to make sure the pregnancy is not ectopic; your GP can refer you to the hospital for assessment and scan if required.

4 What checks will I need while using it? You will need to see your Dr/Family Planning Clinic (FPC) after your first period. IUDs have short threads attached, which hang through the cervix into the top of the vagina. You will be taught how to feel for these, to make sure the IUD is still there. You need to do this monthly usually after each period. You should see your Dr/FPC if you think there is a problem related to the IUD, you want to stop using it or have it removed. Intrauterine system (IUS) What is it? A small plastic device that is inserted in the womb and slowly releases progestogen. Progestogen is an artificial hormone that has the same effect as the natural hormone progesterone. Progesterone is a hormone naturally secreted by the ovarian corpus luteum in the second/third weeks of the menstrual cycle prepare the uterus for a fertilized egg. How does it work? Mainly by preventing a fertilized egg from implanting in the womb. In some women it prevents sperm from fertilizing an egg. How long does it last? 5 years. If you are 45 or older when an IUS is fitted and you are not having periods when using it, it may stay in place until you no longer need contraception after the menopause. How effective is it? Fewer than 10 of every 1000 women using the IUS for 5 years get pregnant.

5 Can it affect my chance of getting pregnant in the future? No. How might it affect periods? There may be some irregular bleeding or spotting for the first 6 months. Usually periods become less frequent or stop after about a year. What unwanted effects does it have? A few women can develop acne. Overall the risk of ectopic pregnancy (where the fertilized egg implants outside the womb) is lower in women using IUS than in women using no contraception, but in women who become pregnant while using IUS the risks is higher. If you get pregnant while using IUS you need a check to make sure the pregnancy is not ectopic, your GP can refer you to the hospital for assessment and scan if required. What checks will I need while using it? The checks are the same as the IUD. You should see a Dr/nurse at any time if you think there is a problem, you want to stop using it or it is time to have it removed.

6 Contraceptive injection. What is it? An injection that slowly releases progestrogen. Progestogen is an artificial hormone that has the same effect as the natural hormone progesterone. Progesterone is a hormone naturally secreted by the ovarian corpus luteum in the second/third weeks of the menstrual cycle to prepare the uterus for a fertilized egg. How does it work? Mainly by stopping the ovaries releasing an egg each month, thickening cervical mucus to prevent sperm reaching an egg and thinning the lining of the womb to prevent an egg implanting. How long does it last? 12 weeks from the most commonly used injectable contraceptive (Depo provera) or 8 weeks from Noristerat. It can be injected into the mid outer leg or the buttock. How effective is it? Fewer than 4 in every 1000 women using injectable contraceptives for 2 years get pregnant. Can it affect my chance of getting pregnant in the future? It can take up to a year for fertility to return to normal after your last injection but you should start using another method of contraception as soon as your injection runs out, even if your periods have not yet re-started. How might it affect periods? Periods may stop. Some women have irregular persistent bleeding when using contraceptive injections.

7 What unwanted effects does it have? Women may gain weight (2-3kg over a year) There may be some thinning of the bones, but this largely recovers after stopping the injections and it does not seem to make breaking a bone more likely. The injection cannot be removed from the body so any side effects may continue for as long as it works and for some time afterwards. What checks will I need while using it? None-but you need to go back regularly for repeat injections. You need to see your Dr/nurse at any time if you think there is a problem related to the injection.

8 Contraceptive implant. What is it? A small flexible rod that is placed under the skin, usually on the upper arm and slowly releases progestrogen. Progestogen is an artificial hormone that has the same effect as the natural hormone Progesterone. Progesterone is a hormone naturally secreted by the ovarian corpus luteum in the second/third weeks of the menstrual cycle to prepare the uterus for a fertilized egg. How does it work? By stopping the ovaries releasing an egg each month, thickening cervical mucus to prevent sperm reaching an egg, thinning the lining of the womb to prevent an egg implanting. How long does it last? 3 years but can be taken out at any time. How effective is it? Less than 1 in every 1000 women who have an implant for 3 years get pregnant. Can it affect my chance of getting pregnant in the future? No. How might it affect periods? Periods may stop or become longer or irregular, usually until implant is removed. Period pain may improve. What unwanted effects does it have? A few women may develop acne.

9 What checks will I need while using it? None. You should see your Dr/nurse at any time if you think there is a problem related to the implant, you want to stop using it or it is time to have it removed and replaced. So is LARC right for you? Your Dr/nurse will make sure that you understand this information, so you can decide if long acting reversible contraceptives are right for you. The Dr/nurse will need to check whether there is any reason a particular method may not be suitable for you. You will be asked about your general health, any medical problems in your family, your periods and contraceptives you have used before. You will be asked if you could be at risk of having a sexually transmitted infection. Some LARC s may not take effect immediately, depending on when in your monthly cycle you start using them or you may not be able to start using the method immediately. If you are considering an IUS or IUD, you will need a vaginal examination. You will be offered tests to ensure you do not have any sexually transmitted infection as this would need to be treated prior to fitting the device. Not all health professionals are trained to fit IUD s, the IUS or implants. If your Dr/nurse cannot give you the method you choose, they should refer you to someone who can.

10 Long acting reversible contraceptive methods do not protect against sexually transmitted infections. Condoms can help protect against these infections. Special circumstances. All methods described in this leaflet can generally be used by: Women of any age. Women who have never had a baby. Women who are breastfeeding, or have recently had a baby. Women who have recently had a termination. Women who are over-weight. Women with diabetes. Women with epilepsy. Women who have migraines. Women who can t use contraceptives containing a hormone called oestrogen. Women who are HIV positive. If you are considering contraceptive injections, you should discuss advantages and disadvantages with your Dr/nurse if you are: A teenager. More than 40 years old. For further advice contact Sr Angela Wheater on Ward 13 ( ) or Contraception and Sexual Advice ( ) or your own GP.

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12 Barnsley Hospital NHS Foundation Trust Gawber Road, Barnsley S75 2EP Tel: Fax: Author: Angela Wheater Date Originated: Jun 2010 Next Review Date: Jun 2017 BHNFT266