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Long-acting Reversible Contraception: The Effective and Appropriate Use of Long-Acting Reversible Contraception

Long-acting Reversible Contraception: The Effective and Appropriate Use of Long-Acting Reversible Contraception

NICE Clinical Guidelines - National Collaborating Centre for Women’s and Children’s Health (UK)

Version: October 2005

Progestogen-only subdermal implants (POSDIs)

Contraceptive implants are inserted subdermally under the skin in the upper arm. Implanon Update 2013: The progestogen-only subdermal implant, Implanon, recommended in this guideline is no longer available. Implanon was replaced by Nexplanon. Nexplanon contains the same amount of the same drug as Implanon, but the summaries of product characteristics for the two devices are not identical. In the light of the change in the implant available, NICE will review the evidence and update the section of the guideline that makes recommendations on progestogen-only subdermal implants. All recommendations that refer to Implanon should be accompanied by a footnote which states the following: “The progestogen-only subdermal implant (Implanon) recommended in this guideline is no longer available. Healthcare professionals considering offering the replacement device, Nexplanon, should refer to the summary of product characteristics.” is currently the only subdermal implant licensed for use in the UK. Norplant has not been marketed in the UK since 1999. However, it is still in use in many other countries and women still attend UK clinics requesting removal. Jadelle® (Norplant-2) has not been marketed in the UK, but is licensed elsewhere in the world and women sometimes attend UK clinics requesting removal.

Progestogen-only injectable contraceptives (POICs)

Progestogen-only injectable contraceptives (POICs) are slow-release preparations lasting 2 or 3 months. Depot medroxyprogesterone acetate (DMPA) and norethisterone enantate (NET-EN) are the two POICs available in the UK. DMPA is licensed as a first-line contraceptive for long-term and short-term use. NET-EN is licensed for short-term use (up to two injections) by women whose partners undergo vasectomy, until the vasectomy is effective, and by women immunised against rubella, to prevent pregnancy until immunity develops.

Summary of recommendations and practice algorithm

Women requiring contraception should be given information about and offered a choice of all methods, including long-acting reversible contraception (LARC) methods. (Chapter 3.2) D(GPP)

Copper intrauterine devices (IUDs)

Intrauterine devices (IUDs) are small contraceptive devices inserted through the cervix and positioned in the cavity of the uterus. Copper-containing IUDs currently available in the UK include: U-shaped (Multiload Cu375, MultiSafe 375, Multi-Safe 375 Short Loop, Load 375); plain T-shaped (Nova-T 380, Neo-Safe T 380, UT 380, UT 380 Short, Flexi-T 300); banded T-shaped (T-Safe CU 380A, Flexi-T 380, TT 380 Slimline); and frameless (GyneFix). The TT 380 Slimline is licensed for 10 years of use, the T-Safe CU 380A for 8 years and the remaining available IUDs for 5 years of use. For the purposes of the guideline we have regarded T-Safe CU 380A as comparable to TCu 380A. The available IUDs have copper on a plastic frame or a thread (frameless), with a small thread that protrudes through the cervical canal into the upper part of the vagina allowing easy removal. The tails also can be checked regularly by the wearer to ensure correct placement. It may occasionally require local anaesthesia and dilation of the cervical canal to aid insertion in nulliparous or perimenopausal women. IUDs vary in structural design and amount of copper. The levonorgestrel-only intrauterine system (LNG-IUS) has some similar features to IUDs and is considered in a separate chapter (see Chapter 5).

Evidence Tables

Usage of implants and injectables

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