Premium
Long‐Acting Reversible Contraception: A Review in Special Populations
Author(s) -
Prescott Gina M.,
Matthews Christina M.
Publication year - 2014
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1358
Subject(s) - medicine , etonogestrel , long acting reversible contraception , levonorgestrel , intrauterine device , family planning , contraceptive implant , breastfeeding , population , obstetrics , desogestrel , pill , gynecology , developed country , pediatrics , environmental health , research methodology , nursing
Almost half of the pregnancies in the U nited S tates are unintended. Currently available contraceptive methods are highly efficacious, but the most commonly used methods rely on patients for appropriate use. There has been a push to advocate for long‐acting reversible contraceptives ( LARC s) as first‐line methods because they are placed by medical professionals and are the most effective form of reversible contraception available. There are four LARC s currently available in the United States : the Copper T intrauterine device, two forms of the levonorgestrel intrauterine system, and the etonogestrel subdermal implant. Once inserted, they can be left in place for 3–10 years, depending on the device. Some of these devices have been available for a number of years, but their use is limited in the United States due to controversies and misconceptions. A MEDLINE search from 1990–2012 was conducted to identify articles describing the use of LARC s in populations with limited data, including postpartum women, adolescents and nulliparous women, and women with sexually transmitted infections, including human immunodeficiency virus ( HIV ). Health care provider safety concerns surrounding intrauterine device ( IUD ) expulsions and infection are issues for use in adolescents and nulliparous women. Concern regarding IUD expulsion in the postpartum population questions the benefit of immediate versus delayed insertion, and the progestin effect in the levonorgestrel IUD and etonogestrel implant is of theoretic concern for breastfeeding women. In women with HIV , concerns have been raised about increased viral shedding with the IUD and drug interactions with the progestin methods. Many misconceptions surrounding LARC s are unfounded, but individual risk factors may leave LARC users at risk of unintended pregnancy if not addressed properly.