ACOG Strengthens Opinion on IUDs and Implants

Diana Phillips

September 23, 2015

An updated committee opinion from the American College of Obstetricians and Gynecologists urges healthcare providers to increase access to long-acting reversible contraception (LARC) for all appropriate patients. Healthcare professionals should encourage patients to consider implants and intrauterine devices, educate patients on LARC options, and advocate for insurance coverage and appropriate payment and reimbursement for every type of contraceptive method, according to the committee opinion published by the American College of Obstetricians and Gynecologists (ACOG) in the October issue of Obstetrics & Gynecology.

"ACOG has long recommended LARC as the most effective reversible contraceptive option for most women, including those who have not given birth and adolescents who are sexually active," David E. Soper, MD, chair of ACOG's Gynecologic Practice Committee, noted in a news release. "We continually see more and more data to support and strengthen our recommendations at the same time that more LARC options are becoming available."

In particular, the committee points to data from the Contraceptive CHOICE Project, an observational clinical trial, indicating that improving access to and knowledge about LARC methods increases their use "and may decrease unintended pregnancy, abortion, repeat abortion and adolescent birth rates."

In addition, CHOICE Project studies have demonstrated that implants and IUDs are significantly more effective than oral contraceptive pills, patches, or rings. Further, the authors write, "Evidence from several other studies indicates that increasing use of LARC methods can reduce rapid repeat pregnancy among adolescents and repeat abortion among women who have had an induced abortion."

At this time, five LARC devices are available in the United States: one single-rod etonogestrel implant approved by the US Food and Drug Administration for up to 3 years, and four brands of IUDs. The copper IUD is approved for up to 10 years of use, and three levonorgestrel-releasing intrauterine systems also are available: two approved for use up to 3 years and one approved for up to 5 years of use.

The opinion recommends that obstetrician-gynecologists should:

  • provide counseling on all contraceptive options, including implants and IUDs;

  • encourage consideration of implants and IUDs for all appropriate candidates, including women who have not given birth and sexually active adolescents;

  • adopt best practices for LARC insertion;

  • advocate for coverage for every contraceptive method by all payers in all clinically appropriate circumstances; and

  • become familiar with programs at all levels that improve affordability of all contraceptive methods.

"Increasing familiarity with changes in practice guidelines and improvements associated with the newer LARC devices may address some obstetrician–gynecologists’ reluctance to encourage LARC use," the authors explain. "Although obstetrician–gynecologists generally have favorable attitudes about IUDs, they may use overly restrictive criteria to identify IUD candidates."

In addition to the effectiveness of LARCs, "independent from coitus, user motivation, and adherence," the opinion points to the fact that LARCs have the highest effectiveness, continuation, and user satisfaction of all reversible methods as a particular advantage. Additional benefits include the fact that LARCs are highly cost-effective and are reversible, with a rapid return to fertility. Also, there are few absolute contraindications to using LARC methods, the authors write.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;126:e44-e48.


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