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Long-acting reversible contraception overview

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Long-acting reversible contraception

About

What is covered

This pathway covers the effective and appropriate use of long-acting reversible contraception.

Update of the recommendations on progestogen-only subdermal implants

NICE has reviewed the evidence and updated the section of this pathway that makes recommendations on progestogen-only subdermal implants.

Long-acting reversible contraception

It is estimated that about 30% of pregnancies are unplanned. The effectiveness of the barrier method and oral contraceptive pills depends on their correct and consistent use. By contrast, the effectiveness of LARC methods does not depend on daily concordance.
Expert clinical opinion is that LARC methods may have a wider role in contraception and their increased uptake could help to reduce unintended pregnancy. Healthcare professionals need guidance and training so that they can help women make an informed choice. Health providers and commissioners also need a clear understanding of the relative cost effectiveness of LARC compared with other methods of fertility control. Enabling women to make an informed choice about LARC and addressing women's preferences is an important objective of this pathway.
LARC is defined in this pathway as contraceptive methods that require administration less than once per cycle or month. Included in the category of LARC are:
  • copper IUDs
  • progestogen-only IUSs
  • progestogen-only injectable contraceptives
  • progestogen-only subdermal implants
The pathway offers the best-practice advice for all women of reproductive age who may wish to regulate their fertility by using LARC methods. It covers specific issues for the use of these methods during the menarche and before the menopause, and by particular groups, including women who have HIV, learning disabilities or physical disabilities, or are younger than 16 years.

Updates

Updates to this pathway

27 August 2015 Minor maintenance update.
7 July 2015 Minor maintenance update.
2 September 2014 Paths on offering information about contraception and follow-up and managing problems with long-acting reversible contraception updated in line with the NICE clinical guideline on progestogen-only subdermal implants.
17 December 2013 Minor maintenance update.
6 August 2013 Minor maintenance updates
24 May 2013 Minor maintenance updates

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

The effective and appropriate use of long-acting reversible contraception

What is covered

This pathway covers the effective and appropriate use of long-acting reversible contraception.

Update of the recommendations on progestogen-only subdermal implants

NICE has reviewed the evidence and updated the section of this pathway that makes recommendations on progestogen-only subdermal implants.

Long-acting reversible contraception

It is estimated that about 30% of pregnancies are unplanned. The effectiveness of the barrier method and oral contraceptive pills depends on their correct and consistent use. By contrast, the effectiveness of LARC methods does not depend on daily concordance.
Expert clinical opinion is that LARC methods may have a wider role in contraception and their increased uptake could help to reduce unintended pregnancy. Healthcare professionals need guidance and training so that they can help women make an informed choice. Health providers and commissioners also need a clear understanding of the relative cost effectiveness of LARC compared with other methods of fertility control. Enabling women to make an informed choice about LARC and addressing women's preferences is an important objective of this pathway.
LARC is defined in this pathway as contraceptive methods that require administration less than once per cycle or month. Included in the category of LARC are:
  • copper IUDs
  • progestogen-only IUSs
  • progestogen-only injectable contraceptives
  • progestogen-only subdermal implants
The pathway offers the best-practice advice for all women of reproductive age who may wish to regulate their fertility by using LARC methods. It covers specific issues for the use of these methods during the menarche and before the menopause, and by particular groups, including women who have HIV, learning disabilities or physical disabilities, or are younger than 16 years.

Updates

Updates to this pathway

27 August 2015 Minor maintenance update.
7 July 2015 Minor maintenance update.
2 September 2014 Paths on offering information about contraception and follow-up and managing problems with long-acting reversible contraception updated in line with the NICE clinical guideline on progestogen-only subdermal implants.
17 December 2013 Minor maintenance update.
6 August 2013 Minor maintenance updates
24 May 2013 Minor maintenance updates

Sources

NICE guidance and other sources used to create this pathway.
Long-acting reversible contraception update (2005 updated 2014) NICE guideline CG30

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
NICE has written information for the public explaining its guidance on long-acting reversible contraception.

Pathway information

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

Body mass index
Depo medroxyprogesterone acetate
Intrauterine device
Intrauterine system
Long-acting reversible contraception
Norethisterone enantate
Sexually transmitted infection
Venous thromboembolism
The progestogen-only subdermal implant (Implanon) recommended in 'Long-acting reversible contraception' (NICE guideline CG30) is no longer available. Healthcare professionals considering offering the replacement device, Nexplanon, should refer to the summary of product characteristics.

Paths in this pathway

Pathway created: April 2013 Last updated: August 2015

© NICE 2016

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