What do you know about IUDs and hormonal implants?

contraception contraceptive iud pill women's health reproductive reproduction

Most women are unaware or misinformed about the most effective reversible contraceptives on the market, say women’s health experts

The Australian Healthcare and Hospitals Association has released a statement on the use of long-acting reversible contraceptive methods (LARCs), in order to summarise and reflect the views of leading health professionals and experts across the country.

It specifically refers to progestogen-only implants (Implanon), hormonal intrauterine devices (Mirena IUD) and copper IUDs, and not progestogen depot injections.

AHHA CEO Alison Verhoeven says the uptake of LARCs is low in Australia, despite clinical experts both here and internationally recommending them as the most effective reversible contraceptives.

Meanwhile unintended pregnancies continue to occur, with an estimated 40-50% of Australian women having an unintended pregnancy during their reproductive lives.

“The pill continues to be used widely—estimates for primary contraceptive method for Australian women are that 33% use oral contraceptives, 30% condoms and 19% sterilisation.

“Despite this, unintended pregnancy remains a significant health issue. Around 60% of Australian women who have had an unintended pregnancy were using contraception—most notably the pill (43%) and condoms (22%). The problem with the pill was usually a missed dose,” says Ms Verhoeven.

What are the benefits?

LARCs are more effective than oral contraceptives or condoms as they are a less user-dependent method, says Ms Verhoeven.

Dr Deborah Bateson, Medical Director of Family Planning NSW, agrees.

“They’re more effective than typical use with the pill. IUDs and implants have an effectiveness rate of over 99%.

“The contraceptive pill has 99% effectiveness rate, meaning about one woman in every 100 will become pregnant per year – but this is only with perfect use.

“With typical or ‘real life’ use, the contraceptive pill is less effective (about 91%).”

Meanwhile LARCs don’t require the woman to remember to take something daily, for example a pill.

“We also refer to them as ‘set and forget’ method of contraception,” says Dr Bateson.

Dr Bateson points out that many reasons women decide not to take up LARCs are based on misinformation, not evidence.

“Contrary to what some belief, LARCs can be used by most women, right across the lifespan.

“Another key thing is that they’re long-lasting, but they’re also immediately reversible.

“They’ve also got a few benefits, for example the hormonal IUD (also known as Mirena) is very effective at reducing heavy menstrual bleeding. Mirena would be a very useful option for women with bleeding and menstrual issues.”

AHHA says that when women are provided with comprehensive, accurate and unbiased counselling, LARC methods are preferred and have the highest rates of satisfaction and 12-month continuation compared with other combined hormonal methods (e.g. oral contraceptive pill, vaginal ring).

What are the risks?

Dr Bateson says Family Planning NSW has quantified the risks for every woman that has come into its clinics.

“We’ve found there’s a very small risk of [uterine] perforations, equalling two in 1000 insertions. A recent study has found perforation risk is slightly higher in women who are breastfeeding.

“There’s also small risk of infection that’s limited to the first three weeks after insertion.”

However this is mainly related to contraction of STIs, she says, as the IUD doesn’t increase risk of pelvic infection—and reminds women who are using LARCs to be still be aware of safe sex practices including use of condoms.

What if a woman becomes pregnant on the IUD?

“If someone becomes pregnant on the IUD, then what we would do is discuss options with her as normal,” says Dr Bateson.

“If she wants to continue the pregnancy, we would remove with IUD before 12 weeks gestation and the pregnancy would continue.”

However she says past the 12-week mark it can be more dangerous to remove, meaning the pregnancy would need to continue with the IUD in place under the close supervision of an obstetrician.

LARCs in the pharmacy

Pharmacists have a very important role in women’s contraceptive options, says Dr Deborah Bateson.

“They’re often the first port of call. It’s great for pharmacists to provide patients with effective information, and to be aware about the different contraceptive options including LARCs.

“Pharmacists might have a patient coming in for years taking the same pill. It can be useful for the pharmacist to be proactive and say, are you aware there are other options?

“Also knowing where to direct people to more in-depth resources is useful.”

Further resources

Family Planning NSW

Marie Stopes Australia

Children by Choice

Australian Healthcare & Hospitals Association

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