‘LARCs are suitable for women of all reproductive ages.’

contraception contraceptive iud pill women's health reproductive reproduction

Pharmacist-led research has found rates of hormonal LARC use almost doubled over the past decade, but uptake in Victoria and NSW was lower

A new nationwide study has found that the rate of supply for hormonal long-acting reversible contraceptives (LARCs) in Australia increased over the past decade—although it began to plateau in some states from 2015.

LARCs include the copper-based intrauterine device, and the hormonal based intrauterine device or the hormonal implant.

Using a PBS data sample, researchers included Australian women of reproductive age (15–44 years) with a dispensing claim for LARCs from January 2006 to December 2018.

During this period two LARCs were available for subsidy on the PBS: levonorgestrel 52 mg intrauterine system (IUS; Mirena) and etonogestrel 68 mg implant (Implanon).

They found that annual PBS claims for LARCs increased approximately doubled between 2006 and 2018 from 21.7 to 41.5 per 1000 reproductive‐aged women.

Increases were observed across all age groups and states/territories.

After taking into account duration of activity and published continuation rates for each LARC, it was estimated that, in 2018, 10.8% of women aged 15–44 were using a LARC; 4.5% for the implant and 6.3% for the IUS.

The study found overall rates of LARC uptake in Victoria and New South Wales were 20-50% lower than other states, and seemed to plateau from 2015. Northern Territory uptake declined between 2015 and 2018.

Meanwhile the highest uptake was among women in Tasmania, followed by South Australia, Queensland and Western Australia. In these states, LARC supply has continued on an upward trajectory.

Temporal trends in the rate of dispensing for hormonal long‐acting reversible contraceptives (LARCs) combined, according to state/territory in Australia, 2006–2018. Source: The Australian and New Zealand Journal of Obstetrics and Gynaecology

A notable observation in the study was the slowing in the rate of increase of LARC dispensing from 2016 onward. This was most pronounced for the use of the implant among those aged 15–24 years.

In contrast, the rate of IUS dispensing has stalled from 2015 onward among those aged 30–44 years, but significant increases continued to be observed among those aged 15–29.

The study, published in The Australian and New Zealand Journal of Obstetrics and Gynaecology, was led by Monash University’s Faculty of Pharmacy and Pharmaceutical Sciences (FPPS) Affiliate and pharmacist, Associate Professor Luke Grzeskowiak, alongside Dr Jenni Ilomaki from the FPPS Centre for Medicine Use and Safety.

“Such a significant variation in uptake across age group and state/territories indicates opportunities to try and understand what is happening here – where uptake has plateaued, or even declined in some cases, we have to ask ourselves what is behind these barriers to uptake,” said A/Prof Grzeskowiak, from Flinders University in Adelaide.

“The more we understand, the better placed we are to put the right measures in place to ensure all women are provided the option of deciding on and accessing the most appropriate form of contraception for them.

“Pharmacists should be familiar with all available contraceptive methods and can play a key role in addressing common barriers to LARC uptake, which include lack of awareness and misperceptions regarding their appropriateness and/or safety,” A/Prof Grzeskowiak told AJP.

“LARCs are suitable for women of all reproductive ages, have few contraindications and have high rates of acceptability and continuation, as compared with other contraceptive methods such as the oral contraceptive pill,” he said.

“While LARC is becoming increasingly promoted as first-line contraception, discussions about contraception should be focused on taking into account individual circumstances and supporting fully informed decision making.

“Pharmacists are well positioned to intervene with patients at risk for unintended pregnancy, whether it is due to inconsistent or incorrect contraceptive use or a concurrent medication or condition that renders other methods inappropriate, among other situations,” A/Prof Grzeskowiak added.

“Furthermore, pharmacists are well positioned to discuss ongoing contraception requirements following provision of emergency contraception or supply of medications for termination of pregnancy.”

A/Prof Grzeskowiak was supported by a Robinson Research Institute Career Development Fellowship and Lloyd Cox Research Fellowship from the University of Adelaide, as well as a Mid‐Career Fellowship from The Hospital Research Foundation.

The study was also supported by the Head of the Department of General Practice at Monash University, Professor Danielle Mazza, who is also Chief Investigator and Director of SPHERE – a Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care.

See the full study here

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