Reproductive Health Conference Notes: New Findings in Long-acting Reversible Contraception

Contributor
School of Nursing

A couple of weeks ago, I attended the Association of Reproductive Health Professionals (ARHP) annual conference in Charlotte, North Carolina, as a conference ambassador. In this article, I’ll share a few points that I found interesting and relevant for clinical practice and research.

Several sessions discussed long-acting reversible contraception (LARC) birth control methods, such as intrauterine devices (IUDs) and implants. As those of us rotating through clinics can attest, starting and maintaining women and teens on LARC methods can be challenging, and the efficacy of LARC methods is often clouded by myths or side effects.

So, my attention was caught by the CHOICE project, which succeeded in getting 75% of its participants to choose a LARC method by eliminating three main barriers: cost, education and access.  Based in St. Louis, the project enrolled 9,256 women, provided education regarding all birth control methods, and offered the methods at no cost. Moreover, 86% of those who chose a LARC method were still using the method after one year, at which point they were 20 times less likely to have an unintended pregnancy than participants who opted for the pill, patch or ring.

A hot topic during the conference was research regarding extended use of LARC methods. One of the sub-studies that emerged from the CHOICE project is EPIC, which stands for “Effectiveness of Prolonged Use of IUD/Implant for Contraception.”  Preliminary data suggests that Nexplanon, an etonogestrel implant, has sustained efficacy beyond three years. This could have important implications, especially if the patient is concerned about the cost of getting the implant replaced.

Another session was dedicated to reviewing the data regarding extended use of IUDs. A literature review published earlier this year in Contraception found good evidence to support the extended use of the Paragard to 12 years (currently approved for 10 years) and Mirena to seven years (currently approved for five years) among women who have borne children and were 25 years or older at the time of IUD insertion.  The authors of the study, Justine Wu and Sarah Pickle, emphasized that clinicians must consider the patient’s age, parity, access to contraception and pregnancy desire before making a decision. Data did not support the extended use of Skyla (currently approved for three years), which is slightly smaller and has a lower dose than the Mirena IUD.

While in the exhibit hall I found a great online resource for patients. Bedsider does a terrific job of explaining and illustrating all the various contraception choices in a fun and simple manner. It is especially suited for teens and young adults, and there is also a section for providers.  The representatives told me that there is a Spanish version in development, so keep an eye out!

To learn more about the the CHOICE project, go to http://www.choiceproject.wustl.edu.  To learn more about Bedsider, go to bedsider.org.