Position Statement on LARC access during the COVID-19 pandemic

SHINE SA, April 7, 2020

SHINE SA, along with Family Planning VictoriaFamily Planning NTFamily Planning TasmaniaSexual Health and Family Planning ACTSexual Health Quarters, and True Relationships & Reproductive Health have co-signed a Position Statement on LARC access during the COVID-19 pandemic.

Extended use of and ongoing access to LARCs during the COVID-19 pandemic

Provision of contraception is essential during the COVID-19 pandemic to prevent unintended pregnancies. This is particularly important for individuals most at risk, including young people due to their high levels of fertility, people with serious health conditions, and for those who are post-abortion. Long Acting Reversible Contraceptive methods (LARCs) are more effective than shorter acting methods and increased community access and uptake is associated with lower abortion rates.

Ongoing access to LARC insertion is essential during the pandemic

Contraception is essential health care and all efforts should be made to continue the insertion of LARCs during the pandemic. To reduce the risk of infection with COVID-19, this may require different approaches to insertion such as a wearing mask during insertion of contraceptive implant or using an inserter-only approach for IUD insertion (with an assistant outside the room for emergencies).

Summary of recommendations during the pandemic

  • All efforts should be made to continue access to insertion of LARCs during the pandemic, particularly for younger people, people with serious health conditions, and post-abortion
  • The etonogestrel implant (Implanon NXT) can be extended off-label for use up to 4 years
  • The 52mg LNG IUD (Mirena) can be extended off-label for use up to 6 years
  • The 19.5mg LNG IUD (Kyleena) cannot be extended beyond 5 years
  • Standard sized T shaped banded copper IUDs can be extended off-label for use up to 12 years
  • 5-year copper IUDs (Load 375 and Copper T short) can be extended off-label for use up to 6 years
  • Additional use of condoms and/or a contraceptive pill should be discussed with users for whom the risk of an unintended pregnancy is unacceptable during extended use.

 

Efficacy of Contraceptive Methods chart – new edition 2019

Family Planning Alliance Australia, 2019

How effective is each contraceptive method? This revised chart compares methods of contraception for their efficacy. 

The figures have been derived by expert consensus using results from a variety of studies, selecting figures from studies which appear to be most comparable to Australian conditions.

SHINE SA Media Release: Response to ABC report on Long Acting Reversible Contraception (LARCs)

SHINE SA, Issued: 13 December 2017

SHINE SA believes that decisions about contraception should be made in conjunction with a health care professional and that everyone should have access to accurate and unbiased information to enable appropriate informed contraceptive choice.

LARCs (Long Acting Reversible Contraception) including the levonorgestrel IUD1 (Mirena) and the subdermal implant (Implanon NXT) are the most effective reversible methods of contraception available. They have the additional advantage of being long lasting, convenient to use and generally well regarded by most users. LARC method failure rates rival that of tubal sterilization at <1% and unintended pregnancy rates are lower than those reported for contraceptive pill users.

Like all progestogen only contraceptive methods, LARCs may result in a change of bleeding pattern which may include no bleeding, frequent or prolonged bleeding. Users of the levonorgestrel IUD most commonly experience a reduction in bleeding over time and it is used as a treatment for Heavy Menstrual Bleeding for this reason. Only 1 in 5 users of the contraceptive implant have an increase in bleeding that persists beyond the first few months.

LARC use, and in particular the subdermal implant, is not known to be associated with pelvic inflammatory disease (PID) which is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries. PID is a known side effect of IUD insertion but occurs in less than 1 in 300 people. The risk of PID is only increased for the first 3 weeks after insertion, after which it returns to the previous background risk. Users of IUDs are encourage to return at any sign of infection and when treated promptly with antibiotics are unlikely to experience any long term complications.

Push to dispel myths about long-lasting contraception

Guardian Australia, Tuesday 26 September 2017 

Misplaced concerns and myths about long-acting reversible contraceptives have prompted medical experts to release Australia’s first consensus statement, saying they are more reliable and effective than condoms or the pill.

Despite their safety, efficacy and widespread use internationally, the uptake of long-acting reversible contraceptives (LARCs) is low in Australia. On Tuesday the Australian Healthcare and Hospitals Association released a consensus statement – endorsed by 18 agencies, including SHINE SA – on the use of LARCs.

Essure contraceptive device: Hazard Alert from TGA

Therapeutic Goods Administration, August 30, 2017

Consumers and health professionals are advised that Australasian Medical and Science Ltd (AMSL), in consultation with the TGA, has issued a hazard alert for Essure. AMSL is also recallingunused stock and withdrawing the device from the Australian market.

Contraception for women living with violence

Children by Choice, Last modified on: 22 May 2017

Contraceptive use is often compromised for women living with violence. 

Contraceptive options that are safe and appropriate for one woman may not work for another. If you’re working with women experiencing violence, it’s important to explore each woman’s unique circumstances and draw on her own knowledge to assess the degree of comfort and safety with her contraceptive options.

Important factors to consider include whether the perpetrator is likely to:

  • Monitor the woman’s Medicare or prescription records through her MyGov account;
  • Restrict or monitor access to health care professionals;
  • Monitor menstruation and fertility patterns;
  • Engage in severe physical assaults;
  • Be actively searching for the use of contraceptive drugs or devices; and/or
  • Engage in rape and other forms of sexual assault.

This guide is not intended to replace a full medical consultation with a professional, but does provide a starting point for thinking further about which contraceptive options might be safest and most appropriate given an individual patient’s or client’s circumstances.

  • Read more here
  • Download full resource (PDF) here