RACGP offers new suite of IUD resources

RACGP, 25th August 2020

The newly released suite consists of five intrauterine device (IUD) resources, including a checklist and patient confirmation form, patient pre- and post-insertion checklist, practitioner checklist and disclaimer. Current evidence-based options for pain relief during IUD procedures are provided as an appendix.

Dr Amy Moten, Chair of the RACGP Specific Interests Sexual Health Medicine network, led development of the resources, which she says are designed to provide guidance and support to all Australian practitioners.

NEW Fact Sheet for Health Professionals – Contraception During the COVID-19 Pandemic.

SHINE SA, 15/4/2020

SHINE SA have released a new Fact Sheet for health professionals: Contraception During the COVID-19 Pandemic.

Contraception is an essential service during the COVID-19 pandemic. This includes the provision of emergency contraception, access to long acting reversible contraception (LARC) and management of complications of LARC. Health professionals can continue to facilitate access to contraception via telehealth consults and limited face-to-face consultations where possible.

This Fact Sheet provides advice for health professionals on the provision and management of contraception during the COVID-19 pandemic. This includes LARC, combined hormonal contraception, emergency contraception, progestogen only pill and depot medroxyprogesterone acetate (DMPA).

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.

New clinical guidelines to help with heavy menstrual bleeding

ABC Health & Wellbeing, 20/10/2017

25 percent of Australians who menstruate experience heavy menstrual bleeding. Now, new guidelines for doctors will help ensure these people have access to the best available treatment for heavy menstrual bleeding.

Professor Anne Duggan, senior medical advisor at the Australian Commission on Safety and Quality in Health Care, said some patients were not being offered the full range of treatments.

clinical guidelines

Implementation resources

These resources can be used to promote and explain what the Heavy Menstrual Bleeding Clinical Care Standard means to health services, clinicians, patients and their carers.