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Objective: To document the efficacy and safety of etonogestrel subdermal contraceptive implants, levonorgestrel (LNG) intrauterine systems (IUS), and copper (Cu) intrauterine devices (IUDs) for birth control when extended beyond prescription limits.
Data sources: A systematic search of MEDLINE, Embase, and Global Health electronic databases.
Study selection: The search identified articles published between January 2000 and June 2023 on long-acting reversible contraceptive (LARC) methods and extended duration of use. Publications on LNG subdermal implants or the "frameless" IUD (not marketed in Canada), case reports, case series, animal studies, and publications not written in English or French were excluded.
Synthesis: Twenty-five publications were included. No pregnancies were reported during prolonged use of the etonogestrel-releasing implant for 1 or 2 additional years beyond the recommended limits (783 participants and 306 participants, respectively), nor with the use of the TCu380A IUD for years 8 to 11 (682 participants), 8 to 12 (356 participants), and 11 to 16 (228 participants). No pregnancies were reported with the LNG-IUS in 9 studies with follow-up from 6 to 15 years, while 2 pregnancies were reported during year 6 in 2 studies, and 4 pregnancies during year 7 in 3 studies. The risk of expulsion persisted during prolonged use of the TCu380A device and the 52-mg LNG-IUS. Other adverse events were infrequent.
Conclusion: Prolonged use of LARCs is safe and much more effective than short-acting contraceptive methods. Prolonged use of LARCs might be beneficial for individuals requiring contraception especially those with disrupted access to social and health care services or living in more remote areas.
Oral contraceptives are pills that prevent pregnancy. Most oral contraceptive pills contain 2 hormones—estrogen and progestin—that are naturally present in the bodies of individuals who are capable of becoming pregnant. Progestin-only oral contraceptive pills can be used by individuals who should avoid additional estrogen, such as those who smoke, are breastfeeding, or have heart disease or diabetes.
In the US, nearly all oral contraceptives require a prescription. In July 2023, the US Food and Drug Administration (FDA) approved the first oral contraceptive pill (Opill) that will be available without a prescription.
U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by CDC from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers (1). During January-February, 2021, CDC evaluated the 2019 WHO recommendation on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (2). CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.
Women have the opportunity to meet personal contraceptive goals with convenient, highly reliable, and easily reversible methods. Long-acting reversible contraception represents an increasingly popular option for most women throughout the reproductive lifespan. Nonetheless, many women and their health care providers are challenged by coexisting medical issues. We aim to help clinicians individualize contraception and use shared decision-making to enhance patient satisfaction and continuation with their method.
