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April 2020

FSRH recommends extended use of LARCs

Replacement of long-acting reversible contraception can be deferred for a year in most cases to avoid the need for face-to-face contact between patients and clinicians, the Faculty for Sexual and Reproductive Health has advised.

The FSRH says the risk of pregnancy in the fourth year of use of an etonogestrel implant (ENG-IMP), and in the sixth year of use for Mirena and Levosert intrauterine systems (LNG-IUS) is very low, and use can be extended. Copper IUDs with a 10 year licence could be effective for up to 12 years, but women may wish to use condoms for additional protection.

Beyond 4 years of use of an ENG-IMP, and 6 years for LNG-IUS, an additional degosgestrel progestogen only pill (POP) should be offered. There is no need to bring users in for removal of expired implants, IUS or IUDs unless they wish to become pregnant or have serious side effects.

For existing combined hormonal contraception users, it is reasonable to provide a further remote 6-12 months without rechecking body mass index or blood pressure: the risk of an unplanned pregnancy is likely to be greater than the risk relating to continued use. Current POP users may also be offered a further 12 month supply without review.

Women using injectable depot contraception (i.e. Depo Provera) should be switched to desogestrel POP. Face-to-face assessment is not needed – if the woman had no contraindications to the depot injection, they are unlikely to have contraindications to POP unless absorption or adherence are significant concerns.

Self-administering users of Sayana Press (or those who have been using Depo Provera during Sayana Press shortage) can be provided with up to a 12-month supply of Sayana Press if it is available.