More women reported to be moving to long-acting reversible contraceptives

Results from two analyses of national data indicate that women are increasingly turning to use of long-acting reversible contraceptives (LARCs) such as the intrauterine device (IUD) and implant for birth control.^1,2

In the first report, statisticians with the Centers for Disease Control and Prevention’s National Center for Health Statistics looked at contraceptive use among women ages 15-44 collected in the 2011-2013 rounds of the National Survey of Family Growth (NSFG), a national compilation of information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and men’s and women’s health.

In their analysis, the researchers found that the most commonly used methods were the pill (25.9%, or 9.7 million women), female sterilization (25.1%, or 9.4 million women), the male condom (15.3%, or 5.8 million women, and LARCs (11.6%, or 4.4 million women). Use of LARCs has almost doubled since the report on the 2006 to 2010 National Survey of Family Growth, when the rate of LARC use was only 6.0%, researchers note. Use of IUDs made up the bulk of this category, with 10.3% of current contraceptors using an IUD during 2011-2013.¹

The second report, prepared by researchers with the New York City-based Guttmacher Institute, found that use of the IUD and the contraceptive implant by female birth control users ages 15-44 increased from about 9% in 2009 to nearly 12% in 2012, with increases seen across virtually all groups of women.² Comparison with previous studies shows that this increase is a part of a decade-long trend. In 2002, only about 2.4% of U.S. women using contraception were using LARC methods.³

The Guttmacher Institute report, which looked at NSFG data from 2009 to 2012, notes that while LARC use increased across nearly every group of women studied, the most significant increases were among Hispanic women (from 8.5% to 15.1%), those with private insurance (from 7.1% to 11.1%), those with fewer than two sexual partners in the previous year (from 9.2% to 12.4%), and those who were nulliparous (from 2.1% to 5.9%).²

“LARC methods have the potential to significantly decrease unintended pregnancy in the United States because they are ‘set and forget,’ meaning they require no intervention from women, resulting in greater effectiveness,” said Megan Kavanaugh, DrPH senior research associate at the Guttmacher Institute, in a release accompanying the report.

LOOK AT OTHER BENEFITS

While many women might choose an IUD or implant for the high level of effectiveness offered, some women might consider the two methods for their benefits outside of birth control.

Anne Burke, MD, MPH, associate professor in the Department of Gynecology and Obstetrics at the Johns Hopkins University of School of Medicine in Baltimore, spoke on the noncontraceptive benefits of LARC methods at the 2015 Contraceptive Technology Quest for Excellence conference in Atlanta.⁴ While all progestin-containing methods reduce menses, the levonorgestrel IUD is the most effective, notes Burke.

According to Contraceptive Technology, the levonorgestrel IUD reduces dysmenorrhea and menstrual blood loss from a variety of causes; overall blood loss drops about 90%, and at least 20% of women stop bleeding.⁵

In studies looking at the contraceptive implant, 48% of women saw a decrease in dysmenorrhea, and 61% saw a decrease in acne, states Burke.^6-7

The levonorgestrel IUD and the implant have been eyed for use in relieving pain from endometriosis. Data indicates that the levonorgestrel IUD relieves symptoms and is effective as other methods, but offers better compliance.⁸

In a small study looking at use of the contraceptive injection depot medroxyprogesterone acetate (DMPA) and the implant, researchers report during a one-year follow-up period, clear improvement in pain intensity was seen for both treatment options.⁹ After six months, the average decrease in pain was 68% in the implant group and 53% in the DMPA group.⁹

Remember that side effects are low in LARC users, says Burke. Such bothersome side effects as weight gain, mood changes, depression, nausea, low back pain, breast tenderness, headaches, and acne are observed in less than 5% of LARC users, she states.

REFERENCES

1. Daniels K, Daugherty J, Jones J, et al. Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013. Natl Health Stat Report 2015; 86:1-15.
2. Kavanaugh ML, Jerman J, Finer LB. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009-2012. Obstet Gynecol 2015; 126(5):917-927.
3. Finer LB, Jerman J, Kavanaugh ML. Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertil Steril 2012; 98(4):893-897.
4. Burke A. Non-contraceptive benefits of LARC. Presented at the 2015 Contraceptive Technology Quest for Excellence conference. Atlanta; November 2015.
5. Dean G, Schwarz EB. Intrauterine contraceptives (IUCs). In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
6. Funk S, Miller MM, Mishell DR Jr, et al; Implanon US Study Group. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception 2005; 71(5):319-326.
7. Mansour D, Korver T, Marintcheva-Petrova M, et al. The effects of Implanon on menstrual bleeding patterns. Eur J Contracept Reprod Health Care 2008; 13 Suppl 1:13-28.
8. Heikinheimo O, Gemzell-Danielsson K. Emerging indications for the levonorgestrel-releasing intrauterine system (LNG-IUS). Acta Obstet Gynecol Scand 2012; 91(1):3-9.
9. Walch K, Unfried G, Huber J, et al. Implanon versus medroxyprogesterone acetate: Effects on pain scores in patients with symptomatic endometriosis — A pilot study. Contraception 2009; 79(1):29-34.