Guidelines for the use of long-acting reversible contraceptives.

Volume 85, Number 4 www.aafp.org/afp American Family Physician 403 The use of long-acting reversible contraceptives (LARCs) has increased from 1.3 to 5.5 percent over the past decade. There are three LARCs available in the United States: the etonogestrel single-rod implant and two types of intrauterine devices (IUDs; copper T380A and levonorgestrel intrauterine system [Mirena]). Rates of unintended pregnancy are lower and continuation of the contraceptive is higher in women who use LARCs compared with other methods (see accompanying table). LARCs are also less expensive than other methods and do not require ongoing efforts by the patient for long-term effectiveness. Encouraging appropriate patients to use LARCs may help lower the rate of unintended pregnancies in the United States, especially in high-risk women. There are few contraindications for the use of LARCs, even in nulliparous women and adolescents. The American College of Obstetricians and Gynecologists has released a practice bulletin to guide physicians on the use of LARCs.