Researchers have discovered that long-acting reversible contraceptives (LARCs), such as etonogestrel subdermal contraceptive implants, levonorgestrel (LNG) intrauterine systems (IUS), and copper (Cu) intrauterine devices (IUDs), are effective and safe when used longer than their approved time. A recent study was conducted by Edith G. and fellow researchers which was published in The Official Journal of the College of Family Physicians of Canada. The results indicate that extended use of LARCs is far more effective compared to short-acting contraceptive methods, and thus they are an appropriate choice for individuals, particularly those with poor access to healthcare services.
Systematic review was done using MEDLINE, Embase, and Global Health databases. The literature search centered on articles posted between January 2000 and June 2023, and it reviewed research that compared outcomes of prolonged LARC use. Exclusion reasons were LNG subdermal implants, "frameless" IUDs from outside Canada, case reports and case series, animal research, and non-French or non-English reports. There were 25 included publications, as they provided solid data on protracted LARC use and associated clinical outcomes.
Key Findings
• Etonogestrel Subdermal Implant: No pregnancy was observed with 1 extra year of use (783 participants) or 2 extra years of use (306 participants) in excess of the recommended period.
• Copper IUD (TCu380A): No pregnancy was seen with extended use from year 8 through year 11 (682 participants), year 8 through year 12 (356 participants), and year 11 through year 16 (228 participants).
• Levonorgestrel IUS: There were no pregnancies in 9 studies that had extended durations of follow-up from 6 to 15 years. 2 pregnancies did occur in year 6 (2 studies) and 4 pregnancies in year 7 (3 studies).
• Risk of Expulsion: There was a residual risk of expulsion with both TCu380A and 52-mg LNG-IUS when used for the long term.
• Adverse Events: Other side effects were few, supporting prolonged LARC's safety profile.
The study authors concluded that prolonged use of LARCs beyond the prescribed duration is safe and extremely effective. With the low pregnancy rates and few adverse effects, extended use may be a pragmatic and useful strategy for those requiring long-term contraception, especially those with interrupted access to healthcare services. The results indicate that reconsideration of LARC prescription durations can enhance contraceptive availability and decrease healthcare burdens of device replacement.
Reference:
Guilbert, E., Arguin, H., & Bélanger, M. (2025). Extended duration of use of long-acting reversible contraceptives: Systematic review. Canadian Family Physician Medecin de Famille Canadien, 71(2), e35–e52. https://doi.org/10.46747/cfp.7102e3
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