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Advising patients on long-acting reversible contraception

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Long-term reversible contraception is convenient Long-term reversible contraception is convenient and reliable but is associated with some challenges

Women with contraception needs should be given information about and offered a choice of all methods according to NICE. Women should also be counselled regarding long-acting reversible contraception (LARC) methods.1 It is worth considering that LARCS are more cost effective than the combined oral contraceptive pill even at one year of use.1 NICE advises that increasing the number of women who choose a LARC method may reduce the numbers of unintended pregnancies. Contraceptive counselling should be individualised to the woman and her needs. Furthermore, efficacy, risks and benefits, how to start and stop contraception should be discussed.1 Importantly the risk of sexually transmitted infections should be assessed. This review focusses on LARC methods.

Progestogen-only implant

The etonogestrel implant Nexplanon is the only progestogen-only contraceptive subdermal implant available in the UK.2 Nexplanon is licensed for use for up to three years, importantly there is evidence that the risk of pregnancy in the fourth year of use is very low. It is a radio-opaque, progestogen-only implant. It is approximately 4cm long and 2mm in diameter.2 It is preloaded in a sterile, disposable applicator and requires fitting. Etonogestrel inhibits ovulation and causes changes in cervical mucus.2

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