By Dr Cliff Neppe, Director Obstetrics and Gynaecology, Joondalup Health Campus

Dr Cliff Neppe

Despite more effective hormonal contraception options, the combined oral contraceptive pill (COCP; released in 1961) remains the preferred contraceptive for Australian women. Data suggests that 33% of women use the COCP, 30% condoms, 19% permanent sterilisation and 15% a combination of other options including Long Acting Reversible Contraception or LARC (e.g. Implanon, Mirena, Copper IUD and Depo Provera.)

Inconsistent contraceptive use plays a major role in putting women at risk of an unintended pregnancy; 60% of women with an unintended pregnancy were using at least one form of contraception (COCP 43 %, condoms 22%).

Compliance remains the leading cause of COCP failure. A key way to reduce these unintended pregnancies is using a more effective, less user-dependent method of contraception – LARC.

As well as being indicated for contraception, certain LARCs are also indicated for the treatment of idiopathic menorrhagia and the prevention of endometrial hyperplasia during oestrogen replacement therapy.

Why are LARC’s not more widely used?

When women are provided with comprehensive, accurate and unbiased counselling, LARC methods are preferred and have been shown to have higher rates of satisfaction and 12-month continuation compared with combined hormonal methods.

Papers give us some clues about reduced use.

An opinion paper cited knowledge gaps in healthcare providers and insufficient training in LARC insertion as reasons for low uptakes in LARCs. Family planning Alliance of Australia (2014) agreed with the low uptake but stated that there is no conclusive evidence that identifies the reasons.

A paucity of Australian research impedes closure of evidence gaps regarding contraceptive prescription and use. Barriers identified include lack of familiarity with LARC, misconceptions about its use; and lack of access to GPs trained in LARC insertion and removal, plus affordability.

Training enables GPs to insert IUDs in their practices but follow up revealed 68% fitted fewer than 12. Inadequate remuneration, time constraints and lack of appropriate patients are barriers.It has been found that most IUDs, even in nulliparous women, can be inserted in a primary care setting and that access to training and ongoing support for practitioners willing to develop and maintain this procedural skill are essential to enhance uptake of IUDs in  Australia.

The benefits of LARCs is clear. Our challenge is to increase uptake. In hospital post-partum insertion of LARCs would certainly increase uptake. A single dedicated LARC inserter in each practice as well as same day insertion could also possibly increase uptake.

Author competing interests: nil relevant disclosures.

Key Messages

  • LARC is an effective underused contraception method
  • Better GP support and training is needed
  • Adequate patient counselling and same day insertion could increase uptake

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