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Home | Long Acting Reversible Contraceptives (LARCs): Beyond Birth Control

Long Acting Reversible Contraceptives (LARCs): Beyond Birth Control

March 4, 2020

Long Acting Reversible Contraceptives (LARC) methods, which include intrauterine devices (IUDs) and the etonogestrel implant, are the first-line birth control methods recommended for adolescents. However, their use extends far beyond contraception alone.  This article will review medical indications of LARCs for non-contraceptive use.

Adolescents with dysmenorrhea, anemia and bleeding disorders

Many adolescents experience heavy, painful periods that interfere with their quality of life. Hormonal IUDs can be an excellent therapy, especially the 52mg levonorgestrel device, as 90 percent of users report reduced blood loss or amenorrhea. Those with anemia or bleeding disorders, such as Von Willebrand disease, may also benefit from this side effect. While most users will experience irregular spotting after initial placement, bleeding patterns tend to improve over time.  If placement is a barrier to treatment, placement under anesthesia or with sedation can be considered; however, most adolescents tolerate placement quite well.

Unfortunately, the etonogestrel implant’s bleeding pattern is less predictable. About 22 percent of users experience amenorrhea, 24 percent experience light/infrequent spotting, and about 25 percent experience increased and/or irregular bleeding. Thus, the etonogestrel implant may be less preferred for patients with heavy bleeding.

Adolescents with learning and/or physical disabilities

Many adolescents with disabilities have unique physical needs, and menstrual suppression may be desired by the patient and their caregivers. Hormonal IUDs may be considered to achieve this goal, as they may have a more favorable safety profile than other methods of contraception. For example, estrogen-containing methods may be contraindicated in adolescents with limited mobility or prolonged immobilization due to the increased risk of thrombosis. Oral contraceptive pills may also require attention to dosing as they can interact with other medications, such as antiepileptics. In some patients, anesthesia or sedation may be necessary for placement; therefore, the benefits and risks should be discussed with patients and families using shared decision-making.

Transgender, non-binary, and gender non-conforming adolescents

In some patients experiencing gender incongruence, menstruation may contribute to worsening gender dysphoria and can result in significant distress. While transmasculine patients on testosterone typically experience amenorrhea with appropriate dosing and duration of testosterone treatment, trans and non-binary patients may wish to induce amenorrhea without the use of testosterone. If this is the case, hormonal IUDs may be considered, particularly if the adolescent would also gain contraceptive benefit.

Adolescents with polycystic ovarian syndrome (PCOS)

Adolescents with PCOS are at increased risk of endometrial hyperplasia due to prolonged exposure of the endometrium to unopposed estrogen, which occurs in the setting of chronic anovulation. Similar to combined hormonal contraception, hormonal IUDs can be used to reduce this risk by thinning the endometrium. There is evidence suggesting that the etonogestrel implant is similarly protective, although high-quality studies are lacking.

In summary, LARCs have a wide range of uses beyond contraception and should be considered as viable treatment options by pediatric providers.

 

About the Authors

Katy Miller, MD, FAAP; Janna R. Gewirtz O’Brien, MD, FAAP; Mollika Sajady, DO, FAAP; Taylor Argo, MD; Nicole Chaisson, MD, MPH; Christy Boraas, MD, MPH contributed this article.

Works Cited

1. Braverman PK, Adelman WP, Alderman EM, et al. Contraception for adolescents. Pediatrics. 2014;134(4):e1244-e1256. doi:10.1542/peds.2014-2299

2. Jeffery E, Kayani S, Garden A. Management of menstrual problems in adolescents with learning and physical disabilities. Obstet Gynaecol. 2013;15(2):106-112. doi:10.1111/tog.12008

3. Teal SB, Romer SE, Goldthwaite LM, Peters MG, Kaplan DW, Sheeder J. Insertion characteristics of intrauterine devices in adolescents and young women: Success, ancillary measures, and complications. Am J Obstet Gynecol. 2015;213(4):515.e1-515.e5. doi:10.1016/j.ajog.2015.06.049

4. Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. The effects of Implanon® on menstrual bleeding patterns. Eur J Contracept Reprod Heal Care. 2008;13(SUPPL. 1):13-28. doi:10.1080/13625180801959931

5. WPATH. Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming people – WPATH World Professional Association for Transgender Health.

6. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-1618. doi:10.1093/humrep/dey256

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