LARCS

Question 1

What type of contraceptives have the highest rates of effectiveness?

Answer 1

Long-acting contraceptives

They are associated with the highest rates of continuation and patient satisfaction.

Question 2

Are age and parity barriers for using levonorgestrel implants and intrauterine contraception?

Answer 2

No, they can be used by patients of any age, including nulliparous individuals

This means that both young women and those who have never given birth can use these methods.

Question 3

How long can levonorgestrel implants provide contraception?

Answer 3

Up to five years

These implants are fully funded without restriction.

Question 4

What is the licensed duration for copper and levonorgestrel IUCs?

Answer 4

Three to ten years

They are also fully funded without restriction but can be used for shorter or longer durations.

Question 5

What is one indication for the levonorgestrel intrauterine system (IUS) Mirena?

Answer 5

Treatment of heavy menstrual bleeding

It can also provide endometrial protection during menopausal hormone therapy.

Question 6

In what clinical scenarios can copper intrauterine devices (IUDs) be used?

Answer 6

When hormonal contraceptives are not recommended

This includes patients with higher cardiovascular risk or current or past breast cancer.

Question 7

What is the primary mechanism by which levonorgestrel implants prevent pregnancy?

Answer 7

Inhibiting ovulation and altering cervical mucus to prevent sperm penetration

Levonorgestrel implants are the most effective form of reversible contraception.

Question 8

How long can levonorgestrel implants provide contraception?

Answer 8

Up to five years

Effectiveness may decrease after the fourth year, especially in individuals weighing over 60 kg.

Question 9

What percentage of females planning pregnancy become pregnant within three months after removing a levonorgestrel implant?

Answer 9

45%

86% become pregnant within 12 months.

Question 10

What is the size and content of the Jadelle implant?

Answer 10

Two flexible rods, approximately the size of matchsticks, each containing 75 mg of levonorgestrel.

Question 11

Where is the levonorgestrel implant typically inserted?

Answer 11

Sub-dermally on the inside of the non-dominant arm

Insertion requires a disposable, sterile trocar and training.

Question 12

What complications may occur at the insertion site of a levonorgestrel implant?

Answer 12

Local pain, bruising, tingling, and a small scar

Approximately one in five patients experience these symptoms.

Question 13

When is the ideal time to insert a levonorgestrel implant for patients on combined oral contraceptives?

Answer 13

In the second week (or longer) of active hormone pills.

Question 14

What should be done immediately after the removal of a levonorgestrel implant if pregnancy is not planned?

Answer 14

Initiate a contraceptive method immediately.

Question 15

What are the contraindications for using levonorgestrel implants?

Answer 15

• Current breast cancer
• Unexplained vaginal bleeding
• Severe liver disease

Use of hormonal contraceptives in patients with a history of breast cancer is generally not recommended.

Question 16

List some conditions where levonorgestrel implants should be used with caution.

Answer 16

• New symptoms of ischaemic heart disease
• History of stroke or transient ischaemic attack
• Acute porphyrias

Question 17

What effect do hepatic enzyme-inducing medicines have on levonorgestrel implants?

Answer 17

Reduce their effectiveness.

Question 18

What percentage of patients report having regular bleeding similar to their normal menstrual cycle after six months to one year of using a levonorgestrel implant?

Answer 18

Approximately 35%.

Question 19

What are the two types of intrauterine contraceptives (IUCs)?

Answer 19

• Levonorgestrel IUS
• Copper IUD

Question 20

How long can a levonorgestrel IUS provide contraception?

Answer 20

Three to ten years, depending on the type.

Question 21

What is the recommended timing for IUC insertion in relation to STIs?

Answer 21

A STI check should be done prior to insertion; if asymptomatic, insertion can occur before results.

Question 22

What is the risk of uterine perforation during IUC insertion?

Answer 22

Approximately 1-2 per 1,000 insertions.

Question 23

What is the reported incidence of severe vasovagal reactions during IUC insertion?

Answer 23

Approximately one in 500 patients.

Question 24

What should be done if a patient has not responded to antibiotic treatment for pelvic inflammatory disease within 72 hours?

Answer 24

Remove the IUC.

Question 25

What are the common effects of using a copper IUD regarding menstrual bleeding?

Answer 25

Initial heavier and more painful menstrual bleeding, which typically improves after three months.

Question 26

What should patients be advised about using tampons and menstrual cups with IUCs?

Answer 26

There is no increased risk of expulsion, but care should be taken when removing a menstrual cup.

Question 27

What is the risk of pelvic inflammatory disease associated with IUC placement?

Answer 27

Very low, with a 0.5% increase within the first 20 days.

Question 28

What is the typical follow-up requirement after IUC insertion?

Answer 28

Not essential if patients understand how to check thread placement and recognize symptoms.

Question 29

What is the efficacy duration for the Copper IUD labeled 'Choice TT380 standard'?

Answer 29

10 years, with a possible extended duration of 12 years.

Question 30

What is the recommended action for patients who have undergone a caesarean section regarding IUC insertion?

Answer 30

Consultation is recommended.

Question 31

What is the typical return to fertility after removal of an IUC?

Answer 31

Immediate return to fertility.

Question 32

What is the association between IUC placement and pelvic inflammatory disease risk?

Answer 32

Placement of an IUC is associated with a small increase in the risk of pelvic inflammatory disease (0.5% of insertions within the first 20 days) ## Footnote Screening for STIs before IUC insertion does not reduce this risk.

Question 33

When should an IUC be removed after antibiotic treatment?

Answer 33

An IUC should be removed if the patient has not responded to antibiotic treatment within 72 hours ## Footnote This guideline is critical for managing potential complications.

Question 34

What are the reported expulsion rates of IUCs?

Answer 34

Expulsion rates of 2 – 15% have been reported for follow-up periods ranging from one to ten years ## Footnote On average, fewer than one in 20 patients experience IUC expulsion over five years.

Question 35

When does expulsion of IUCs most often occur?

Answer 35

Expulsion most often occurs in the first three months of use and during menstruation.

Question 36

What should be done if a patient using an IUC becomes pregnant?

Answer 36

The IUC should be removed, if possible, in the first 12 weeks of pregnancy ## Footnote Continuing a pregnancy with an IUC increases the risk of complications such as spontaneous abortion and preterm delivery.

Question 37

What is the estimated risk of ectopic pregnancy for those using an IUC?

Answer 37

If a pregnancy occurs while using an IUC, it is estimated that up to half of cases will be ectopic.

Question 38

What is the extended licensed duration of Mirena for contraception in the UK as of January 2024?

Answer 38

The licensed duration of use of Mirena has been extended to eight years for contraception.

Question 39

How does the FDA in the United States regard the duration of Mirena use?

Answer 39

The FDA has approved an extension to the possible duration of use by one year, allowing Mirena to be used for up to eight years.

Question 40

What is the recommended duration of use for Mirena in New Zealand?

Answer 40

The approved duration of use of Mirena in New Zealand remains at five years.

Question 41

What does the Faculty of Sexual and Reproductive Healthcare recommend regarding IUC use for patients aged 45 years or older?

Answer 41

Patients can extend the use of some IUCs for seven years or until menopause if amenorrhoeic.

Question 42

What should patients do when returning for a replacement Mirena between five and seven years after insertion?

Answer 42

They can have an immediate replacement if they have a negative pregnancy test.

Question 43

What should be done if more than seven years have passed since the IUC insertion?

Answer 43

Replacement should be delayed until there has been a negative pregnancy test at least three weeks since the last instance of unprotected sexual intercourse.

Question 44

What is advised for patients returning for a replacement copper IUD outside the recommended duration of use?

Answer 44

Pregnancy should be excluded before insertion of the new device.

Question 45

Fill in the blank: An IUC should be removed if pregnancy occurs within the first ______ weeks.

Answer 45

12

Question 46

True or False: There are concerns with short-term delays in replacing IUCs.

Answer 46

False