NICE clinical guidelines
Issued: October 2005 (last modified: April 2013)
CG30

Long-acting reversible contraception

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg30

Introduction

Update of the recommendations on progestogen-only subdermal implants

The progestogen-only subdermal implant, Implanon, recommended in this guideline is no longer available.

Implanon was replaced by Nexplanon. Nexplanon contains the same amount of the same drug as Implanon, but the summaries of product characteristics for the two devices are not identical.

In the light of the change in the implant available, NICE will review the evidence and update the section of the guideline that makes recommendations on progestogen-only subdermal implants. Information on the progress of the update is available on the NICE website.

Healthcare professionals considering offering Nexplanon should consult the summary of product characteristics.

It is estimated that about 30% of pregnancies are unplanned. The effectiveness of the barrier method and oral contraceptive pills depends on their correct and consistent use. By contrast, the effectiveness of long-acting reversible contraceptive (LARC) methods does not depend on daily concordance. The uptake of LARC is low in Great Britain, at around 8% of women aged 16–49 in 2003–04, compared with 25% for the oral contraceptive pill and 23% for male condoms.

Expert clinical opinion is that LARC methods may have a wider role in contraception and their increased uptake could help to reduce unintended pregnancy. The current limited use of LARC suggests that healthcare professionals need better guidance and training so that they can help women make an informed choice. Health providers and commissioners also need a clear understanding of the relative cost effectiveness of LARC compared with other methods of fertility control. Enabling women to make an informed choice about LARC and addressing women's preferences is an important objective of this guideline.

LARC is defined in this guideline as contraceptive methods that require administration less than once per cycle or month. Included in the category of LARC are:

  • copper intrauterine devices

  • progestogen-only intrauterine systems

  • progestogen-only injectable contraceptives

  • progestogen-only subdermal implants

  • combined vaginal rings – these are excluded from this guideline because they do not have UK Marketing Authorisation at the time of publication (October 2005).

The guideline offers the best-practice advice for all women of reproductive age who may wish to regulate their fertility by using LARC methods. It covers specific issues for the use of these methods during the menarche and before the menopause, and by particular groups, including women who have HIV, learning disabilities or physical disabilities, or are younger than 16 years.