NICE clinical guidelines
Issued: September 2014
CG30

Long-acting reversible contraception (update)

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

Introduction

Recommendations on progestogen-only subdermal implants in section 1.5 have been updated and replaced. The addendum to NICE clinical guideline 30 contains details of the methods and evidence used to update these recommendations.

The 8-year review of the NICE guideline on long-acting reversible contraception concluded that there were changes to product licensing that meant that the section on progestogen-only subdermal implants was out of date. This is because the guideline referred specifically to the subdermal implant Implanon, which is no longer available. Implanon has been replaced by the implant Nexplanon, which contains the same drug (etonogestrel) and dose, but also contains barium to make it radio-opaque, and has a different insertion device. The evidence on progestogen-only subdermal implants has been reviewed and the recommendations in this section have been updated.

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 12% of women aged 16–49 in 2008–09, compared with 25% for the oral contraceptive pill and 25% 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 the original guideline because they did not have UK Marketing Authorisation at the time the original guideline was published in 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.

Drug recommendations

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.