Long-Acting Reversible Contraception: Implants and Intrauterine Devices
Publication Date: October 31, 2017
Last Updated: March 14, 2022
Recommendations
Insertion of an IUD immediately after first-trimester uterine aspiration should be offered routinely as a safe and effective contraceptive option. (A)
320000
Insertion of the contraceptive implant on the same day as first-trimester or second-trimester induced or spontaneous abortion should be offered routinely as a safe and effective contraceptive option. (A)
320000
Routine antibiotic prophylaxis is not recommended before IUD insertion. (A)
320000
Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. (B)
320000
Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded. (B)
320000
Insertion of an IUD immediately after confirmed completion of first-trimester medication-induced abortion should be offered routinely as a safe and effective contraceptive option. (B)
320000
Immediate postpartum IUD insertion (ie, within 10 minutes after placental delivery in vaginal and cesarean births) should be offered routinely as a safe and effective option for postpartum contraception. (B)
320000
Immediate postpartum initiation of the contraceptive implant (ie, insertion before hospital discharge after a hospital stay for birth) should be offered routinely as a safe and effective option for post-partum contraception, regardless of breastfeeding status. (B)
320000
Women who have not undergone routine screening for STIs or who are identified to be at increased risk of STIs based on patient history should receive CDC-recommended STI screening at the time of a single visit for IUD insertion. Intrauterine device insertion should not be delayed while awaiting test results. Treatment for a positive test result may occur without removal of the IUD. (B)
320000
Intrauterine devices may be offered to women with a history of ectopic pregnancies. (B)
320000
Long-acting reversible contraceptives have few contraindications and should be offered routinely as safe and effective contraceptive options for most women. (C)
320000
The copper IUD should be offered routinely to women who request emergency contraception and are eligible for IUD placement. (C)
320000
To improve LARC method satisfaction and continuation, patient counseling should include information on expected bleeding changes and reassurance that these changes are not harmful. (C)
320000
Endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling may all be performed with an IUD in place. (C)
320000
Actinomyces on cytology is considered an incidental finding. In the absence of symptoms, no antimicrobial treatment is needed, and the IUD may be left in place. (C)
320000
Intrauterine device removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal. (C)
320000
There is no compelling evidence for the removal of an IUD or implant before its expiration date in menopausal women. (C)
320000
Recommendation Grading
Overview
Title
Long-Acting Reversible Contraception: Implants and Intrauterine Devices
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
October 31, 2017
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Adolescent, Adult
Health Care Settings
Ambulatory
Intended Users
Physician, nurse, nurse practitioner, physician assistant
Scope
Counseling, Prevention, Management
Diseases/Conditions (MeSH)
D003271 - Contraceptive Agents, Female, D003267 - Contraception, D000075523 - Long-Acting Reversible Contraception, D007434 - Intrauterine Devices
Keywords
intrauterine devices, contraception, reversible contraception, long-acting contraception, LARC
Methodology
Number of Source Documents
151
Literature Search Start Date
December 31, 1999
Literature Search End Date
May 31, 2017