Excerpt

Contraception can be divided into two broad categories: hormonal and nonhormonal. There are two categories of hormonal contraception: combined oestrogen and progestogen and progestogen-only. Long-acting reversible contraception (LARC) is defined in this guideline as methods that require administering less than once per cycle or month.

Included in the category of LARC are the copper intrauterine devices (nonhormonal) and three progestogen-only methods of contraception (intrauterine system, injectables and the implants). The combined vaginal ring is not licensed in the UK and is therefore excluded from this guideline.

In 2003/04, about 8% of women aged 16–49 years in Great Britain used LARC as a method of contraception. [EL = 3]

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1. Aim of the guideline
  • 1.2. Areas outside the remit of the guideline
  • 1.3. For whom is the guideline intended?
  • 1.4. Who has developed the guideline?
  • 1.5. Other relevant documents
  • 1.6. Guideline development methodology
• 2. Summary of recommendations and practice algorithm
  • 2.1. Summary of recommendations
  • 2.2. Future research recommendations
  • 2.3. LARC selection algorithm
• 3. Contraceptive use and principles of care
  • 3.1. Normal fertility
  • 3.2. Contraceptive provision
  • 3.3. Contraceptive prevalence
  • 3.4. Efficacy and effectiveness of contraception
  • 3.5. Provision of information and informed choice
  • 3.6. Contraceptive prescribing
  • 3.7. Health benefits of contraception
  • 3.8. Acceptability
  • 3.9. Adherence
  • 3.10. Discontinuation
  • 3.11. Contraception and sexually transmitted infection
  • 3.12. User autonomy and consent
  • 3.13. Contraception for special groups
  • 3.14. Training of healthcare professionals in contraceptive care
  • 3.15. Cost effectiveness of LARC methods versus other reversible contraceptive methods
  • 3.16. Brief overview of features common to progestogen-only methods
• 4. Copper intrauterine devices (IUDs)
  • 4.1. Introduction
  • 4.2. Effectiveness
  • 4.3. Expulsion
  • 4.4. Discontinuation and reasons for discontinuation
  • 4.5. Adverse effects
  • 4.6. Common concerns and symptoms
  • 4.7. Risks
  • 4.8. Return to fertility
  • 4.9. Details of method use
  • 4.10. Training of healthcare professionals
  • 4.11. Specific groups
  • 4.12. Medical conditions and contraindications
  • 4.13. Drug interactions
  • 4.14. Follow-up
• 5. Intrauterine system (IUS)
  • 5.1. Introduction
  • 5.2. Effectiveness
  • 5.3. Expulsion
  • 5.4. Discontinuation and reasons for discontinuation
  • 5.5. Adverse effects
  • 5.6. Common concerns and symptoms
  • 5.7. Risks
  • 5.8. Return to fertility
  • 5.9. Details of method use
  • 5.10. Training of healthcare professionals
  • 5.11. Specific groups
  • 5.12. Medical conditions and contraindications
  • 5.13. Drug interactions
  • 5.14. Follow-up
• 6. Progestogen-only injectable contraceptives (POICs)
  • 6.1. Introduction
  • 6.2. Effectiveness
  • 6.3. Discontinuation and reasons for discontinuation
  • 6.4. Adverse effects
  • 6.5. Common concerns and symptoms
  • 6.6. Risks
  • 6.7. Return to fertility
  • 6.8. Details of method use
  • 6.9. Training of healthcare professionals
  • 6.10. Specific groups
  • 6.11. Medical conditions and contraindications
  • 6.12. Drug interactions
  • 6.13. Follow-up
• 7. Progestogen-only subdermal implants (POSDIs)
  • 7.1. Introduction
  • 7.2. Effectiveness
  • 7.3. Discontinuation and reasons for discontinuation
  • 7.4. Adverse effects
  • 7.5. Common concerns and symptoms
  • 7.6. Risks
  • 7.7. Return to fertility
  • 7.8. Details of method use
  • 7.9. Training of healthcare professionals
  • 7.10. Specific groups
  • 7.11. Medical conditions and contraindications
  • 7.12. Drug interactions
  • 7.13. Follow-up
• 8. Economic evaluation
  • 8.1. Introduction – the role of health economics in this guideline
  • 8.2. Literature review
  • 8.3. Development of a model for the economic evaluation of LARC methods
  • 8.4. Results of the economic analysis
  • 8.5. Limitations of the economic analysis – further considerations
• 9. Auditable standards
• Appendix A. Summary of changes after stakeholders consultation
• Appendix B. Schematic structure of the decision-analytic model used in the economic analysis
• Appendix C. Results of cost effectiveness analysis in the form of graphs
• Appendix D. Results of the sensitivity analysis
• References
• Evidence Tables

Update 2013: 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.

All recommendations that refer to Implanon should be accompanied by a footnote which states the following: “The progestogen-only subdermal implant (Implanon) recommended in this guideline is no longer available. Healthcare professionals considering offering the replacement device, Nexplanon, should refer to the summary of product characteristics.”

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.