New Guidelines on Long-acting reversible contraceptives,LARC Released by ACOG

Long-acting reversible contraceptives (LARC), including implants and intrauterine devices (IUDs), are a safe and effective contraception option for many women, according to a practice bulletin published online Oct. 24 in Obstetrics & Gynecology.

Summary of Recommendations

The following recommendations are based on good and consistent scientific evidence (Level A):

• Insertion of an IUD immediately after first-trimester uterine aspiration should be offered routinely as a safe and effective contraceptive option.


• 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.


• Routine antibiotic prophylaxis is not recommended before IUD insertion.

The following recommendations are based on limited or inconsistent scientific evidence (Level B):

• Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents.


• Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded.


• 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.


• 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.


• 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 postpartum contraception, regardless of breastfeeding status.


• 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.


• Intrauterine devices may be offered to women with a history of ectopic pregnancies.

The following recommendations are based primarily on consensus and expert opinion (Level C):

• Long-acting reversible contraceptives have few contraindications and should be offered routinely as safe and effective contraceptive options for most women.


• The copper IUD should be offered routinely to women who request emergency contraception and are eligible for IUD placement.


• To improve LARC method satisfaction and continuation, patient counseling should include information on expected bleeding changes and reassurance that these changes are not harmful.


• Endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling may all be performed with an IUD in place.


• 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.


• Intrauterine device removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal.


• There is no compelling evidence for the removal of an IUD or implant before its expiration date in menopausal women.

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