ACOG: Recommendations for LARC Initiation and Management

Insertion of IUD should be offered after first-trimester uterine aspiration, on same day as abortion
Insertion of IUD should be offered after first-trimester uterine aspiration, on same day as abortion

(HealthDay News) — 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.

Eve Espey, M.D., M.P.H., and Lisa Hofler, M.D., M.P.H., M.B.A., from the University of New Mexico School of Medicine, developed the practice bulletin in collaboration with the American College of Obstetricians and Gynecologists' Committee on Practice Bulletins -- Gynecology and the Long-Acting Reversible Contraception Work Group. They discussed data on the safety of LARC, which are the most effective reversible contraceptive methods.

The authors note that LARC do not require an ongoing effort on the part of the patient and are associated with rapid return of fertility after the device is removed. Insertion of an IUD should be offered routinely as a safe and effective contraceptive option after first-trimester uterine aspiration. Insertion of the implant should be offered routinely on the same day as first- or second-trimester induced or spontaneous abortion. Before IUD insertion, routine antibiotic prophylaxis is not recommended. These recommendations are based on good and consistent scientific evidence. Based on limited or inconsistent evidence, IUDs and contraceptive implants should be offered routinely for nulliparous women and adolescents; insertion may occur at any time during the menstrual cycle when pregnancy can be excluded; insertion immediately after completion of first-trimester medication-induced abortion should be offered routinely; and immediate postpartum insertion should be offered routinely for postpartum contraception regardless of breastfeeding status.

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"Counseling will help women to align their contraceptive choice with other health care priorities, whether that's preventing pregnancy during adolescence or making a plan for contraceptive use following pregnancy," Espey said in a statement.

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