Long-Acting Reversible Contraception
Key Points
- LARC methods (IUD/IUC and implant) are among the most effective reversible contraception options and are not adherence-dependent day to day.
- LARCs are office-based procedures with rapid return to fertility after removal.
- LARCs do not protect against STIs, so dual-protection counseling remains necessary.
- Key safety education includes recognition of pregnancy, expulsion/misplacement, perforation, and infection warning signs.
Pathophysiology
LARC methods prevent pregnancy through sustained local or systemic progestin effects (depending on device) or nonhormonal intrauterine copper effects that disrupt sperm function and fertilization capacity. Because contraceptive action is continuous after placement, method efficacy is less influenced by daily user adherence compared with short-acting methods.
Hormonal intrauterine devices may reduce endometrial proliferation and menstrual volume, and in some patients lead to amenorrhea. Copper intrauterine devices provide a hormone-free long-duration option with broad candidacy when contraindications are absent. Subdermal implants provide prolonged progestin-mediated suppression effects and high reliability.
Although uncommon, complications can be serious and require early recognition: ectopic pregnancy risk when method failure occurs, device expulsion or misplacement, uterine perforation during/after placement, and infection-related sequelae. Nursing follow-up and symptom teaching are central to safe long-term use.
Classification
- Hormonal intrauterine devices: Levonorgestrel-releasing devices with multi-year duration.
- Nonhormonal intrauterine device: Copper IUD option with long duration and no estrogen/progestin exposure.
- Subdermal implant: Progestin-containing upper-arm implant for extended contraception.
- Complication domains: Pregnancy failure, expulsion/malposition, perforation, and infection/PID-related risk.
Nursing Assessment
NCLEX Focus
Prioritize candidacy assessment, informed consent, and post-placement complication surveillance education.
- Assess pregnancy status and contraindications before placement.
- Evaluate need for nonhormonal versus hormonal contraception based on risk profile and preferences.
- Assess readiness for long-duration contraception and understanding of STI nonprotection.
- Establish baseline bleeding pattern and expectations for post-placement bleeding changes.
- Screen ability to perform monthly placement checks (strings for IUD/IUC, palpation for implant).
Nursing Interventions
- Provide balanced counseling on efficacy, duration, reversibility, and expected side effects.
- Teach self-check routines and backup-contraception use if placement is uncertain.
- Educate on urgent warning symptoms (for example PAINS-style red flags after IUC placement).
- Reinforce immediate reporting of suspected pregnancy, severe pain, heavy bleeding, fever, or missing strings/implant.
- Support informed, person-centered choice including adolescent and high-risk populations that may benefit from adherence-independent methods.
Hidden-Complication Delay
Delayed response to missing strings, severe pain, or pregnancy symptoms with LARC in place can allow ectopic pregnancy or perforation complications to progress.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| levonorgestrel-intrauterine-system | Mirena, Liletta, Kyleena, Skyla contexts | May reduce heavy bleeding/cramping; counsel on irregular bleeding and device-check routines. |
| etonogestrel-implant | Nexplanon context | High efficacy with prolonged duration; teach monthly palpation and insertion-site symptom monitoring. |
Clinical Judgment Application
Clinical Scenario
A patient with a hormonal IUD reports new severe unilateral pelvic pain, light bleeding after prior amenorrhea, and inability to feel strings.
Recognize Cues: Possible malposition, expulsion, or pregnancy complication with device in place. Analyze Cues: Symptoms raise concern for ectopic pregnancy or perforation-related complication. Prioritize Hypotheses: Immediate priority is emergent evaluation rather than routine follow-up. Generate Solutions: Advise urgent assessment, pregnancy testing, and imaging/device-location confirmation. Take Action: Escalate promptly and advise backup contraception until status is clarified. Evaluate Outcomes: Complication is identified early, managed safely, and contraceptive plan is updated.
Related Concepts
- short-acting-reversible-hormonal-methods-of-contraception - LARC is an alternative when short-acting adherence is difficult.
- contraception-the-nurses-role - Counseling and informed consent are foundational to safe LARC selection.
- barrier-methods-of-contraception - Condom use remains important for STI prevention while using LARC.
- emergency-contraception - Relevant if expulsion/method failure occurs before replacement.
- health-promotion-across-the-reproductive-lifespan - LARC suitability varies by reproductive goals and stage.
Self-Check
- Why are LARCs more effective in typical use than daily or weekly user-dependent methods?
- Which post-placement findings require immediate emergency evaluation?
- How should STI-prevention counseling be integrated for patients choosing LARC?