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LARCs suitable for stable relationships

Clinical Update - Contraception: Long Acting Reversible Contraceptives (LARCs) include copper coils, Mirena coils, Implanon implants and Depo provera injections (which are given every 12 weeks). All of the long-acting reversible contraceptives are progesterone only.

There are three types. The progesterone in Implanon is potent and effective, and this reversible device can be rapidly taken out. Depo Provira is an injection that must be given every 12 weeks.

The Mirena is a device placed in the uterus. It has a progestogen ‘depot’ on its main stem, which affects the womb lining by releasing the progesterone levonorgestrel. It works predominantly on the cervix and the womb.

In a fifth to a quarter of cases, it will interfere with ovulation (though it does not rely on this, for its effect). It also has a lower failure rate than combined pills.

The risk of thrombosis does not appear to be increased by using the long-acting devices with progesterone-only treatments. Installing a Mirena is a minor and sterile procedure.

There were initial fears Mirena insertion could cause a uterine infection, which might affect fertility.

That has not transpired, nor is any increased risk of ectopic pregnancy evident, Cork University Maternity Hospital’s Dr Richard Horgan said.

“The Mirena is a safe, effective contraceptive,” he added. Side effects such as headaches, acne and irregular bleeding are usually transient.

NuvaRing is a product that is used once a month. It is a flexible transparent vaginal ring containing oestrogen (ethinyl estradiol) and progestogen (etonogestrel).

These are dispersed throughout the ring’s core and absorbed through the vaginal lining directly into the bloodstream. The ring works, like ‘the pill’, by inhibiting ovulation.

Laparoscopic tubal ligations in Ireland reduced from 2,566 (1999) to 910 (2004).
In the corresponding period the use of Mirena coils increased from 4,840 (1999) to 17,077 (2004). Experience with the Mirena was good because compliance is not a problem.

The Mirena has a value in relation to physiological menorrhagia, where there is no disease process. The Mirena, however, is not a first-line treatment in women under 25 who haven’t had a pregnancy.

Most of the long-term contraceptives would tend to be used within a stable relationship.

It is also important to note that none of these contraceptives protect against sexually transmitted infections.

Posted in Genito-urinary on 20 November 2009
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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

«Previous article | Next article»

LARCs suitable for stable relationships

Clinical Update - Contraception: Long Acting Reversible Contraceptives (LARCs) include copper coils, Mirena coils, Implanon implants and Depo provera injections (which are given every 12 weeks). All of the long-acting reversible contraceptives are progesterone only.

There are three types. The progesterone in Implanon is potent and effective, and this reversible device can be rapidly taken out. Depo Provira is an injection that must be given every 12 weeks.

The Mirena is a device placed in the uterus. It has a progestogen ‘depot’ on its main stem, which affects the womb lining by releasing the progesterone levonorgestrel. It works predominantly on the cervix and the womb.

In a fifth to a quarter of cases, it will interfere with ovulation (though it does not rely on this, for its effect). It also has a lower failure rate than combined pills.

The risk of thrombosis does not appear to be increased by using the long-acting devices with progesterone-only treatments. Installing a Mirena is a minor and sterile procedure.

There were initial fears Mirena insertion could cause a uterine infection, which might affect fertility.

That has not transpired, nor is any increased risk of ectopic pregnancy evident, Cork University Maternity Hospital’s Dr Richard Horgan said.

“The Mirena is a safe, effective contraceptive,” he added. Side effects such as headaches, acne and irregular bleeding are usually transient.

NuvaRing is a product that is used once a month. It is a flexible transparent vaginal ring containing oestrogen (ethinyl estradiol) and progestogen (etonogestrel).

These are dispersed throughout the ring’s core and absorbed through the vaginal lining directly into the bloodstream. The ring works, like ‘the pill’, by inhibiting ovulation.

Laparoscopic tubal ligations in Ireland reduced from 2,566 (1999) to 910 (2004).
In the corresponding period the use of Mirena coils increased from 4,840 (1999) to 17,077 (2004). Experience with the Mirena was good because compliance is not a problem.

The Mirena has a value in relation to physiological menorrhagia, where there is no disease process. The Mirena, however, is not a first-line treatment in women under 25 who haven’t had a pregnancy.

Most of the long-term contraceptives would tend to be used within a stable relationship.

It is also important to note that none of these contraceptives protect against sexually transmitted infections.

Posted in Genito-urinary on 20 November 2009
Tags: