This article is more than 5 years old. Information may no longer be current.

ACOG offers recommendations on adverse events associated with long-acting reversible contraceptives

The American College of Obstetricians and Gynecologists issued a Committee Opinion on how clinicians should manage patients who experience complications related to long-acting reversible contraceptives.

“Intrauterine device complications ... occur in less than 1% of women regardless of age or [intrauterine device (IUD)] type,” David L. Eisenberg, MD, in the department of obstetrics and gynecology at Washington University in St. Louis, and colleagues wrote. “Similarly, implant complications ... are uncommon. As [long-acting reversible contraception (LARC)] use increases, however, the absolute number of complications will increase.”

The American College of Obstetricians and Gynecologists made the following recommendations:

• Only use misoprostol before difficult IUD insertion in nulliparous women;
• If IUD strings are not visualized, emergency oral contraceptives should be recommended until the IUD is confirmed to be located in the endometrial cavity;
• An IUD should be removed if it is within the cervix and should stay if the woman is asymptomatic and the IUD is above the internal os;
• If a woman becomes pregnant while an IUD is in place, the IUD should be removed if strings are visible or the IUD is within the cervix; and
• If the implant is not palpable, the woman should use contraception until the presence of the implant is confirmed and the implant should only be removed once it has been located.

For the first recommendation, Eisenberg and colleagues cited a 2015 Cochrane Review concluding that misoprostol was not effective for reducing pain associated with insertion in nulliparous women, and that the delay that comes with misoprostol use may be a barrier to access.

For the second recommendation, the authors cited the fact that string retraction into the cervix is the most common reason for IUD strings that were found to be missing.

For the third recommendation, the authors cited the fact that IUD removal is more likely to lead to pregnancy than IUD retention when the woman is asymptomatic and the IUD is above the internal os.

For the fourth recommendation, the authors cited the FDA and the CDC recommendations that IUDs be removed from pregnant women if it is possible to do so without an invasive procedure.

For the fifth recommendation, the authors cited reports of failed insertions with the single-rod etonogestrel implant.

“Although uncommon, possible LARC complications should be included in the informed consent process,” Eisenberg and colleagues wrote. “Obstetrician-gynecologists and other gynecologic care providers should understand the diagnosis and management of common clinical challenges,” Eisenberg and colleagues wrote. – by Will Offit

Disclosure: Healio.com could not confirm relevant financial disclosures at the time of publication.