Update on long- and short-acting contraceptive methods

SUMMARY

Long-acting reversible contraceptive methods, including the contraceptive implant and intrauterine devices, are highly effective and cost-effective options for women who have no specific contraindications. Long-acting reversible contraceptives are more effective at reducing unintended pregnancy than short-acting contraceptives.

Short-acting contraceptive methods consist of combined hormonal contraception (e.g. the combined oral contraceptive pill, vaginal ring), progestogen-only pills, and the progestogen-containing contraceptive injection.

Choice of contraception is based on factors such as medical eligibility (i.e. precautions, contraindications), patient preference and reproductive life stage.

Counselling patients on the benefits and risks of all contraceptive methods is important for informed decision-making. Regular contraceptive review can allow for patient education and monitoring of adverse effects.

 

Introduction

It is estimated that around two-thirds of Australian women of childbearing age currently use a form of contraception.^1,2 The combined oral contraceptive pill is the most commonly used method, followed by condoms.^1,2

Long-acting reversible contraceptives (LARCs) include the contraceptive implant and intrauterine devices (IUDs) and are the most effective methods of contraception. The short-acting hormonal forms of contraception (e.g. combined oral contraceptive pill, progestogen-only pill, contraceptive injection, vaginal ring) are more user-dependent methods and their failure rates with typical (real-world) use are higher than LARCs.

The uptake of LARCs in Australia has slowly increased over the past decade. In 2018, it was estimated around 10.8% of women aged 15 to 44 years were using a LARC, with 4.5% using the contraceptive implant and 6.3% using an IUD.³ However, the proportion of women using LARCs in Australia is lower than in other countries of comparable development status;⁴ for example, in Sweden, a 2017 report found 30.9% of women were using a LARC.⁵

The reliance on less effective methods of contraception is reflected in the unintended pregnancy rate across Australia, estimated to be around 40%, and higher among women in rural areas.⁶ Around 30% of unintended pregnancies end in abortion,⁷ and continuing unintended pregnancies are associated with poorer maternal and child outcomes.⁸ Increased LARC uptake results in a lower rate of unintended pregnancies and abortions, reducing the associated risks.⁹ The high effectiveness of LARCs in preventing unintended pregnancy makes them the most cost-effective forms of reversible contraception.^10,11

Providing education around the range of contraceptive options, as well as removing barriers to access, is key to improving reproductive autonomy. There is good evidence that when barriers such as access and cost are removed, and the contraceptive and non-contraceptive effects of LARCs are explained, women are more likely to choose LARCs.^9,10

This article provides an update on long- and short-acting contraceptive methods in Australia. The article also discusses the factors influencing choice of contraception, management of adverse effects, contraceptive considerations for different population groups, and means to increase contraceptive accessibility. Clinicians should be aware of barrier, permanent and other nonpharmacological forms of contraception, as well as emergency contraception, which are not discussed in this article.

This article focuses on contraceptive advice relevant for people with a uterus. While the word ‘women’ is occasionally used, the authors recognise that this information may be relevant to people with a range of gender identities.

 

Long-acting reversible contraceptive methods

In Australia, the following LARCs are available (Table 1):

• hormonal contraceptive implant
• hormonal IUDs (52 mg or 19.5 mg levonorgestrel)
• copper IUDs (umbrella or T-shaped).

Table 1 Long-acting reversible contraceptive methods available in Australia^11-15

	Contraceptive implant	Hormonal intrauterine devices		Copper intrauterine devices
Brand example	Implanon NXT	Mirena	Kyleena	TT380 TT380 short Load 375 CU375 CU380
Hormone dose	68 mg etonogestrel	52 mg levonorgestrel	19.5 mg levonorgestrel	–
Mechanism of action	Thickens cervical mucus Inhibits ovulation Possibly thins endometrium	Thickens cervical mucus Causes endometrial atrophy Affects sperm and oocyte motility Occasionally prevents ovulation		Is toxic to sperm Has an endometrial effect
Duration	3 years	8 years for contraception (except when inserted for contraception in women aged 45 years and older, in which case it can remain in situ until age 55) 5 years for endometrial protection with estrogen-containing menopausal hormone therapy	5 years	5 to 10 years (depending on device)
Efficacy	99.9%	99.9%	99.7%	99.2%
Effect on bleeding	Variable bleeding patterns	Reduction in bleeding Users may experience amenorrhoea or infrequent light bleeding	Users may experience irregular bleeding	Can increase menstrual bleeding and pain
Other benefits	Periods may be less painful	Management of dysmenorrhoea and heavy menstrual bleeding Endometrial protection for users of estrogen-containing menopausal hormone therapy	Slightly smaller device frame compared with Mirena [NB1]; may offer easier insertion for young and nulliparous women16	Can be used as emergency contraception if inserted within 5 days of unprotected intercourse
PBS subsidy	Yes	Yes	Yes	No
PBS = Pharmaceutical Benefits Scheme (Australia) NB1: Size of Kyleena: 28 × 30 mm frame; 3.8 mm inserter tube diameter; has a silver ring at neck. Size of Mirena: 32 × 32 mm frame; 4.4 mm inserter tube diameter; no silver ring at neck.

In 2024, the approved duration of use for the 52 mg levonorgestrel IUD (Mirena) was extended from 5 to 8 years for the purpose of contraception in Australia.¹⁷ This change was based on data from a large US-based study that found the contraceptive efficacy of the Mirena IUD at 8 years was comparable with its efficacy at 5 years.¹⁸ The Mirena is approved for managing heavy menstrual bleeding for 5 years; however, if heavy menstrual bleeding has not returned, continuation up to 8 years may be considered.¹⁹ Extended use, beyond 5 years, of the 19.5 mg levonorgestrel IUD (Kyleena) is not recommended.

 

Short-acting contraceptive methods

Short-acting contraceptive methods in Australia include (Table 2):

• the combined oral contraceptive pill
• vaginal ring
• progestogen-only pill
• contraceptive injection.

Table 2 Short-acting contraceptive methods available in Australia

	Combined hormonal contraception		Progestogen-only methods
	Combined oral contraceptive pill	Vaginal ring	Progestogen-only pill20	Contraceptive injection (depot medroxyprogesterone)13,21
Brand example	See Table 3	NuvaRing	Noriday Microlut Slinda	Depo-Provera
Hormone dose	See Table 3	11.7 mg etonogestrel and 2.7 mg ethinylestradiol (120 micrograms etonogestrel and 15 micrograms ethinylestradiol daily)	Noriday: 350 micrograms norethisterone Microlut: 30 micrograms levonorgestrel Slinda: 4 mg drospirenone	150 mg medroxyprogesterone acetate
Mechanism of action	Inhibits ovulation Changes cervical mucus		Thickens cervical mucus Inhibits ovulation (drospirenone only)	Inhibits ovulation Changes cervical mucus to limit sperm penetration Causes endometrial changes unfavourable for implantation
Dosing schedule	Daily	Placed in vagina for 3 weeks. Ring then removed, and a new ring inserted with an optional 7 day hormone break	Daily	Administered every 12 weeks If adminstered within 14 weeks of last injection, no additional contraception needed
Efficacy13,22	99.5% with perfect use 93% with typical use	99.5% with perfect use 93% with typical use	99.5% with perfect use 91% with typical use	99.8% with perfect use 96% with typical use
Effect on bleeding	Typically reduced menstrual bleeding		Variable	Some patients may experience initial irregular bleeding; majority of users become amenorrhoeic over time
Non-contraceptive benefits	Reduced menstrual bleeding and pain May improve acne and hirsutism Reduced endometriosis recurrence after surgical management Reduced risk of some cancers		Limited evidence; however, some suggestion that drospirenone may reduce dysmennorhoea, acne and hirsutism20	Amenorrhoea or reduced bleeding; may benefit those with heavy menstrual bleeding or endometriosis Discrete
PBS subsidy	See Table 3	No	Yes (all)	Yes
PBS = Pharmaceutical Benefits Scheme (Australia)

Combined oral contraceptive pills

There are many combined oral contraceptive pills available in Australia (Table 3). The efficacies of all the preparations are considered equal. A newer combined oral contraceptive pill became available in Australia in 2022 (Nextstellis). It contains drospirenone, as the progestogen component, and estetrol, a newly created hormone compound that aims to match a form of naturally occurring estrogen. This combination offers the benefit of a low rate of unscheduled bleeding.²³ Further, estetrol appears to have a minimal impact on haemostasis compared with other available estrogen preparations.²³

Table 3 Combined oral contraceptive pills available in Australia²⁴

Brand name	Estrogen	Progestogen	PBS listing
Femme-Tab ED 20/100 Loette Microgynon 20 ED Micronelle 20 ED	20 micrograms ethinylestradiol	100 micrograms levonorgestrel	Only Femme-Tab ED 20/100 listed on PBS
Eleanor 150/30 ED Evelyn 150/30 ED Femme-Tab ED 30/150 Lenest 30 ED Leveth 150/30 ED Levlen ED Microgynon 30 ED Micronelle 30 ED Monofeme Seasonique	30 micrograms ethinylestradiol	150 micrograms levonorgestrel	All are listed on the PBS except Microgynon 30 ED, Monofeme and Seasonique
Microgynon 50 ED	50 micrograms ethinylestradiol	125 micrograms levonorgestrel	Yes
Logynon ED Trifeme 28 Triquilar ED	6 × 30 micrograms ethinylestradiol	6 × 50 micrograms levonorgestrel	All are listed on the PBS
	5 × 40 micrograms ethinylestradiol	5 × 75 micrograms levonorgestrel
	10 × 30 micrograms ethinylestradiol	10 × 125 micrograms levonorgestrel
Norimin 28 Day	35 micrograms ethinylestradiol	500 micrograms norethisterone	Yes
Norimin-1 28 Day	35 micrograms ethinylestradiol	1000 micrograms norethisterone	Yes
Madeline Marvelon 28	30 micrograms ethinylestradiol	150 micrograms desogestrel	No
Minulet	30 micrograms ethinylestradiol	75 micrograms gestodene	No
Brenda-35 ED Diane-35 ED Estelle-35 ED Jene-35 ED Juliet-35 ED	35 micrograms ethinylestradiol	2 mg cyproterone acetate	No
Bella Brooke Rosie Yana Yaz	20 micrograms ethinylestradiol	3 mg drospirenone	Yaz only
Brooklynn Isabelle Petibelle Rosalee Yasmin Yelena	30 micrograms ethinylestradiol	3 mg drospirenone	Yasmin only
Valette	30 micrograms ethinylestradiol	2 mg dienogest	No
Qlaira	2 × 3 mg estradiol valerate	–	No
	5 × 2 mg estradiol valerate	5 × 2 mg dienogest
	17 × 2 mg estradiol valerate	17 × 3 mg dienogest
	2 × 1 mg estradiol valerate	–
Zoely	1.5 mg estradiol	2.5 mg nomegestrol acetate	No
Nextstellis	14.2 mg estetrol	3 mg drospirenone	No
PBS = Pharmaceutical Benefits Scheme (Australia)

Vaginal ring

The vaginal ring is another form of combined hormonal contraception, having a similar mechanism, contraindications and precautions to the combined oral contraceptive pill (Table 2). The vaginal ring is not affected by gastrointestinal absorption and may benefit women with malabsorptive disorders who wish to use an estrogen-containing regimen.

Progestogen-only pills

There are 2 types of progestogen-only pills available in Australia (Table 2). ‘Traditional’ progestogen-only pills contain norethisterone (Noriday) or levonorgestrel (Microlut). Doses of these are considered ‘missed’ if they are taken more than 3 hours late.¹³

The second type of progestogen-only pill contains drospirenone (Slinda) which has been available in Australia since 2021. It differs from traditional progestogen-only pills in that it additionally prevents ovulation and has a 24-hour ‘missed pill’ window.¹³ The pill packs contain 24 active pills and 4 inactive pills, offering the potential for more predictable, scheduled bleeding patterns compared with traditional progestogen-only pills.²⁵

Contraceptive injection

A contraceptive injection that is available in Australia is depot medroxyprogesterone acetate (DMPA), a long-acting progestogen that is administered via intramuscular injection in either the gluteal site (preferred) or the deltoid muscle (Table 2). DMPA is associated with a small loss in bone density in users; however, this is thought to recover upon cessation.²⁶ For women with additional risk factors for osteoporosis or younger women who have not reached their peak bone density, an alternative form of contraception may be more suitable. Prior to commencing DMPA, patients should be advised there may be a delay in return to fertility of up to 12 months,^13,27 and those desiring pregnancy sooner, or women in the later stages of their fertility window, should consider an alternative contraceptive. Overseas, a contraceptive injection that may be patient-administered subcutaneously is available.

 

Factors influencing choice of contraception

Many factors influence the choice of contraception, such as:²⁸

• clinical history including reproductive history
• medical eligibility, including contraindications and precautions
• reproductive stage of life
• potential for drug interactions
• reversibility
• lifestyle.

General principles to consider when choosing contraception are in Box 1. The UK Medical Eligibility Criteria (UKMEC) provides comprehensive guidance on which contraceptive methods can be safely used, and when caution or contraindication is relevant to specific medical conditions, reproductive history, and clinical characteristics such as cardiovascular risk.²⁹ The online UKMEC calculator is a helpful tool for clinicians when selecting a contraceptive method.

 

Managing adverse effects

Adverse effects can impact on a person’s wellbeing and the likelihood of continuing their chosen contraceptive method. LARC users are 3 times more likely to continue their contraceptive method compared with non-LARC users.³⁰ In a large study, LARC continuation rates at 3 years were almost 70% compared with 31% for non-LARCs, with non-LARC users commonly discontinuing their contraception due to adverse effects. LARC users have been found to discontinue use due to irregular bleeding patterns and perceived feelings of decreased wellbeing.³⁰

Counselling on adverse effects prior to starting a contraceptive and on review is an important part of providing contraceptive care. Evidence suggests that more intensive counselling may be associated with a decreased rate of discontinuation of short-acting contraceptives due to adverse effects.³¹ Common adverse effects and possible management strategies for LARCs and combined oral contraceptive pills can be found in Table 4.

Table 4 Managing common adverse effects of long-acting reversible contraceptive methods and combined oral contraceptive pills [NB1]^11,14,32,33

Adverse effect	Management strategies
Long-acting reversible contraceptive method (intrauterine devices and contraceptive implant)
Problematic bleeding	Ensure adequate counselling on expected bleeding patterns before use. Clinical assessment and investigation (e.g. pregnancy test, cervical screening, testing for sexually transmitted infections, pelvic ultrasound) may be warranted to exclude underlying pathology. If no alternative cause of bleeding detected, provide education and reassurance. If bleeding frequent or prolonged, consider: addition of a combined oral contraceptive pill for 3 months (continuous or cyclical) if medically eligible (refer to UK Medical Eligibility Criteria) a 5-day course of a nonsteroidal anti-inflammatory drug or tranexamic acid if bleeding is heavy. Other management strategies such as adding norethisterone or a progestogen-only pill have been suggested; however, evidence is currently limited.
Hormonal adverse effects (e.g. headaches, mood changes, weight gain, breast tenderness, loss of libido)	Review and manage any potential contributing lifestyle causes or factors. If symptoms are persistent and/or bothersome, consider alternative contraception.
Combined oral contraceptive pills
Nausea	Exclude pregnancy. Reduce estrogen dose. Take pills at night. Change to progestogen-only method.
Breast tenderness	Reduce estrogen and/or progestogen dose. Change progestogen – consider using a pill containing drospirenone (mild diuretic effect).
Headache	Reduce estrogen dose and/or change progestogen. If headache occurs in hormone-free week, consider one of the following: extend use of active tablets give 50 micrograms estradiol transdermal patch in this week try estradiol valerate + dienogest pill.
Dysmenorrhoea	Extend pill regimen to reduce the frequency of bleeding.
Decreased libido	No evidence supports a benefit of one type of oral contraceptive pill over another.
Breakthrough bleeding	If taking an ethinylestradiol 20‑microgram pill, increase estrogen dose to a maximum of 35 micrograms. Change progestogen if already taking an ethinylestradiol 30 to 35‑microgram pill. Consider alternative forms of contraception.
Mood changes	Seek medical review and assessment if new or worsening mood symptoms. Address other causes. Consider extended use or switching to a drospirenone regimen, particularly if symptoms premenstrual.
Weight gain	A causal association between combined hormonal contraception and weight gain has not been found. Identify and manage potential alternative causes.
NB1: Adapted from reference 33

 

Drug interactions and hormonal contraception

The most important drug interactions affecting hormonal contraception involve drugs that induce hepatic cytochrome P450 enzymes. Some examples include:

• antiepileptic drugs (e.g. barbiturates, primidone, phenytoin, carbamazepine)
• tuberculosis medications (e.g. rifampicin, rifabutin)
• antiretroviral drugs for human immunodeficiency virus (e.g. ritonavir, efavirenz)
• antifungal drugs (e.g. griseofulvin).³⁴

These drugs increase clearance of hormonal contraceptives and can reduce the effectiveness of all combined hormonal contraceptive methods, all progestogen-only pills, and the contraceptive implant.

Caution is advised with the use of hormonal contraceptives and antibiotics if the antibiotics are enzyme inducers (e.g. rifampicin, rifabutin) or the antibiotic (or the illness being treated) causes vomiting or diarrhoea.

The copper and hormonal IUDs are unaffected by liver enzyme–inducing drugs and are the preferred method where drug interactions are an issue.

 

Venous thromboembolism risk

Combined hormonal contraceptives are associated with an increased risk of venous thromboembolism (VTE) (3 to 15/10,000 woman-years in users versus 1 to 5/10,000 in non-users).³⁵ This risk is still lower than the risk in pregnancy and appears to decline over time. The risk of VTE is significantly higher with pills containing 50 micrograms ethinylestradiol plus levonorgestrel compared with pills containing 20 micrograms ethinylestradiol.

Naturally based estrogens like estradiol valerate and estetrol have fewer VTE events reported.^36,37

People with Factor V Leiden and other inheritable thrombophilias should not use combined hormonal contraceptives. For the combined oral contraceptive pill, the risk varies with the type of progestogen and is lowest in preparations containing progestogens such as levonorgestrel, and highest in pills such as desogestrel.

Progestogen in lower doses, as contained in the implant, pills and IUDs, do not increase the risk of VTE.³⁸

 

Key contraceptive considerations for different population groups^13,29,39-42

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the UK Faculty of Sexual and Reproductive Healthcare have comprehensive guidelines for contraceptive use in specific population groups. When used in conjunction with UKMEC, these guidelines can assist in selecting appropriate contraception. Key contraceptive considerations for selected population groups are summarised below.

Postpartum³⁹

Contraception should be initiated as soon as possible postpartum, as pregnancy can occur as early as 21 days after birth. Provision of postpartum contraception can optimise interpregnancy interval, as an interpregnancy interval of less than 12 months is associated with an increased risk of preterm birth, low birth weight and small-for-gestational-age babies.³⁹ Antenatal contraceptive counselling can facilitate timely provision of the woman’s chosen method.

Not all contraceptive methods can be started early postpartum. Estrogen-containing contraception such as the combined oral contraceptive pill cannot be used immediately postpartum due to an increased risk of VTE. The timing of commencement depends on a range of factors including breastfeeding status. Practitioners should refer to the UKMEC, which provides detailed and specific guidance.²⁹

The contraceptive implant, progestogen-only pill and contraceptive injection can be started at any time after birth. The hormonal IUDs may be inserted up to 48 hours after uncomplicated caesarean section or vaginal birth, otherwise at least 28 days after delivery (because of risk of perforation between 48 hours and 28 days after delivery). The risk of IUD expulsion is higher if inserted immediately after delivery; however, immediate insertion is associated with high continuation rates and a reduced risk of unintended pregnancy.

Progestogen-only methods of contraception can all be safely used in breastfeeding.

Post-abortion^13,39

Contraception can be provided at the time of, or immediately after, an abortion unless medical contraindications exist.³⁹

Copper and hormonal IUDs can be inserted at the time of surgical abortion at any gestation.^43-45 They can be inserted after a medical abortion once expulsion of the products of conception has been confirmed, and post-abortion infection has been excluded.

Progestogen-only contraceptives can be initiated at any time following medical or surgical abortion. The contraceptive implant may be inserted at the time of prescribing or taking mifepristone. Administration of the contraceptive injection at the time of mifepristone administration has a slightly higher risk of continuing pregnancy and patients should be adequately counselled on the signs and symptoms of a failed abortion.

Combined hormonal contraception can be started at any time following an abortion.

Patients should be counselled that additional contraceptive precautions are required if contraception is initiated more than 5 days after an abortion.

Young people⁴⁰

Providers of contraception should assess the individual’s ability to provide consent using frameworks such as the Fraser guidelines or Gillick competence,^46,47 consider the possibility of exploitation and coercion, and be aware of local mandatory reporting requirements. Young people should be informed of confidentiality and the limitations of this.

The high efficacy, reliability and ‘set and forget’ nature of LARCs may be attractive to young people. However, the need to see a healthcare professional and have a procedure to insert LARCs may be a barrier to their use.

The non-contraceptive benefits of the combined oral contraceptive pill, including improvement in symptoms of primary dysmenorrhoea and acne, may benefit young people affected by these conditions.

Given the potential for delay in return to fertility and potential decrease in bone mineral density associated with the contraceptive injection, alternative methods are preferred for those aged 18 years and under.

Women aged over 40 years⁴¹

Effective contraception until menopause is required to prevent unintended pregnancy. Medical eligibility (UKMEC) should be carefully examined for each patient, as many women over 40 have elevated background risks of cardiovascular disease, VTE, and other comorbidities.

The contraceptive implant and progestogen-only pill can be safely used in women over 40, with no associated increased risk of VTE, stroke, myocardial infarction, or bone mineral density effect.

The 52 mg levonorgestrel IUD (Mirena) can be used for contraception until menopause or age 55 if inserted at age 45 or over, provided it is not being used for endometrial protection with menopausal hormone therapy (Table 1). The copper IUD can be used until menopause when inserted in women aged over 40 years.

Women over 40 using the contraceptive injection should be reviewed regularly to assess the risks and benefits in relation to bone mineral density. Women over 50 should use an alternative method.

The combined oral contraceptive pill may be used in women over 40 if they are medically eligible; however, women over 50 should use an alternative method. If the combined oral contraceptive pill is the chosen method in a woman over 40, consider prescribing pills containing a lower dose of estrogen (30 micrograms ethinylestradiol or less) and with levonorgestrel or norethisterone progestogen components, given their potentially lower risk of VTE, cardiovascular disease and stroke.

The potential non-contraceptive benefits of some contraceptives may be relevant to women in this age group. For example, the hormonal IUD may be used to manage heavy periods common in perimenopause, or the combined oral contraceptive pill may be used in medically eligible women to relieve the symptoms of menopause and prevent loss of bone mineral density.

People with obesity⁴²

While evidence suggests that body mass index (BMI) does not affect contraceptive efficacy (excluding that of emergency contraception), BMI may affect medical eligibility for certain contraceptive methods.

Estrogen-containing contraceptives are not recommended for women with a BMI of 35 kg/m² or greater. In women with a BMI of 30 kg/m² or greater, the use of the contraceptive injection has been associated with increased weight gain. A longer length needle may be required to administer intramuscular injections in women with obesity.

Women using weight loss medications that may cause diarrhoea or vomiting may experience reduced effectiveness of oral contraceptives. Women who have undergone weight loss surgery are recommended to use non-oral contraceptive methods given the potential issues with absorption.

People with migraine

Estrogen-containing contraceptives are contraindicated in individuals who experience migraine with aura. In those with a history (of at least 5 years) of migraine with aura or who develop a migraine without aura while using these methods, the use of the combined oral contraceptive pill or the vaginal ring is not recommended. Non-hormonal contraception such as the copper IUD, or any of the progestogen-only methods can be used by people experiencing migraine.²⁹

 

Improving access to contraception in Australia

A variety of strategies has been implemented and proposed to improve access to contraception in Australia, including:

• patients’ ability to access a resupply of their prescribed oral contraceptive pill through community pharmacist dispensing. This exists in most areas of Australia, with variable conditions and dispensing laws between jurisdictions. Studies overseas have demonstrated increased contraception uptake with access to contraception through pharmacies,⁴⁸ and a recent Australian study found the idea was generally favourable, with women emphasising the need for safe and private delivery of care through pharmacies⁴⁹
• building workforce capacity by increasing training opportunities in LARC insertion and removal for practitioners,⁵⁰ as well as enhancing the ability of nurse practitioners, registered nurses and midwives to prescribe, insert and remove contraceptive devices.⁵¹ Large trials are underway in Australia to further investigate nurse-led models of care for providing contraception, particularly in rural and regional areas⁵²
• adjustment of the Medicare Benefit Schedule to increase rebates for LARC-related services, and expand item numbers for nurse practitioners, nurses and midwives providing contraceptive care⁵⁰
• clear referral pathways for LARC insertion and removal. While some states provide referral sites, such as Children By Choice (Queensland) and 1800 My Options (Victoria), this is not uniform across Australia and practitioners should be aware of local options for referral
• professional networks such as The Australian Contraception and Abortion Primary Care Practitioner Support Network, which provide primary care practitioners with further support, education and training.

 

Conclusion

LARCs are the most effective methods of contraception. Contraception prescribing should be guided by the individual’s medical eligibility and other factors such as reproductive life stage, drug interactions, reversibility and lifestyle. Education on the range of contraceptive options including a discussion around the risks and benefits of each method can empower individuals to choose their preferred contraceptive. Encouraging follow-up can offer the opportunity for managing adverse effects and providing ongoing sexual and reproductive health care. It is good practice to regularly reassess each woman’s contraceptive needs and medical eligibility as this will change over time.

This article was finalised on 13 May 2025.

Conflicts of interest: Emma Mason received funding from ASHM Health for conference attendance in 2024.

Kirsten Black is an investigator within the Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care which is funded by the National Health and Medical Research Council. Kirsten has received research funding from the Women’s Plans Foundation, Department of Health and Aged Care, and the Medical Research Future Fund. Kirsten is the Chair of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ Special Interest Group in Sexual and Reproductive Health.

This article is peer reviewed.

 

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