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Long-acting reversible contraceptives (LARCs) are effective at preventing pregnancy beyond their prescription limits, new data suggested.

A systematic review of 25 studies found no reported pregnancies during the prolonged use of the etonogestrel-releasing implant for 1 or 2 additional years beyond the recommended limits. Nor were pregnancies reported with the TCu380A intrauterine device (IUD) for years 8-11, 8-12, or 11-16. Finally, no pregnancies were reported with the levonorgestrel intrauterine system (LNG-IUS) in nine studies with follow-up periods of 6-15 years. Two pregnancies were reported during year 6 in two studies, and four pregnancies during year 7 in three studies.

The findings are not a revelation for obstetrician-gynecologists and family planning professionals, study author Martin Bélanger, MD, an obstetrician-gynecologist and family planning fellow at the University of Montreal, Montreal, told Medscape Medical News.

“The first studies to examine prolonged use of IUS, IUDs, and contraceptive implants were published in the 1990s. Even then, the data showed long-term efficacy,” said Bélanger. “Many studies of high methodological quality conducted afterward were sufficient for international health organizations to recommend extended use of LARCs during the COVID-19 pandemic.” The results of this systematic review corroborate these extended use guidelines, he said.

The study was published online in February in Canadian Family Physician.

No Adverse Event Increase

The authors did not find an elevated risk for complications or side effects like irregular menstrual bleeding or abdominal pain during extended use of LARCs compared with the approved period of use. “The data are reassuring regarding the safety and efficacy of these LARCs for the extension periods mentioned in our paper,” said Bélanger.

The extended use of LARCs brings several advantages, including decreased risks linked to removals and replacements of devices and reduced need for visits to healthcare professionals, the investigators wrote.

The analysis may have been limited by selection bias, according to Bélanger. The participants recruited for long-term studies were often healthy, multiparous patients who might not be representative of the general population. The generalizability of the results is thus limited.

“Future studies should investigate the extended use of LARCs in more diverse populations,” said Bélanger. These studies should include primiparous patients or those with particular health conditions, he clarified.

Comprehensive Review Reassuring

Commenting on the study for Medscape Medical News, Dustin Costescu, MD, associate professor of obstetrics and gynecology at McMaster University in Hamilton, Ontario, commended the authors on their method. “The authors did a really comprehensive job of reviewing the papers,” said Costescu. “As someone who follows the story of extended-use birth control, I think that they did highlight some of the major landmark papers on this.”

The findings reinforce the long-term safety and efficacy of LARCs, Costescu added. “This [study] provides us some reassurance that there’s not a strict timeline that people need to follow. One of the challenges is staying to the approved indication versus the realities of the patient who may not remember [when it was placed] or may not have access to someone who can do a replacement.”

One benefit of LARCs is that they are “forgettable” birth control, Costescu added. “These extension trials highlight for us that the patient can really not worry about pregnancy for an extended duration.”

The data also allay worries about risk for infection. “What we know from the literature is that infections are generally related to the insertion itself, and as time goes on, the risk of infection is actually quite low,” said Costescu.

Rachel Flink-Bochacki, MD, MPH, an obstetrician-gynecologist and complex family subspecialist in Albany, New York, noted that the findings of the review are consistent with the Society of Family Planning guidelines with respect to the prolonged use of various LARCs. This systematic review will likely encourage Canadian healthcare providers to communicate the extended contraceptive benefit that LARCs offer, she added.

The analysis also indicated that the efficacy of extended use of 52 mg LNG-IUS is independent of body mass index. “It makes people feel confident that it has been reported in this paper that [52 mg LNG-IUS] will be effective in people of all body sizes,” said Flink-Bochacki.

No funding for the study was reported. Bélanger and Costescu reported no relevant financial relationships. Flink-Bochacki is a trainer for Organon, which is the US distributor of the Nexplanon etonogestrel implant.