Update on current contraceptive options: A case-based discussion of efficacy, eligibility, and use

Alexa Nicole Fiffick; Tara K. Iyer; Tiffany Cochran; Pelin Batur

doi:10.3949/ccjm.90a.22075

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TABLE 1

Comparison of commonly used LARCs, all with > 99% efficacy^a

Brand	LARC type	Progestogen, dose	Size, mm	FDA-approved duration of use	Data-supported duration of use	Bleeding patterns	Amenorrhea according to package insert	Other clinical pearls
Mirena	Levonorgestrel-IUD	52 mg	32 x 32	8 years	8 years	More likely to have significantly decreased menstrual bleeding and pain, especially after 1 year of use Progestin-only methods may be associated with irregular bleeding and	1 year: 20% 5 years: 40%	Approved for treatment of heavy menstrual bleeding Can be used as emergency contraception⁵⁶
Liletta	Levonorgestrel-IUD	52 mg	32 x 32	8 years	8 years	spotting	1 year: 19% 5 years: 40%	More affordable for patients with limited insurance coverage
Kyleena	Levonorgestrel-IUD	19.5 mg	28 x 30	5 years	5 years		1 year: 12% 5 years: 23%	Smaller size may be more suitable to nulliparous patients or those with anatomically smaller uterus
Skyla	Levonorgestrel-IUD	13.5 mg	28 x 30	3 years	3 years		1 year: 6% 3 years: 12%
Paragard	Copper IUD	Hormone-free	32 x 36	10 years	12 years	Possible increased amount and duration of menstrual bleeding	No causal relationship established	Can be used as emergency contraception Best for highly effective contraception that is hormone free (ie, after breast cancer) When used during age of mid-late 30s, can provide contraception into menopause transition
Nexplanon	Subdermal etonogestrel implant	68 mg	2 x 40	3 years	5 years	Unpredictable bleeding pattern, though lightens over time for most	2 years: 20%	Does not require a pelvic examination Easy to learn procedure, training via drug company as opposed to clinician

↵a All the contraceptives are the most-effective contraceptive methods; safe in breastfeeding; no long-term effects on fertility, fertility is immediate following discontinuation; safe for women who cannot or prefer not to take estrogen.
FDA = US Food and Drug Administration; IUD = intrauterine device; LARC = long-acting reversible contraceptives
Based on data from references 5, 6, 53, and 56.