| November 2012 · Vol. 24, No. 11
LARCs: Why they should be
first-line contraceptive options
for your patients
Let’s improve contraceptive effectiveness in this country by increasing the use of long-acting reversible contraceptive methods. Here’s a report of the Contraceptive CHOICE Project—important data about women’s adoption and satisfaction with intrauterine devices and the etonogestrel implant.
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READ MORE ABOUT LARCs
Let’s increase our use of implants and DMPA and improve contraceptive effectiveness in this country
Robert L. Barbieri, MD (Editorial, September 2012)
Let’s increase our use of IUDs and improve contraceptive effectiveness in this country
Robert L. Barbieri, MD (Editorial, August 2012)
Malpositioned IUDs: When you should intervene (and when you should not)
Kari P. Braaten, MD, MPH; Alisa B. Goldberg, MD, MPH (August 2012)
Update on Contraception
Tami Rowen, MD, MS; Mitchell D. Creinin, MD (August 2012)
Does long-acting reversible contraception prevent unintended pregnancy better than OCs, transdermal patch, and vaginal ring—regardless of a patient’s age?
Andrew M. Kaunitz, MD (Examining the Evidence, July 2012)
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Elizabeth O. Schmidt, MDDr. Schmidt is Fellow, Family Planning. 
Tessa Madden, MD, MPHDr. Madden is Assistant Professor. 
Jeffrey F. Peipert, MD, PhDDr. Peipert is Robert J. Terry Professor and Vice Chair of Clinical Research.
All are colleagues in the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Dr. Schmidt reports no financial relationships relevant to this article. Dr. Madden has been a speaker for Bayer Healthcare Pharmaceuticals and has received research support from the National Institutes of Health. Dr. Peipert has served as an etonogestrel implant trainer for Merck. Fees for this service are paid to Washington University in St. Louis.
 CASE: Typical use of LARC in a young woman
A 21-year-old woman with no previous pregnancies presents to her gynecologist requesting a highly effective contraceptive. After discussion of all reversible methods of contraception, the patient chooses a levonorgestrel intrauterine system (LNG-IUS). Results from a pregnancy test today are negative, and the patient reports no sexual activity since her last menstrual period. The LNG-IUS is placed without difficulty.
The patient returns in 4 weeks for a string check and reports intermittent spotting, but no other complaints. The strings are seen, and the patient is reassured.
Six months later, she returns and reports amenorrhea, with no further spotting. She says the amenorrhea is bothersome to her and that she desires a monthly period to “confirm I’m not pregnant.” The LNG-IUS is removed easily, and a copper intrauterine device (IUD) is placed during the same visit.
At her follow-up appointment 1 month later, she reports intermittent spotting, but she is happy with the copper IUD.
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