Pulse February 2019 issue - Page 26

Key questions on LARC Dr Priyanka Patel and Dr Tracey Masters on when to use copper IUDs, which LARC to recommend for diff erent life stages and how to increase uptake of LARCs Q In what circumstances would you choose a copper IUD (Cu-IUD) over the IUS? Are there any contraindications to an IUS that would not apply to a Cu-IUD? Supporting a woman in making her A choice between a Cu-IUD and an IUS will be based on weighing up the advantages and disadvantages for each individual patient. For example, are her periods heavy or painful, how does she feel about hormonal side-effects, does she mind having light erratic bleeding or no menses or does she want regular periods? There are some circumstances where the Cu-IUD would be preferable to the IUS 1 : • The woman does not feel comfortable with the possibility of no menses or erratic menses. • If the woman is seeking emergency contraception, when the IUS cannot be used and the Cu-IUD may be retained for future contraception. Pulse February 2019 1.5 CPD hours • Non-hormonal contraception is most appropriate for women with a history of breast cancer. In women with current breast cancer, UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) 2 advises that the IUS represents an ‘unacceptable health risk’ (UKMEC 4). For those with a past history and no recurrence in past five years, UKMEC advises that risks of using the LNG-IUS generally outweigh the advantages (UKMEC 3). Any consideration of the IUS should involve the woman’s cancer specialist. • Severe liver disease, such as decompensated cirrhosis, hepatocellular adenoma or hepatocellular carcinoma are all also contraindications (UKMEC 3) to the IUS. Progestogen-only contraception is metabolised by the liver and its use may adversely affect women whose liver function is compromised. Combined oral contraception (COC) use is associated with growth of hepatocellular adenoma, but it is still unknown whether other hormonal contraceptives have similar effects. Q Is it right that if you insert an IUS in a woman who is 45 or older she will not need a further IUS? At what age would you remove the device? What happens if she develops menses after fi ve years – would this be an indication that the device is no longer eff ective? The 52mg IUS is licensed for five A years of use but there is evidence that it may provide effective contraception for up to seven years. The fact that the release rate of the 52mg IUS at five years is twice that of the new 13.5mg IUS at three years suggests that it may be effective for some time beyond its five years’ licensed indication. 1 NICE guidance from 2005 states that if women have an IUS inserted at 45 years or older and are amenorrhoeic, they may continue to use the IUS until they are postmenopausal. 3 Subsequently the 26