Improving LARC access for teens

Long-acting reversible contraceptives (LARCs) are an extremely effective method of preventing pregnancy and have other noncontraceptive benefits like reducing dysmenorrhea and heavy menstrual flow. The American Academy of Pediatrics (AAP) has issued a clinical report to provide pertinent information.¹

Many forms of LARC have been recommended by numerous organizations including AAP and American College of Obstetricians and Gynecologists. However, only 20% to 50% of adolescents recognize LARC as a form of contraceptive. Many of the teenagers who know that LARC is a form of contraceptive have some concerns such as fear of pain and having a foreign object in the body, lack of knowledge of the insertion process, and unfounded worries concerning permanent fertility loss.

The report included several recommendations to increase access and use of LARCs by adolescent patients:

• Take time to discuss expected side effects with the patient. This discussion should include expected changes to bleeding patterns.
• Consider a levonorgesterel intrauterine device for patients with cognitive or physical disabilities as well as patients diagnosed with anemia that can be attributed to heavy menstrual bleeding.
• Obtain the necessary treatment for placing and removing LARCs.
• Know that LARC placement shouldn’t delay screening for sexually transmitted infections (STIs).
• Remind patients that condoms are still needed to prevent STIs.
• Tell patients that parents may become aware of LARC placement because of insurance billing and access to electronic health records.
• When the patient is getting a LARC on the same day as the initiating appointment, a clinician should ensure that all available contraceptives and their side effects are discussed. Clinicians should also be sure to assess for intimate partner violence and coerced sexual activity.

Reference

1. Menon S, Committee on adolescence. Long-acting reversible contraception: specific issues for adolescents. Pediatrics. July 20, 2020. Epub ahead of print. doi:10.1542/peds.2020-007252