Long-acting reversible contraception: selection and safety.

• Long-acting reversible contraception (LARC) methods are highly effective for a long-term protection against pregnancy, similar to sterilisation. They are not dependent on user compliance or correct use; they are reversible, with a rapid return to fertility once removed: and they have a good safety profile.
• No LARC method protects against sexually transmitted infections, which means the use of condoms is recommended when exposed to unsafe sex.
• When choosing a LARC in certain clinical conditions or situations, WHO medical eligibility criteria for contraceptive use should be followed.
• Before the insertion and during the use of the contraception method, counselling and information are the best strategy to ensure users are aware of and accept bleeding alterations, and they do not abandon the method.
• The alterations in patterns of bleeding, especially frequent and/or heavy bleeding happening within the first 3 to 6 months after insertion, are the main reason for early discontinuation of LARC.
• In etonogestrel implant (ENG) and levonorgestrel intrauterine device (LNG IUDs) users, amenorrhea is a normal consequence after the first few months of use and requires no treatment.
• Heavy bleeding and dysmenorrhea during menstruation, common after copper intrauterine device (Cu-IUD) insertion, are likely to settle down over time (3 to 6 months), but intermenstrual bleeding and pain do not.