Abstract
Long-acting reversible hormonal contraceptives are effective methods of birth control that provide contraception for an extended period without requiring user action. Long-acting reversible hormonal contraceptives include progesterone only injectables, subdermal implants and the levonorgestrel intrauterine system. These methods have several advantages over other reversible contraceptive methods. More importantly, once in place, they require minimal maintenance and their duration of action ranges from 8 weeks to 5 years. Despite the advantages of long-acting reversible hormonal contraceptive methods, they are infrequently used in South Africa. Short-acting methods, specifically oral contraceptives and condoms, are by far the most commonly used reversible methods. A shift from the use of short-acting methods to long-acting reversible contraceptive methods could help reduce the high rates of unintended pregnancies in South Africa. In this review of long-acting reversible hormonal contraceptive methods, we discuss the long-acting progesterone injectables, the etonogestrel implant and the levonorgestrel intrauterine system available in South Africa, the side effects of each of these preparations and the non-contraceptive benefits. It is imperative that health professionals and educators inform women of reproductive age about the benefits, risks, and common side effects of long-acting reversible hormonal contraception to improve consideration and recognition of these methods.
Highlights
Despite the significant amount of research and advances in contraceptive developments, ill-timed and unintended pregnancies continue to be a global concern.[1]
Preconception counselling should be offered.There is a tendency to feminise contraception based on the perception that it is a woman’s issue and responsibility, but wherever possible both partners should be involved.1,2,3The use of hormonal contraception has increased in many parts of the world, especially in high population countries in Asia and Latin America, yet remains low in sub-Saharan Africa.[2]
Several studies suggest that the bone mineral density that diminishes during use of depot medroxyprogesterone acetate (DMPA) recovers after discontinuation of the injection.[11]
Summary
Despite the significant amount of research and advances in contraceptive developments, ill-timed and unintended pregnancies continue to be a global concern.[1]. Long-acting reversible hormonal contraceptives are methods of birth control that provide effective contraception for an extended period of time without requiring user action. They include injections, intrauterine hormonal-releasing devices (IUD) and subdermal contraceptive implants. The principal mechanism of action is by the suppression of ovulation by interfering with the mid-cycle production of luteinizing hormone and causing morphological changes in the endometrium which renders implantation of the fertilised ovum difficult They cause thickening of the cervical mucus which renders it impervious to spermatozoa, preventing the ascent of sperm into the uterine cavity.[8] DMPA is a highly reliable long-acting reversible contraception, with a failure rate of about 0.2%.9,10. Several studies suggest that the bone mineral density that diminishes during use of DMPA recovers after discontinuation of the injection.[11]
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