Updated November 2022 as both LNG 52mg IUDs are now FDA approved for eight years
The scenario:
A 20 year-old patient (they/them) had a birth control implant placed three years ago this month. They are happy with their method and want to keep using an implant for birth control.
Do you remove and replace this patient’s implant today?
While the implant is FDA approved for use for up to three years, good evidence shows that it’s highly effective at preventing pregnancy for up to five years. Additionally, providers can recommend the use of approved medications in ways that are best for their patients, even if it is outside of the approved labeling, sometimes referred to as “off-label.” Evidence-based, off-label medications are used this way all the time—such as methotrexate which is FDA approved for choriocarcinoma but widely studied and used to medically manage an ectopic pregnancy, or misoprostol for labor induction, which is also widely studied but “off-label.”
What is the evidence to support extended use of IUDs and implants?
Research shows that the copper IUD (Paragard) and the implant (Nexplanon) are effective beyond their FDA-approved durations of use. Extended use of the implant and the copper IUD is supported by the American College of Obstetricians and Gynecologists (ACOG), the Society of Family Planning (SFP), and the American Academy of Family Physicians (AAFP).
How should I discuss extended use with patients?
You can begin conversations about the discrepancy between the FDA approval and the evidence-based duration of effectiveness when you are placing IUDs and implants. At each visit, talk to your patient about how long they want to continue using their method and the evidence-based duration of effectiveness. If they want their method removed at any point, their request for removal should be respected and their IUD or implant should be promptly removed, for any reason, at any time. For patients who have used their IUD or implant for the FDA-approved duration and want to continue using their method, you can safely recommend that they keep their method up to the evidence-based effectiveness duration. However, it is also reasonable to remove and replace (if desired) a patient’s method of birth control after the FDA-approved duration of use if that is their preference.
Back to the scenario–do you remove and replace their implant today?
It depends on what they want! After three years, the patient’s implant is still effective as birth control and it’s reasonable for them to continue using it up to the evidence-based duration of effectiveness of five years. However, patients may not feel comfortable continuing to use their method beyond the FDA-approved duration of use and that’s ok. If this patient doesn’t feel comfortable continuing with their implant, you should replace it today.
Key points
- Extended use of IUDs and implants is evidence-based and supported by major medical organizations, including ACOG, SFP, and AAFP.
- Data supports that contraceptive implants remain effective for up to five years, beyond FDA approval for three years.
- LNG 52mg IUDs (Mirena and Liletta) are FDA approved for eight years as of November 2022.
- Data supports copper IUD (Paragard) effectiveness up to 12 years, beyond FDA approval for 10 years.