Extended use of long acting reversible contraception (LARC)

25th January 2021

During covid-19 there may be fewer appointments available for contraception. Read on for answers to your questions about what this means for you and your contraceptive method.

I have had my implant in for 3 years and it is now due for a change.  Will it still protect me?

The risk of getting pregnant in the year after an implant expires (during the 4th year of use) is very low.  Even though this is the case, it cannot be guaranteed that your implant will still be fully effective, and therefore you may want to use condoms or another form of contraception, such as the contraceptive pill, as well.

Why is it recommended to have my implant changed after 3 years if it is still working?

Studies have shown that using the implant beyond 3 years is unlikely to lead to pregnancy.  However, at the moment there are not enough women in these studies to say definitely that the implant works as well in the 4th year as in the first 3 years so additional protection is recommended. 

My 5 year hormonal IUS has now expired and is due for a change.  Will it still protect me?

If you are using a 5 year hormonal IUS from the UK, it is likely to be either Mirena or Levosert.  The risk of getting pregnant a year after one of these 5 year devices expire (that is, during the 6th year of use) is very low.   In fact, Levosert is now actually licensed for 6 years of use, and it is likely that this will also be true in the near future of Mirena.  This is because there is now enough evidence that shows it works well as a contraceptive in the sixth year.  However since at this time the guidance is still under review, if it is critical for you not to get pregnant you may still opt to use additional contraceptive cover.

Do older women using the IUS need to have their device changed after 45?

People who are more than 45 when they have the Mirena or Levosert inserted can use the device for contraception until the age of 55 as it will continue to provide protection against pregnancy.  After this age, contraception is no longer needed.  People who are using the Mirena IUS as part of their hormone replacement therapy (HRT) taken with oestrogen, still need to change the IUS after 5 years.  Levosert is not currently licensed to be given as part of an HRT regime.

However, for those using the lower dose or shorter use hormonal IUS (eg Kyleena, Jaydess) it is not currently recommended that you extend the use of these products.  This is because there is not enough research to say how long they will continue to work well.  If you have one of these devices you are advised to use additional contraception if it has reached its expiry date.

My copper IUD has expired and is now due for a change.  Will it still protect me?

Those using a 10 year banded copper IUD can continue to use this device for 12 years after insertion.  The risk of pregnancy remains extremely low, although full protection cannot be guaranteed.  Some people may therefore choose to use additional precautions after 10 years have passed.  5 year IUDs should not be assumed to be effective after the 5 years has passed.

Is it safe to leave my implant or IUD in place after it has expired?

It is safe for your expired device to be left until you are able to get into services again.  The only risk is of an unintended pregnancy so make sure you use additional precautions such as condoms or contraceptive pills to provide protection.

I have been advised to use other hormones for contraception while my implant/hormonal IUS is still there.  Will this harm me?

The amount of hormones in the body with either the implant or the hormonal IUS is extremely small.  In addition, progestogen, which is the type of hormone used in both the implant and hormonal IUS is a very safe hormone and one that almost every woman can use even if they have other health problems.  It will therefore not harm you to take other hormones as well.  When starting any new hormone however it is always important to check that it is safe for you to use.

I was advised to extend using my IUS/Implant I wasn’t having periods before, and now they have come back.  Does this mean my implant or IUS has stopped working? 

It is not uncommon for your bleeding pattern to gradually change towards the end of the lifespan of the device. 

If your bleeding pattern changes very suddenly with the IUS, check that your IUS is still in place by checking for threads.

Lots of users have sporadic bleeding when using implant or IUS, however if this is unusual for you and you are beyond your replacement date it is recommended to use additional contraception such as condoms or have a chat with your prescriber about adding hormonal contraception. Although in the first year after change date of implant and some IUS it is highly unlikely you will get pregnant, it is not guaranteed. Organising additional contraception can usually be done remotely via your usual provider.

I don’t have periods with my implant or IUS so how will I know whether or not I am pregnant once it is beyond the usual replacement date.

Extended use within guidelines makes the likelihood of pregnancy very low but there is still a risk, that’s why the advice is to either use condoms or if suitable another hormonal method until you can have your implant or IUS replaced. If you think you might be pregnant you should take a test 3 weeks after any risk and use condoms until you are sure.

If you are worried your IUD or IUS might have fallen out and are unable to find your threads then you should also use condoms until you are able to get it checked. Organising additional contraception can usually be done remotely via your usual provider.

If I get pregnant will my IUD/IUS harm the baby?

Getting pregnant with an IUD/IUS in place is very unusual.  If the IUD or IUS stays in place for the whole pregnancy it can sometimes cause problems like miscarriage or infection so the device will be removed early in the pregnancy if it is possible to do so. Sometimes removing the IUD or IUS can itself cause a miscarriage.

If you get a positive pregnancy test when you have an IUD or IUS in place it is important that you contact your GP or provider without delay as there is a slightly increased risk that the pregnancy could develop in the fallopian tube (ectopic pregnancy). If you have lower tummy pain too, you need to seek urgent medical review. Contact your GP or NHS 111 and seek advice from them.

For those in extended use who are wanting to plan a pregnancy and unable to have their IUD/IUS removed due to current restrictions, it would be advisable to use additional contraception until you are able to have the device removed rather than risk any complications by conceiving when it is still inside.

If I get pregnant while using hormonal contraception, will the hormones harm the baby?

Many women who become pregnant whilst using hormonal contraception continue unknowingly to take hormones before the pregnancy is identified.  There are no known adverse effects on the baby