Matching Contraceptive Method to Need

Two simple questions can help you introduce the idea of patient-method fit

Finding the Right Match

1) When do you want to have a/another pregnancy, if ever?

• Establish contraceptive need and a timeline to pregnancy
• Immediate desire for pregnancy = no method needed
  • Encourage folic acid use
• Short term = planning pregnancy within one year
• Long term = planning a pregnancy more than a year from now, or not in the foreseeable future/ever

2) How important is it to you NOT to get pregnant right now?

• Said another way: How would you feel right now if you found out you were pregnant?
• Would she be ok with a pregnancy if it happened?
• Would an unplanned pregnancy cause significant distress or disruption?
• The more a woman wishes to avoid pregnancy, the more effective the method should be

Long Acting Reversible Contraception

Long Acting Reversible Contraception (LARC, or sometimes called long-acting contraception-LAC) requires administration less than once per year. In Canada, Intrauterine Contraception (IUC), which consists of Copper Intrauterine Devices (Cu-IUD) and Levonorgestrel-Releasing Intrauterine Systems (LNG-IUS), is the only LARC method available to women.

• Copper IUD (Cu-IUD)
  • 2.5, 3, 5, or 10 years

• Levonorgestrel releasing intrauterine system (LNG-IUS, or progestin-IUS, or hormone IUS)
  Progestin (hormonal) IUS (LNG-IUS)
  • 3 and 5 years

*This is not an endorsement.

Categories of Intrauterine contraceptives (IUC)

IUCs are a form of LARC that is placed into the uterus. Two categories of IUC are available in Canada: the copper IUD (Cu-IUD) and levonorgestrel-releasing intrauterine systems (LNG-IUS).

• Copper IUDs consist of a polyethylene T-shaped frame, around which a pure copper or copper-plated silver wire is wound around the vertical stem and, sometimes, the horizontal arms. One or two monofilament threads extend through the cervix into the vagina.
• LNG-IUS’ consist of a polyethylene T-shaped frame which has a cylindrical reservoir on the vertical arm containing levonorgestrel (a progestin). This cylinder slowly releases the hormone. Two monofilament threads extend through the cervix into the vagina.

• Piece of polyethylene; shaped like a T
• Copper wire wound around vertical stem and sometimes, horizontal parts
• One or two monofilament threads hang from uterus through cervix into vagina

• Piece of polyethylene shaped like a T
• Cylindrical reservoir on vertical arm containing a progestin
• Two monofilament threads hang from uterus through cervix into vagina

Candidates for IUC

Both non-hormonal and hormonal IUCs can be safely used by most women, even in the following situations:

• History of PID or STI (treated)
• Previous ectopic pregnancy
• Wanting future pregnancy
• Previous Caesarean section
• Nulliparous women
• Adolescents
• Multiple sexual partners, serial monogamy, or non monogramy
• Previous venous thromboembolism (VTE)
• Known thrombophilia
• Previous myocardial infraction (MI) or stroke
• Smokers
• Obesity
• Immunocompromised state, including stable HIV infection
• History of migraines*

Absolute Contraindications for IUC (MEC-4)

Some women should NOT consider an IUC. This includes the following:

• Current Pregnancy
• Current cervical cancer*
• Current breast cancer (LNG-IUS)
• Current PID, mucopurulent cervicitis, or known positive and untreated GC/CT swab
• Known distorded uterine cavity‡
• Current endometrial cancer or otherwise unexplained abnormal vaginal bleeding
• Gestational throphoblastic disease with persistent or increasing beta-hCG
• Immediately following septic abortion
• Pelvic tuberculosis
• Puerperal sepsis

The US Medical Eligibility Criteria for Contraceptive Use provides guidance on the use of the various contraceptive methods given a medical condition. To learn more, click here