Guilbert Edith, Arguin Hélène, Bélanger Mathieu
Associate Clinical Professor in the Department of Obstetrics, Gynecology and Reproduction at Laval University in Quebec and Medical Advisor at the Institut national de santé publique du Québec (INSPQ).
Scientific Advisor at INSPQ in Montréal, Que.
Can Fam Physician. 2025 Feb;71(2):e35-e52. doi: 10.46747/cfp.7102e35.
To document the efficacy and safety of etonogestrel subdermal contraceptive implants, levonorgestrel (LNG) intrauterine systems (IUS), and copper (Cu) intrauterine devices (IUDs) for birth control when extended beyond prescription limits.
A systematic search of MEDLINE, Embase, and Global Health electronic databases.
The search identified articles published between January 2000 and June 2023 on long-acting reversible contraceptive (LARC) methods and extended duration of use. Publications on LNG subdermal implants or the "frameless" IUD (not marketed in Canada), case reports, case series, animal studies, and publications not written in English or French were excluded.
Twenty-five publications were included. No pregnancies were reported during prolonged use of the etonogestrel-releasing implant for 1 or 2 additional years beyond the recommended limits (783 participants and 306 participants, respectively), nor with the use of the TCu380A IUD for years 8 to 11 (682 participants), 8 to 12 (356 participants), and 11 to 16 (228 participants). No pregnancies were reported with the LNG-IUS in 9 studies with follow-up from 6 to 15 years, while 2 pregnancies were reported during year 6 in 2 studies, and 4 pregnancies during year 7 in 3 studies. The risk of expulsion persisted during prolonged use of the TCu380A device and the 52-mg LNG-IUS. Other adverse events were infrequent.
Prolonged use of LARCs is safe and much more effective than short-acting contraceptive methods. Prolonged use of LARCs might be beneficial for individuals requiring contraception especially those with disrupted access to social and health care services or living in more remote areas.
记录依托孕烯皮下避孕植入剂、左炔诺孕酮（LNG）宫内节育系统（IUS）和铜（Cu）宫内节育器（IUD）在超出处方限制使用时的避孕效果和安全性。
对MEDLINE、Embase和全球卫生电子数据库进行系统检索。
检索确定了2000年1月至2023年6月期间发表的关于长效可逆避孕（LARC）方法及延长使用期限的文章。排除了关于LNG皮下植入剂或“无支架”IUD（未在加拿大上市）的出版物、病例报告、病例系列、动物研究以及非英文或法文撰写的出版物。
纳入了25篇出版物。在依托孕烯释放植入剂超出推荐限制额外使用1年或2年期间（分别为783名参与者和306名参与者），以及在使用TCu380A IUD的第8至11年（682名参与者）、第8至12年（356名参与者）和第11至16年（228名参与者）期间，均未报告妊娠情况。在9项随访6至15年的研究中，LNG-IUS未报告妊娠情况，而在2项研究的第6年报告了2例妊娠，在3项研究的第7年报告了4例妊娠。在长期使用TCu380A装置和52mg LNG-IUS期间，排出风险持续存在。其他不良事件很少见。
长效可逆避孕方法的长期使用是安全的，且比短效避孕方法有效得多。长效可逆避孕方法的长期使用可能对需要避孕的个体有益，尤其是那些难以获得社会和医疗服务或生活在偏远地区的人。
