Is this patient a candidate for LARC?
“Long-acting reversible contraceptives (LARC) have higher efficacy, higher continuation rates, and higher satisfaction rates compared with short-acting contraceptives among adolescents who choose to use them.”
American College of Obstetricians and Gynecologists, 2018
Long-acting reversible contraceptives — intrauterine devices and subdermal implants — are endorsed by Texas Health Steps and are a covered benefit for patients enrolled in Texas Medicaid, Healthy Texas Women and the Family Planning Program. Providers who are familiar with LARCs are in the best position to counsel young patients and provide effective, long-lasting contraception for those who want to avoid pregnancy.
Review the following case examples and determine whether the patients are eligible for LARC. Also consider whether they are eligible for LARC insertion today.
Case Examples
Maya is in your office for a Texas Health Steps preventive medical checkup. Her exam is normal and she expresses no concerns. During a private conversation with you, she reports being sexually active with one partner. She tells you they use condoms some of the time and she is worried whether she could get pregnant. She asks if there is contraception, “I don’t have to remember … and something my parents don’t have to know about.”
Sofia is in clinic for a postpartum exam six weeks after delivery. She had an uncomplicated vaginal delivery and has returned to school while her mom looks after the baby. She expresses the desire to concentrate on school and her baby and to avoid pregnancy for the foreseeable future. She asks: “Is there anything I can get today so I don’t get pregnant again too soon?”
Alyssa has been your patient through Texas Health Steps for several years. She is in your office today complaining of serious menstrual cramps that have disrupted her normal activities. During a private conversation with you, she reports that she is not currently sexually active but has a serious boyfriend. She asks whether she could “get an implant today” in case she becomes sexually active.
A note about parental consent
All three patients are younger than 18 and are therefore minors under Texas law. In this setting, parental permission is required for prescription contraception. A parent or guardian must sign the general consent for treatment and the method-specific consent for the selected prescription contraceptive. As a provider, you are called on to navigate the discussion between the patient and parents.
According to an American Academy of Pediatrics clinical report, only 20% to 50% of adolescents recognize LARC as a contraceptive. “Counseling from a health care provider has been found to effectively improve knowledge in the adolescent population and can significantly impact LARC use,” the report states.
Take the quick course LARC: Texas Guidelines and Recommendations to learn more.
Why it matters
About half of all pregnancies in Texas are unplanned or unintended. As a provider, your knowledge of LARC can provide young patients and their parents with clear and current information about contraception as part of preconception care.
References
American Academy of Pediatrics. (2020). Clinical Report: Long-Acting Reversible Contraception: Specific Issues for Adolescents.
American College of Obstetricians and Gynecologists. (2018, reaffirmed 2021). Committee Opinion 735: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices.