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Long-acting reversible contraception

CDC person-centered initiation and follow-up for intrauterine devices, contraceptive implants and injectable contraception.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Patients considering or using a copper or levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate injection. Devices and implants are long-acting reversible methods; injectable contraception has repeat-dose and return-to-fertility differences that must be discussed separately.
sources for this section:CDC U.S. MEC 2024CDC U.S. SPR 2024

The Bottom Line

  • Offer intrauterine devices and implants to eligible adolescents and adults using noncoercive counseling; age, parity and disability alone are not reasons to withhold a method.
  • An intrauterine device or implant can often be placed the same day when the clinician is reasonably certain the patient is not pregnant, avoiding unnecessary barriers and loss to follow-up.
  • Risk-based gonorrhea and chlamydia screening can be collected at intrauterine-device placement and generally need not delay insertion unless current cervicitis or known untreated infection is present.
  • Expected bleeding differs by method: copper devices may increase bleeding initially, levonorgestrel devices and implants often alter bleeding unpredictably, and depot injection can lead to amenorrhea.
  • Counsel injectable users about the repeat-injection interval, possible weight and bone-density considerations and potentially delayed return to fertility after discontinuation.
sources for this section:CDC U.S. MEC 2024CDC U.S. SPR 2024

Practical clinical workflow

1
Use shared decision-making to compare efficacy, duration, bleeding effects, insertion procedure, pain preferences, privacy, reversibility, cost and the patient鈥檚 own reproductive goals.
2
Apply U.S. MEC to the selected method, assess pregnancy certainty and infection symptoms, and obtain only examinations or tests needed for safe initiation of that method.
3
For insertion, obtain specific consent, offer evidence-based pain-management options, maintain trauma-informed communication and stop when the patient withdraws consent.
4
Provide method-specific backup guidance, expected symptoms, string or implant counseling when useful, the next injection date where applicable and a direct route for removal or review.
5
At follow-up, investigate unacceptable bleeding or pain, support continuation only if wanted and remove an intrauterine device or implant on request without imposing reproductive goals.
sources for this section:CDC U.S. MEC 2024CDC U.S. SPR 2024

Safety boundaries and escalation

  • Severe post-insertion pain, fever, purulent discharge, heavy bleeding, syncope or suspected perforation requires prompt examination and imaging or emergency care according to severity.
  • Pregnancy with an intrauterine device in place requires urgent location assessment because the proportion of pregnancies that are ectopic is higher, even though the absolute pregnancy risk is very low.
  • A missing intrauterine-device string, suspected expulsion or a nonpalpable implant requires backup counseling and localization before blind removal attempts or assumptions of protection.
  • No long-acting contraceptive prevents sexually transmitted infection, and a positive screening result after insertion requires timely treatment and partner care rather than automatic device removal.
sources for this section:CDC U.S. MEC 2024CDC U.S. SPR 2024

Localization

This page follows CDC U.S. MEC and U.S. SPR and US device labeling. Trained inserter access, analgesia options, state consent law, stocking and insurance coverage differ; every setting should provide an accessible removal pathway.
sources for this section:CDC U.S. MEC 2024CDC U.S. SPR 2024

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. Centers for Disease Control and PreventionU.S. Medical Eligibility Criteria for Contraceptive Use, 2024MMWR 2024;73(No. RR-4); DOI 10.15585/mmwr.rr7304a1 路 published 2024-08-08 路 accessed 2026-08-20
    view source
  2. Centers for Disease Control and PreventionU.S. Selected Practice Recommendations for Contraceptive Use, 2024MMWR 2024;73(No. RR-3); DOI 10.15585/mmwr.rr7303a1 路 published 2024-08-08 路 accessed 2026-08-20
    view source
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