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Tuesday, June 14, 2016

Top Form Tuesday: Prevent LARC from being "SARC"

Long acting reversible contraception(LARC)  is effective and cost effective because women can use it for a long time, however side effects like bleeding can make a woman give up years before the contraceptive expires. LARC is a term that is applied to any method that is designed to be used for a long time: IUDs, DepoProvera, or the Nexplanon are what is usually (in the US) refered to as LARC. However, if you discontinue the LARC we may say you have now made it into "Short-acting reversible contraception or 'SARC." The Nexplanon implantable rod is designed to be used over 3 years. Patient contraindications for Nexplanon are similar to the contraindications for other progestin methods of contraception. Specifically you should not be pregnant, have a clot or clotting disease, have disease of the liver, or breast cancer. If a woman has irregular bleeding, it should be diagnosed and treated before getting the device. Those contraindications aside it is a terrific method for many women. The Nexplanon rod may cause irregular bleeding (usually light) that may not necessarily resolve over time. For women who like their rod, but get the bleeding, not many treatments have been effective. However recently there has been a study that looked at using the breast cancer treatment medication tamoxifen for 7 days to see if it would stop the bleeding. This study, done at many academic institutions looking at women who reported bleeding for an average of 23 days per month while on a Nexplanon. The women were able to reduce their bleeding while on Nexplanon with the Tamoxifen treatment to as little as an average of 6 days per months. The researchers lead by Dr. Katharine Simmons concluded that the medicine did in fact work very effectively to significantly reduce bleeding days. We do not yet know if women will be predisposed to continue their Nexplanon LARC, and prevent it from being SARC,  but it is an available alternative that may work for a particular woman, in consultation with her individual physician.

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