What are the eligibility criteria for prescribing Long-Acting Reversible Contraceptives (LARC) such as IUDs, IUSs, and implants in primary care?

Eligibility criteria for prescribing long-acting reversible contraceptives (LARC) such as intrauterine devices (IUDs), intrauterine systems (IUS), and contraceptive implants in primary care include:

• Women should be offered a choice of all contraceptive methods, including LARC, and provided with detailed verbal and written information to enable informed decision-making, considering individual needs and preferences ¹.
• A full medical history must be taken, including menstrual, contraceptive, sexual, family history, and assessment of comorbidities, allergies, lifestyle factors, and drug treatments to assess medical eligibility using the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) ¹,³.
• Pregnancy must be reasonably excluded before initiation by menstrual and sexual history or pregnancy testing as appropriate ¹,²,³.
• Healthcare professionals must be trained and competent in the insertion and removal of LARC methods; for IUDs and IUS, this includes holding the Faculty of Sexual and Reproductive Healthcare (FSRH) Letter of Competence or equivalent, with evidence of recertification ²,⁴.
• Perform a bimanual pelvic examination immediately prior to IUD/IUS insertion to assess uterine size, shape, and position, unless contraindicated by clinical history; obtain valid consent before examination and insertion ²,³.
• Assess risk of sexually transmitted infections (STIs) by taking a sexual history and offer STI testing and cervical screening as appropriate before insertion ²,³.
• Do not insert IUD/IUS if there is unexplained vaginal bleeding suggestive of underlying pathology until investigated; offer alternative contraception meanwhile ³.
• Women with current venous thromboembolism (VTE) requiring hormonal contraception should be referred to specialist contraceptive care ¹.
• For contraceptive implants, insertion and removal must be performed by trained healthcare professionals ¹.
• Informed consent must be obtained and documented, especially if LARC is used outside UK marketing authorisation ¹.