What are the referral criteria for patients who wish to have a LARC removed or are experiencing complications?

Referral criteria for removal or complications of LARC devices:

• Patients wishing to have a long-acting reversible contraception (LARC) device removed can request removal at any time, including for planned pregnancy or if the device is due for removal according to its licensed duration ².
• Urgent referral or review is indicated if the patient experiences symptoms suggestive of complications such as pelvic infection (e.g., change in vaginal discharge, pelvic pain, intermenstrual or postcoital bleeding), persistent menstrual abnormalities beyond 6 months, positive pregnancy test, or if the patient cannot feel the device threads, which may indicate uterine perforation ².
• Referral is also appropriate if the device causes discomfort to the patient or her partner during intercourse, or if other adverse effects occur that the patient finds intolerable ².
• If pelvic inflammatory disease (PID) is diagnosed, start appropriate antibiotics and review within 48–72 hours; consider referral for device removal if symptoms persist or the patient wishes removal ².
• Patients with current venous thromboembolism (VTE) requiring hormonal contraception should be referred to a specialist in contraceptive care ¹.
• Healthcare professionals who do not provide LARC removal should have an agreed referral mechanism in place to ensure timely access to trained personnel for removal or management of complications ¹.

Summary: Referral is warranted for LARC removal if the patient requests it, if complications arise (infection, pain, bleeding abnormalities, lost threads, pregnancy suspicion), or if specialist input is needed (e.g., VTE). Providers must ensure access to trained clinicians for removal and complication management ¹,².