Injectable medicines commonly used in primary care during COVID-19: Long Acting Reversible Contraception

This page summarises the advice of the Faculty of Sexual and Reproductive Healthcare (FSRH) of the Royal College of Obstetricians and Gynaecologists on the administration of long acting reversible contraception (LARC) during COVID-19.

Long acting reversible contraception includes intrauterine devices (IUDs) and intra-uterine delivery systems (IUSs) as well as depot injections; they are included in the following summary page as they usually require face to face administration which is challenging during the COVID-19 pandemic.

The full guidance can be found here. Advice on other injectable medicines commonly used in primary care is available here.

1.Depot medroxyprogesterone acetate (DMPA)

  • Depo Provera® normal administration: 12 weekly injections
  • Depo Provera® recommendations during COVID-19: switch to desogestrel progesterone only pill (POP).
    • If POP is started up to 14 weeks after the last DMPA injection, no additional contraceptive precautions are required.
    • The FRSH advises that if an individual has no contraindications to DMPA, they are likely to have no contraindications to POP unless absorption or adherence to use are of significant concern. Note that concomitant use of an enzyme-inducing medication could reduce contraceptive effectiveness of the POP. See the BNF for further information on the contra-indications of POP.
  • Sayana Press® normal administration: 13 weekly injections
  • Sayana Press® recommendations during COVID-19:Self-administering users of Sayana Press (or previous self-administering users who have been using Depo Provera during Sayana Press shortage) can receive up to a 12 month supply of Sayana Press (if available) and required equipment to self-administer at home without a face-to- face review or blood pressure check.

2. Etonogestrel implant (ENG-IMP)

  • Normal administration: Implant replaced at 3 years
  • Recommendations during COVID-19: Replacement can be deferred for a year after expiry to avoid unnecessary face-to-face contact. Women should be made aware that contraceptive effectiveness cannot be guaranteed but is likely to be adequate. An alternative option is to offer POP to take in addition.
    • The FRSH advises that if an individual has no contraindications to ENG-IMP, they are likely to have no contraindications to POP unless absorption or adherence to use are of significant concern. Note that concomitant use of an enzyme-inducing medication could reduce contraceptive effectiveness of the POP. See the BNF for further information on the contra-indications of POP.

3. Levonorgestrel intrauterine delivery system (IUS)

  • Mirena® and Levosert® normal administration: IUS replaced at 5 years
  • Mirena® and Levosert® recommendations during COVID-19: Replacement can be deferred for a year after expiry to avoid unnecessary face-to-face contact. Women should be made aware that contraceptive effectiveness cannot be guaranteed but is likely to be adequate. An alternative option is to offer POP to take in addition.
    • The FRSH advises that if an individual has no contraindications to IUS, they are likely to have no contraindications to POP unless absorption or adherence to use are of significant concern. Note that concomitant use of an enzyme-inducing medication could reduce contraceptive effectiveness of the POP. See the BNF for further information on the contra-indications of POP.
  • Jaydess® normal administration: IUS replaced at 3 years
  • Kyleena® normal administration: IUS replaced at 5 years
  • Jaydess® and Kyleena® recommendations during COVID-19: users should be advised to use condoms or add desogestrel POP as above at the end of the licensed duration of use.

4. Copper Intrauterine Device (IUD)

  • Copper IUD normal administration: IUD replaced at 5 years or 10 years, depending on the license of the particular IUD
  • Copper IUD recommendations during COVID-19: Additional use of condoms/desogestrel POP is advised from the time of expiry

The FSRH guidance used to produce this summary page also provides advice about the following related topics:

  • Existing oral contraceptive pill users – both the combined and the progesterone only pill
  • New contraception starters
  • Emergency contraception