GP Connect Clinical feature by Dr Alison Creagh – MBBS DipRANZCOG MHPE; Medical Educator at Sexual Health Quarters
Long acting reversible contraception (LARC), along with permanent sterilisation methods, are the most effective contraceptive methods by a large margin.
Patients are both more satisfied with them, and more likely to be using them by the end of a year, in comparison to the shorter acting methods. They contain low or no doses of hormones, and don’t contain oestrogen, so don’t come with the cardiovascular risks that combined pills and vaginal rings do.
For a number of years, we’ve had a range of LARC options to offer; the contraceptive implant, ImplanonNXT; Mirena hormonal IUD; and three varieties of copper IUD, Copper T Standard, Copper T Short, and Load.
There is a relatively new option to add to the choice of LARCs in Australia – the Kyleena. This device contains 19.5mg levonorgestrel which is a lower dose than the Mirena containing 52mg. So who might choose a Kyleena instead of one of the other options?
Kyleena results in less bleeding than natural cycles, but less hormones than the other hormonal IUD. In practice this seems to be a factor for people who’d much prefer a non-hormonal option, but don’t want to risk an increase in menstrual bleeding that could occur with a copper IUD.
Other advantages include:
- Slightly smaller, and a little less pain with insertion (and a little easier for the inserter, too) compared to other IUDs
- For people without Medicare, a little less expensive than the other hormonal IUD. Like the other LARCs, it’s highly effective and lasts for years.
Those for whom a Kyleena might not be suitable include:
- Those approaching menopause, and considering using their hormonal IUD as part of hormone therapy
- Those who want the lightest possible bleeds
- Obviously, anyone with a contraindication to an IUD (eg current pelvic infection, abnormally shaped uterine cavity, postpartum 48 hours to 4 weeks), or with a contraindication to using hormones (eg breast cancer, severe liver disease).
*Note that all IUDs EXCEPT Kyleena can be used for contraception until after menopause for women who are over 40 (in the case of copper IUDs) or 45 (for hormonal IUDs).
If you or your patients wish to ask specific questions about Kyleena or any other contraception options, please contact the SHQ Helpline: 9227 6178 or sexhelp@shq.org.au. There is also a recently updated “Intrauterine Devices (IUDs)” HealthPathway.
Quick comparison of LARCs available in Australia
| How long it is used for* | Efficacy | Impact on bleeding | On PBS? | |
| Contraceptive implant | 3 years | >99% | Irregular, generally less than natural cycles |
Yes |
| 52mg levonorgestrel IUD | 5 years | >99% | Significant reduction overall, amenorrhoea common; initial frequent spotting 3-6 months |
Yes |
| 19.5mg levonorgestrel IUD | 5 years | >99% | Moderate reduction overall, amenorrhoea for about 25%; initial frequent spotting 3-6 months |
Yes |
| Copper T Standard | 10 years | >99% | Moderate chance of heavier or more painful bleeds than natural cycles |
No |
| Copper T Short | 5 years | >99% | Moderate chance of heavier or more painful bleeds than natural cycles |
No |
| Load | 5 years | >99% | Moderate chance of heavier or more painful bleeds than natural cycles |
No |