Contraceptive care should not be compromised during this global pandemic. As many providers transition to contactless care methods via telehealth, patients that utilize long-acting reversible contraception may be worried if their intrauterine device (IUD) or implant has reached its expiration and needs to be removed or replaced. Pharmacists play an important role in educating patients about birth control, including what options are available to them when in-person appointments are not available at their regular clinic or doctor’s office.
The expiration date listed on the IUD and implant packaging should not be confused with the duration of use. The date stated on the packaging refers to the date by which the implant and IUD should be inserted. Therefore, as long as the contraceptive device is inserted before the expiration date listed on the package, the IUD or implant will be effective for the entire duration indicated for each method. If the expiration date listed on the package has passed, the device is considered expired so it should not be used for a patient and should be discarded.
Studies have demonstrated that IUDs and implants are effective past the FDA-approved duration. This evidence can help minimize concerns about ineffective devices that cannot be replaced due to cancelled doctor’s appointments due to COVID-19 or patient inability to go in due to exposure concerns, insurance loss, or any challenges. See table below to view extended evidence-based durations.
If the IUD or implant usage extends beyond the evidence-based duration, the patient should utilize an alternative birth control method until she is able to resume in-person visits with their provider to remove the device and possibly replace it with a new one if the patient desires. Providers should inform patients that leaving an IUD or implant in place past the evidence-based duration will not cause harm. While there are no safety concerns, there is no benefit as the device is not expected to be effective.
Pharmacists cannot prescribe or insert IUDs or implants, however, pharmacists have the ability to prescribe self-administered hormonal contraceptives in some states and can always provide over-the-counter barrier and emergency methods. If patients want an implant or IUD, pharmacists are able to initiate an alternative method in the meantime until patients are able to visit their clinic or doctor’s office for IUD or implant insertion. See our COVID page for more on providing contraceptive care during COVID-19.
For patients not satisfied with their current birth control regimen who are interested in switching to an IUD or implant, pharmacists can refer the patient to a provider and educate the patient on proper bridging methods to prevent pregnancy during the transition to an IUD or implant.
It is important that pharmacists stay up to date on birth control recommendations and clinical updates in order to provide guidance for patients and providers during a public health emergency. Pharmacists play an integral role in providing patients with the resources and education needed to make informed decisions on their contraceptive options. See the ACCP Women’s Health PRN Opinion Paper on the pharmacist’s role in safe and effective use of long-acting reversible contraceptive methods.
If a patient is having symptoms related to their IUD or implant, they should be seen for this at a local clinic or doctor’s office. To find a clinic that provides contraceptive devices, visit Bedsider’s clinic finder.
- Prescribing information for Depo-SubQ Provera and Depo-Provera.
- Reproductive Health Access Project. How to Switch Birth Control Methods. 2015.
- Ali M, Akin A, Bahamondes L, et al. Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant: comparison to levonorgestrel-releasing subdermal implant. Hum Reprod. 2016;31(11):2491‐2498. Available from: https://doi.org/10.1093/humrep/dew222
- Family Planning National Training Center. Missouri (KS): FPNTC; 2017. What Family Planning Providers Can Do to Meet Client Needs During COVID-19; 2020 May 19 [cited 2020 May 19] Available from: https://www.fpntc.org/resources/what-family-planning-providers-can-do-meet-client-needs-during-covid-19?utm_source=eNews&utm_campaign=March
- Liletta [package insert]. Belgium: Odysea Pharma. 2015.
- Nexplanon [package insert]. Whitehouse Station (NJ): Merck & Co., Inc.; 2011
- Kyleena [package insert]. Whippany (NJ): Bayer HealthCare Pharmaceuticals Inc., 2016
- Rafie S, McIntosh J, Shealy KM, et al. Roles of the pharmacist in the use of safe and highly effective long-acting reversible contraception: an opinion of the Women’s Health Practice and Research Network of the American College of Clinical Pharmacy. Pharmacotherapy 2014;34(9):991-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24989020
- Reproductive Health Access Project. New York (NY): RHAP; 2005. Contraception in the time of COVID-19.; 2020 March [cited 2020 May 19]. Available from: https://www.reproductiveaccess.org/wp-content/uploads/2020/03/03-2020-Contraception-in-the-time-of-COVID-final.pdf
About the Author
Kailey Hifumi is a student pharmacist at the Pacific University School of Pharmacy.