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RESEARCH ARTICLE (Open Access)
Contents Vol 22(4)

Extending the use period of hormonal long-acting reversible contraceptive devices in Australia: exploring patterns of use in a cohort of users before and after COVID-19 guidance

Tahlee B. Stevenson https://orcid.org/0000-0002-6513-4005 A , Alice R. Rumbold B , Kelly Hall A , Jenni Ilomaki C , Deborah Bateson https://orcid.org/0000-0003-1035-7110 D , Danielle Mazza E and Luke E. Grzeskowiak B F *
+ Author Affiliations
- Author Affiliations

A School of Public Health, Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA 5000, Australia.

B SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia.

C Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic 3052, Australia.

D The Daffodil Centre, Faculty of Medicine and Health, University of Sydney, Kings Cross, NSW 1340, Australia.

E School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic 3004, Australia.

F Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.

* Correspondence to: luke.grzeskowiak@flinders.edu.au

Handling Editor: Phillip Keen

Sexual Health 22, SH25004 https://doi.org/10.1071/SH25004
Submitted: 3 January 2025  Accepted: 2 June 2025  Published: 23 June 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

As the accessibility of health services fluctuated throughout the COVID-19 pandemic, recommendations supporting off-label extended use of hormonal long-acting reversible contraceptive (LARC) devices began to appear around the globe. Supported by emerging evidence, these recommendations were intended to encourage consumers to postpone device replacement and reduce the need for face-to-face care interactions.

Methods

In this population-based cohort study, data from the nationally representative Australian Pharmaceutical Benefits Scheme 10% sample were analysed. Specifically, logistic regression analysis was undertaken for females aged 15–49 years who had a hormonal LARC dispensed to them within the COVID-19 pandemic period (between February 2017 and November 2021) to assess timing of replacement, compared with timing for pre-COVID counterparts.

Results

Extended use periods were observed in less than 10% of hormonal implant or intrauterine device users in both the pre- and post-COVID cohorts, with 40% replacing their device on time, and around 50% with no record of replacement. No statistically significant changes occurred after the onset of COVID-19.

Conclusions

Despite recommendations for extending LARC device use periods, typical usage patterns were maintained in Australia throughout the COVID-19 pandemic. Given these extended use periods have since been made permanent in Australian clinical guidelines, targeted education for consumers and providers is likely to be required to ensure understanding, uptake and consistent implementation.

Keywords: contraceptive devices, COVID-19, female, hormonal contraception, intrauterine devices, long-acting reversible contraception.

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