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

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 15-49years 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.