Everything you need to know about the contraceptive implant
FDA approval means US women now have a progestin-only implant among their birth control options
IN THIS ARTICLE
A meta-analysis of 13 studies published between 1989 and 1992 found that, among 1,716 women using the ENG implant, 5.3% discontinued in months 1 to 6, 6.4% discontinued in months 7 to 12, 4.1% discontinued in months 13 to 18, and 2.8% discontinued in months 19 to 24. Overall, 82% of women continued to use the ENG implant for up to 24 months.8
Lack of training, lack of counseling, lack of success
When the ENG implant was introduced in Australia in 2001, an unexpectedly high number of unintended pregnancies were reported: 100 pregnancies during the first 18 months.13 Almost universally, these events were traced to improper insertion by untrained clinicians, as well as poor patient selection, timing, and counseling.
In response, the Royal Australian College of General Practitioners developed policies for adequate documentation of proper insertion procedures and patient education. The problems disappeared.13
Preinsertion counseling and postinsertion follow-up are essential for continued use of implants because they increase the patient’s satisfaction with the method and help minimize costly removals.
What to advise patients30
- Strongly stress the likelihood of changes in bleeding patterns
- Lack of inherent protection against sexually transmitted infections, and importance of protective measures (though the implant likely reduces the risk of pelvic inflammatory disease)
- User-specific lifestyle and health advice, such as the need for supplemental contraception in some women during the first 7 days of use
- Pros and cons of implants compared with other methods
- The date when removal is indicated1
Consent form
The patient should sign a consent form, which should be included in her medical record.
Extensive, worldwide experience
Already the 6-capsule and 2-rod LNG implants and the single-rod ENG implant have been used successfully by millions of women. The benefits are high efficacy, long duration, absence of estrogen, ease of use, reversibility, and safety.
Dr. Darney reports that he is a consultant to Organon and a speaker for Barr Laboratories, Berlex, and Organon.
