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Menstrual Pattern and Characteristics of One-Rod and Two-Rod Levonorgestrel Implant Users. Obstet Gynecol Int 2021; 2021:2904542. [PMID: 33777145 PMCID: PMC7972863 DOI: 10.1155/2021/2904542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The maternal mortality ratio (MMR) in Indonesia reaches 359 per 100,000 live births. The long-acting reversible contraceptive (LARC) method is an effective contraceptive choice for reducing MMR. The contraceptive implant is one of the LARCs that has low usage due to lack of education about the side effects. This study aims to compare the menstrual pattern and characteristics between one-rod and two-rod levonorgestrel implant users. Methods A prospective cohort study was performed in patients at Cipto Mangunkusumo Hospital (RSCM) from March 2016 to May 2018. Subject recruitment was done by consecutive sampling. This study was conducted from March 2016 until May 2019. Statistical analysis was performed on the data using the chi-square test to determine the relationship between menstrual pattern and characteristics, and the use of one-rod or two-rod levonorgestrel implants. Results A total of 140 subjects participated in the study, comprising 70 (50%) one-rod users and 70 (50%) two-rod users. In the first month, 32.9% one-rod users experienced amenorrhea, 22.9% experienced shortened menstrual period, 30% experienced normal menstrual period, and 14,2 % experienced lengthened menstrual period. In comparison, in the first month, 41.4% two-rod users experienced amenorrhea, 15.7% experienced shortened menstrual period, 32.9% experienced normal menstrual period, and 10% experienced lengthened menstrual period. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Conclusion There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Implications. Menstrual patterns and characteristics from levonorgestrel implants user can help clinicians to reduce discontinuation rate from the acceptors. Further research should be conducted to know other side effects aside from menstrual bleeding patterns.
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Øvre-Eide V, Skjeldestad FE. Use pattern for contraceptive implants in Norway. Acta Obstet Gynecol Scand 2016; 95:1244-1250. [DOI: 10.1111/aogs.13002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Vigdis Øvre-Eide
- Research Group Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
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Chiles DP, Roberts TA, Klein DA. Initiation and continuation of long-acting reversible contraception in the United States military healthcare system. Am J Obstet Gynecol 2016; 215:328.e1-9. [PMID: 27005514 DOI: 10.1016/j.ajog.2016.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Long-acting reversible contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, long-acting reversible contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase long-acting reversible contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. OBJECTIVE We aimed to determine long-acting reversible contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. STUDY DESIGN This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for long-acting reversible contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. RESULTS During the study dates, 188,533 women initiated long-acting reversible contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56-1.62; P < .001). Adolescents aged 14-19 years were the least likely age group to discontinue the implant before 36 months; women aged 35-40 years were the least likely to discontinue an intrauterine contraceptive before 60 months. In multivariable analysis that controlled for demographic factors and contraceptive type, early contraceptive method discontinuation was most likely among women aged 20-24 years, implant users, and women with method initiation in military clinics. CONCLUSION In the US military healthcare system, TRICARE Prime, the initiation of long-acting reversible contraception is low but increasing, and continuation rates are high. This evidence supports long-acting reversible contraception as first-line recommendations for women of all ages who seek contraception.
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Affiliation(s)
- Daniel P Chiles
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Timothy A Roberts
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - David A Klein
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
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Diedrich JT, Zhao Q, Madden T, Secura GM, Peipert JF. Three-year continuation of reversible contraception. Am J Obstet Gynecol 2015; 213:662.e1-8. [PMID: 26259905 PMCID: PMC5292132 DOI: 10.1016/j.ajog.2015.08.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/20/2015] [Accepted: 08/02/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this analysis was to estimate the 3-year continuation rates of long-acting reversible contraceptive (LARC) methods and to compare these rates to non-LARC methods. STUDY DESIGN The Contraceptive CHOICE Project (CHOICE) was a prospective cohort study that followed 9256 participants with telephone surveys at 3 and 6 months, then every 6 months for 2-3 years. We estimated 3-year continuation rates of baseline methods that were chosen at enrollment. The LARC methods include the 52-mg levonorgestrel intrauterine device; the copper intrauterine device, and the subdermal implant). These were then compared to rates to non-LARC hormonal methods (depot medroxyprogesterone acetate, oral contraceptive pills, contraceptive patch, and vaginal ring). Eligibility criteria for this analysis included participants who started their baseline chosen method by the 3-month survey. Participants who discontinued their method to attempt conception were censored. We used a Cox proportional hazard model to adjust for confounding and to estimate the hazard ratio for risk of discontinuation. RESULTS Our analytic sample consisted of 4708 CHOICE participants who met inclusion criteria. Three-year continuation rates were 69.8% for users of the levonorgestrel intrauterine device, 69.7% for copper intrauterine device users, and 56.2% for implant users. At 3 years, continuation was 67.2% among LARC users and 31.0% among non-LARC users (P < .001). After adjustment for age, race, education, socioeconomic status, parity, and history of sexually transmitted infection, the hazard ratio for risk of discontinuation was 3-fold higher among non-LARC method users than LARC users (adjusted hazard ratio, 3.08; 95% confidence interval, 2.80-3.39). CONCLUSION Three-year continuation of the 2 intrauterine devices approached 70%. Continuation of LARC methods was significantly higher than non-LARC methods.
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Affiliation(s)
- Justin T Diedrich
- Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Qiuhong Zhao
- Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Tessa Madden
- Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Gina M Secura
- Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jeffrey F Peipert
- Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
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Inoue K, Barratt A, Richters J. Does research into contraceptive method discontinuation address women's own reasons? A critical review. ACTA ACUST UNITED AC 2015; 41:292-9. [PMID: 25605480 DOI: 10.1136/jfprhc-2014-100976] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 12/03/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the clinical and epidemiological literature addressing contraceptive method change or discontinuation and to assess whether the documented reasons reflected women's experiences. METHODS Major databases including Medline and PsycINFO were searched using keywords related to contraception and discontinuation, adherence and satisfaction, for articles published between January 2003 and February 2013. Studies in developed countries that focused on women of reproductive age and reasons for method change or discontinuation were included. Reasons reported were categorised and examined. RESULTS A total of 123 papers were reviewed in detail. Medical terminology was generally used to describe reasons for method discontinuation. The top two reported reasons were bleeding and pregnancy, but there was a lack of consensus about the categorisation of reasons. Broad categories that were not self-explanatory were included in more than half of the papers, often without further explanation. Only 12 studies expanded on categories containing 'other', 'non-medical' or 'personal' reasons. Eight papers included categories that attributed discontinuation to the participant, such as 'dissatisfied with method'. CONCLUSIONS Studies of reasons for discontinuation of contraceptives do not well describe women's specific reasons. Studies rely heavily on medical terms and often fail to document women's subjective experiences. Future studies should create an opportunity for women to articulate their non-medical reasons in their own words, including those related to their sexual lives. Furthermore, researchers should distinguish, if possible, between reasons for discontinuation of a method and reasons for ceasing participation in a research study.
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Affiliation(s)
- Kumiyo Inoue
- PhD Candidate, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia and Adjunct Senior Lecturer, School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Alexandra Barratt
- Professor, School of Public Health, University of Sydney, Sydney, Australia
| | - Juliet Richters
- Professor, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Newton VL, Hoggart L. Hormonal contraception and regulation of menstruation: a study of young women's attitudes towards ‘having a period’: Table 1. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2014; 41:210-5. [DOI: 10.1136/jfprhc-2014-100956] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/13/2014] [Indexed: 11/04/2022]
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Dickson J, Hoggart L, Newton VL. Unanticipated bleeding with the etonogestrel implant: advice and therapeutic interventions. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2014; 40:158-60. [PMID: 24939479 DOI: 10.1136/jfprhc-2013-100817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jane Dickson
- Consultant in Sexual and Reproductive Healthcare, Oxleas NHS Foundation Trust, London, UK
| | | | - Victoria Louise Newton
- Research Fellow, Faculty of Health and Social Care, The Open University, Milton Keynes, UK
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Mark A, Sonalkar S, Borgatta L. One-year continuation of the etonogestrel contraceptive implant in women with postabortion or interval placement. Contraception 2013; 88:619-23. [DOI: 10.1016/j.contraception.2013.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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Hoggart L, Newton VL. Young women’s experiences of side-effects from contraceptive implants: a challenge to bodily control. REPRODUCTIVE HEALTH MATTERS 2013; 21:196-204. [DOI: 10.1016/s0968-8080(13)41688-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Trussell J. Contraceptive failure in the United States. Contraception 2011; 83:397-404. [PMID: 21477680 DOI: 10.1016/j.contraception.2011.01.021] [Citation(s) in RCA: 878] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 11/16/2022]
Abstract
This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.
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Affiliation(s)
- James Trussell
- Office of Population Research, Princeton University, Princeton, NJ 08540, USA.
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Affiliation(s)
- Michelle Isley
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.
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12
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Long-term contraceptives. Best Pract Res Clin Obstet Gynaecol 2010; 24:617-31. [DOI: 10.1016/j.bpobgyn.2010.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 04/15/2010] [Indexed: 02/06/2023]
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Duvan Cİ, Gözdemir E, Kaygusuz I, Kamalak Z, Turhan NÖ. Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period. J Turk Ger Gynecol Assoc 2010; 11:141-4. [PMID: 24591920 DOI: 10.5152/jtgga.2010.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 08/05/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyse the compliance of patients and side effects of Implanon® during breast feeding. MATERIAL AND METHODS Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. RESULTS Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). CONCLUSION If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.
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Affiliation(s)
- Candan İltemir Duvan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Elif Gözdemir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Ikbal Kaygusuz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Zeynep Kamalak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Nilgün Öztürk Turhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
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Forgettable contraception. Contraception 2009; 80:497-9. [PMID: 19913141 DOI: 10.1016/j.contraception.2009.06.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 05/29/2009] [Accepted: 06/02/2009] [Indexed: 11/24/2022]
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Harvey C, Seib C, Lucke J. Continuation rates and reasons for removal among Implanon® users accessing two family planning clinics in Queensland, Australia. Contraception 2009; 80:527-32. [DOI: 10.1016/j.contraception.2009.05.132] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 05/27/2009] [Indexed: 11/27/2022]
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Insertion and 3-year follow-up experience of 372 etonogestrel subdermal contraceptive implants by family physicians in Granada, Spain. Contraception 2009; 80:457-62. [DOI: 10.1016/j.contraception.2009.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/06/2009] [Accepted: 04/08/2009] [Indexed: 11/18/2022]
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Graesslin O, Korver T. The contraceptive efficacy of Implanon®: A review of clinical trials and marketing experience. EUR J CONTRACEP REPR 2009; 13 Suppl 1:4-12. [DOI: 10.1080/13625180801942754] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lipetz C, Phillips C, Fleming C. Actual cost of providing long-acting reversible contraception: a study of Implanon cost. ACTA ACUST UNITED AC 2009; 35:75-9. [PMID: 19356275 DOI: 10.1783/147118909787931555] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The National Institute for Health and Clinical Excellence (NICE) has judged Implanon to be the most cost effective of the long-acting reversible contraception (LARC) methods, and its cost effectiveness is enhanced with increased duration of use. Gwent Sexual and Reproductive Health service provides unrestricted use of Implanon, and with the number of implants fitted increasing annually the service wanted to know how long clients were keeping their contraceptive implants in and the cost of implant provision. METHODS The actual cost of providing Implanon was calculated in a cohort of 493 patients within a community-based sexual and reproductive health service, and compared to that predicted in the NICE Clinical Guideline 30 on LARC. RESULTS The annual cost for the method (using Implanon) was pound77.49, 25% lower than the estimate made by NICE, despite a shorter duration of use of the method. CONCLUSION The actual cost in this community-based sexual and reproductive health service may not be transferable to other settings such as general practice.
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Affiliation(s)
- Clare Lipetz
- Community Gynaecology and Sexual Health, Gwent Healthcare NHS Trust, Cwmbran, UK.
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Wong RC, Bell RJ, Thunuguntla K, McNamee K, Vollenhoven B. Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users. Contraception 2009; 80:452-6. [PMID: 19835719 DOI: 10.1016/j.contraception.2009.03.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 03/30/2009] [Accepted: 03/31/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND The study was conducted to perform a direct comparison of the satisfaction of intrauterine device (IUD) users and Implanon users after 6 months. STUDY DESIGN Women were recruited to this study in the contraception clinics of Southern Health and Family Planning Victoria. Each woman completed a questionnaire at the time of starting her contraception with either an IUD or Implanon. Women were sent a follow-up questionnaire after 6 months to assess their satisfaction with their chosen method of contraception. RESULTS A total of 439 participants were recruited for this non randomized cohort study; 211 choosing an IUD and 228 choosing to use Implanon. The main reason patients in both groups chose their contraceptive method was recommendation by the doctor. Follow-up was achieved in over 84% in both groups. More than 50% of women in both groups reported at least one side effect. The most commonly reported side effect in both groups was abnormal bleeding and this was also the most common reason for having the contraceptive device removed. The IUD users reported a higher rate of satisfaction with their chosen method of contraception, although there was no difference between groups in the removal rate or whether the women would recommend the contraception to others. CONCLUSIONS IUD users reported a higher level of satisfaction than did Implanon users at 6 months. Side effects in women using IUDs and Implanon are common. The range of likely side effects should be included in counseling women about long-term reversible contraception.
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Affiliation(s)
- Renee C Wong
- Women's and Children's Program, Southern Health, Clayton, Victoria 3168, Australia.
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Faculty of Sexual & Reproductive Healthcare Membership Examination. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2009. [DOI: 10.1783/147118909787931870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Women who cannot use hormonal contraception containing estrogen have a variety of progestin-only contraceptive methods from which to choose. Implanon is a new single-rod progestin-only contraceptive implant that is easily inserted and can remain in place for up to 3 years. It is highly effective with a rapid onset of action and an equally rapid return of fertility once removed. Counseling is important to help women decide if this method is appropriate for their needs.
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Affiliation(s)
- Mary A Fischer
- Graduate School of Nursing, University of Massachusetts, Worcester, MA 01655, USA.
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Abstract
Women have many options regarding contraception. A patient's desire for a long- or short-term method, for one that is reversible or permanent, and her belief that she can be compliant with the method all factor into the choice of contraceptive method. Practitioners must discuss coexisting conditions, contraindications, and whether the patient desires scheduled monthly bleeding or if she will tolerate unscheduled bleeding. Finally, cost and coverage by insurance tends to be one of the most important factors in choosing the method of contraception.
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Affiliation(s)
- Kristen A Plastino
- Department of Obstetrics & Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Vidin E, Garbin O, Rodriguez B, Favre R, Bettahar-Lebugle K. Removal of etonogestrel contraceptive implants in the operating theater: report on 28 cases. Contraception 2007; 76:35-9. [PMID: 17586134 DOI: 10.1016/j.contraception.2007.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/21/2007] [Accepted: 03/27/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We describe removal procedures for etonogestrel contraceptive implants in the operating theater. In addition, we discuss the management of removal of contraceptive implants that are difficult to palpate or are impalpable. DESIGN We conducted a retrospective single-center case series analysis of Implanon removals conducted at a university hospital between January 2002 and April 2005. MATERIALS AND METHODS We analyzed case notes for 28 patients who had their contraceptive implant removed in the operating theater. RESULTS Intermenstrual bleeding was the principal reason for removal (52.4%). Ten patients already had one attempted removal of their implant. Preoperative ultrasound localized the implant in all cases. Half of the removals were done under local anesthetic, with three cases progressing to general anesthesia (11%). Thirty percent of the implants had migrated from their initial implantation, 37% were in intramuscular tissue and 11% were in the humeral neurovascular sheath. The only postoperative complications were one small seroma and transient paresthesia in the territory of the ulnar nerve. The implant was not found in one case. CONCLUSIONS The removal of an implant that is not palpable or difficult to palpate should take place in the operating theater following localization by ultrasound. Patients must be fully informed about the procedure, including its complications and the risk for failure.
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Affiliation(s)
- Eric Vidin
- Service de Gynécologie, SIHCUS-CMCO, 67300 Schiltigheim, France
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Lakha F, Glasier AF. Continuation rates of Implanon® in the UK: data from an observational study in a clinical setting. Contraception 2006; 74:287-9. [PMID: 16982226 DOI: 10.1016/j.contraception.2006.05.072] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 05/12/2006] [Accepted: 05/15/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Long-acting reversible methods of contraception can potentially reduce unintended pregnancy. There are few data on "real-life" continuation rates of the contraceptive implant Implanon. MATERIALS AND METHODS Three hundred twenty-four women choosing Implanon in a community family planning clinic in Scotland were followed up by case note review (n=236) or postal questionnaire (n=87) 3 years after insertion of the implant (1 woman chose not to disclose her home address). RESULTS Data were available for 85% of the women. Continuation rates were 89% (CI 84-91) at 6 months, 75% (CI 69-79) at 1 year, 59% (CI 52-63) at 2 years and 47% (CI 40-52) at 2 years and 9 months. Of the 68 women who discontinued Implanon within 1 year, 62 (91%) did so because of unwanted side effects, the most common being frequent and/or unpredictable bleeding (n=42, 62%). Almost half changed to a less-effective method of contraception; however, one third (n=99, 39%) chose to use a second implant when the first one expired. CONCLUSIONS Continuation rates of Implanon in this clinic setting in the UK make it a cost-effective method of contraception and justify its widespread provision.
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Affiliation(s)
- Fatim Lakha
- Department of Clinical Science and Community Health, University of Edinburgh, Scotland, UK
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Abstract
OBJECTIVES Implanon was introduced in the UK in September 1999. We present here the results of our first 106 Implanon insertions, performed over a period of 18 months. The aims of the study were to study the clinical and demographic profile of Implanon users, to assess the continuation rates of Implanon in the local population, and to identify the reasons for removal. METHODS This was a case note-based study in which the data were transferred to a standardised pre-tested proforma. RESULTS The age range of the 106 Implanon users was 15-43 years. Eighty-six of these clients had their Implanon removed and the Implanon status of 20 clients is not known since they were lost to follow-up by our service. Of these 86 cases, 26 had completed the full 3-year period; therefore, the continuation rate at 3 years was 30.2%. The continuation rate at the end of 1 year was 69.8% and at 2 years was 44.1%. Of the 60 women who had their Implanon removed before the recommended 3-year period, the most common reason was for bleeding irregularity (24 cases, 40%). CONCLUSIONS This is the first published study set in the UK within a real-life setting to follow up a cohort of Implanon users for the full 3-year period. No contraceptive failures were found, replicating previous clinical trials. The continuation rate in this real-life situation was quite low compared to clinical trials. This is frequently the case when comparing real-life situations with clinical trials and may be in part due to higher motivation on the part of clinical trial participants.
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Affiliation(s)
- Anjali Agrawal
- South East Hertfordshire Primary Care Trust, Welwyn Garden City, UK.
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26
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Osman N, Dinh A, Dubert T, Goubier JN. [A new cause for iatrogenic lesion of the ulnar nerve at the arm: contraceptive hormonal implant. Report of two cases]. ACTA ACUST UNITED AC 2005; 24:181-3. [PMID: 16121626 DOI: 10.1016/j.main.2005.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The authors describe two cases of iatrogenic lesions of the ulnar nerve at the arm level after insertion of contraceptive hormonal implants. The presence of only a thin subcutaneous fat layer on the medial side of the arm in slim women, exposes the ulnar nerve to danger during the insertion or withdrawal of the implant. We therefore advise the insertion of such implants on the medial side of the thigh in slim women. We equally recommend that withdrawal of non-tangible devices implanted on the medial side of the arm or in case of neurologic symptoms, even transitory, be done by a trained microsurgeon.
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Affiliation(s)
- N Osman
- Clinique la Francilienne, 16, avenue de l'Hôtel-de-ville, 77340 Pontault-Combault, France.
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27
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Osman N, Mirlesse V. [A new complication of contraceptive hormonal implant: about two cases of lesions of the ulnar nerve at the arm level]. ACTA ACUST UNITED AC 2005; 33:322-5. [PMID: 15914069 DOI: 10.1016/j.gyobfe.2005.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Accepted: 04/05/2005] [Indexed: 11/20/2022]
Abstract
The authors refer 2 cases of iatrogenic lesions of the ulnar nerve at the arm level after insertion of contraceptive hormonal implants. The presence of a small under-skinned pannicula of fat on the internal side of the arm of slim women exposes the ulnar nerve during the insertion of the implant or its withdrawal. Therefore we advise the insertion of such implants on medial side of thigh in slim women. We equally recommend that withdrawal of non-tangible devices implanted on the medial side of the arm or in case of neurologic trouble, even transitory, be done by a trained microsurgeon.
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Affiliation(s)
- N Osman
- Clinique La Francilienne, 16, avenue de l'Hôtel-de-Ville, 77340 Pontault-Combault, France.
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28
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Arribas Mir L, Duarte Vallejo S, Saavedra Ruiz A. Indicación de un método anticonceptivo a una adolescente: implante subcutáneo de gestágeno. Aten Primaria 2004; 34:499-503. [PMID: 15563789 PMCID: PMC7688700 DOI: 10.1016/s0212-6567(04)79537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- L Arribas Mir
- Centro de Salud Universitario de La Chana, Distrito Sanitario Granada, Unidad docente de Medicina Familiar y Comunitaria, Granada, España.
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