No effect of Implanon® on inflammatory cardiovascular parameters

Safety and Benefits of Contraceptives Implants: A Systematic Review

Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.

Metabolic safety of the etonogestrel contraceptive implant in healthy women over a 3-year period

OBJECTIVE

To ascertain whether placement of the etonogestrel contraceptive implant induces significant changes in carbohydrate and lipid metabolism, as reflected by metabolic parameters, in healthy women.

STUDY DESIGN

Prospective cohort study of 213 healthy patients who received etonogestrel implants. Weight, BMI, blood pressure and a comprehensive metabolic profile were assessed at baseline, 1, 2 and 3 years. In 21 of the 213 participants, AUC for glucose levels, fasting insulin levels at baseline and year 3 (immediately before implant removal), HOMA-IR score, and the QUICK index were assessed. Parameters were expressed as median and interquartile range. The Wilcoxon test and ANOVA were used for comparison of measurements after implant placement (significance level p<0.05).

RESULTS

Median age was 26 years (range, 22-31.5). Results showed a trend toward increase of the variables weight (63.3-66.1) and BMI (24.7-25.7) and a decrease in TC (172-161.5), TG (75-69.5), and LDL (100.5-98.5) (p>0.05). Of the metabolic variables, FBG (85-88) and HDL (53-46) had significant differences (p<0.002). In the subgroup of 21 patients, there were reductions in insulin levels (9.65 vs. 8.4mU/dL, p=0.03), HOMA scores (2.06 vs. 1.75, p=0.02), QUICK index (0.34 vs. 0.35, p=0.03), TC (178 vs. 160mg/dL, p=0.001), HDL (51 vs. 46mg/dL, p=0.009), and LDL (110 vs. 100mg/dL, p=0.035).

CONCLUSION

These results provide evidence of the metabolic safety of the ENG implant in healthy women over a 3-year period. Indeed, implant placement induces changes consistent with a lower risk of insulin resistance and dyslipidemia.

Effect of oral and vaginal hormonal contraceptives on inflammatory blood biomarkers

The use of combined hormonal contraceptives has been reported to increase the level of C-reactive protein (CRP). We assessed the effect of hormonal contraceptive use on inflammatory cytokines including CRP, monocyte chemotactic protein-1, soluble tumor necrosis factor (sTNF), interleukin-6 (IL-6), and soluble CD40 ligand. We used 79 female subjects (19 to 30 years old) who were combined oral contraceptives users (n = 29), combined vaginal contraceptive users (n = 20), and nonusers (n = 30) with CRP values of ≤1 (n = 46) or ≥3 (n = 33). Information on medical history, physical activities, and dietary and sleeping habits were collected. Both oral and vaginal contraceptive users had higher levels of CRP (P < 0.0001), compared to nonusers. Only oral contraceptive users exhibited elevated sCD40L (P < 0.01). When comparing the groups with CRP ≤ 1 and CRP ≥ 3, levels of IL-6 and sTNF-RI were positively correlated with CRP among oral contraceptive users. We did not observe the same elevation for other inflammatory biomarkers for the CRP ≥ 3 group among vaginal contraceptive users. The clear cause of elevation in CRP level due to the use of different hormonal contraceptive formulations and methods is not well understood. Longitudinal studies with larger sample size are required to better assess the true cause of CRP elevation among hormonal contraceptive users.

Effects of the contraceptive skin patch and subdermal contraceptive implant on markers of endothelial cell activation and inflammation

Changes in blood coagulation factors may partially explain the association between hormonal contraceptives and thrombosis. Therefore, the likely effects of the contraceptive skin patch and subdermal contraceptive implant on levels of inflammatory markers and endothelial activation were analyzed. This was an observational, prospective, longitudinal, nonrandomized study composed of 80 women between 18 and 35 years of age who made the decision to use the contraceptive skin patch or subdermal contraceptive implant. vascular cell adhesion molecule-1 (VCAM-1), endothelial cell leukocyte adhesion molecule-1 (ELAM-1), von Willebrand factor (VWF), and plasminogen activator inhibitor type 1(PAI-1) as well as high-sensitivity C-reactive protein (hsCRP) were assayed before and after 4 months of use of the contraceptive method. VCAM-1, VWF, and PAI-1 remained unchanged in the contraceptive skin patch group; however, a significant increase in hsCRP (0.29-0.50 mg/dL; P =.012) and a significant decrease in ELAM-1 (44-25 ng/mL; P =.022) were observed. A significant diminution in VCAM-1 (463-362 ng/mL; P =.022) was also found in the subdermal contraceptive implant group. Our results strongly suggest that these contraceptive methods do not induce endothelial activation after 4 months of use. Increase in hsCRP levels was unrelated to changes in markers of endothelial activation.

Nexplanon: the new implant for long-term contraception. A comprehensive descriptive review

Nexplanon(®) is a new long-term reversible contraception method. The current review is aimed to analyze the published data concerning the contraceptive effectiveness of Nexplanon(®) and its effects on reproductive function. Pharmacological properties and technical procedures of insertion and removal, as well as the efficacy and safety data available, were discussed. Possible strategies for treating Nexplanon(®)-related bleeding were also described. With regard to the future research and the future scientific developments of contraceptive implants, the possible use of Nexplanon(®) wide-ranging for the symptomatic treatment of endometriosis and premenstrual syndrome (PMS) were considered. Finally, it was defined in which women the use of Nexplanon(®) is indicated and in which it is contra-indicated.