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Implantable Contraception

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Abstract

Contraceptive implants are progestin-based, highly effective, and rapidly reversible methods of contraception that require little of the user and have few side effects. Over the past 35 years they have been approved in more than 60 countries and used by millions of women worldwide (Meirik et al., Hum Reprod Update 9(1):49–59, 2003). Their high efficacy along with ease of use makes them a good contraceptive option for women who require progestin-only methods, teens who find adherence to a contraceptive regime difficult, as well as healthy adult women who desire long-term protection. In most countries, two different contraceptive implants are available: the single-rod etonogestrel implant and the two-rod levonorgestrel system. The pharmacological profile and physical effects of all the implantable contraceptives are similar. While the etonogestrel implant is the only form of implantable contraception available in the United States (and the focus of this chapter), clinicians may encounter other systems in use worldwide.

Keywords

  • Progestin-based
  • Contraceptive regime
  • Single-rod etonogestrel implant
  • Two-rod levonorgestrel system

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References

  1. Meirik O, Fraser IS, D’arcangues C, Who Consultation on Implantable Contraceptives for Women. Implantable contraceptives for women. Hum Reprod Update. 2003;9(1):49–59.

    CAS  CrossRef  PubMed  Google Scholar 

  2. Sivin I, Mishell Jr DR, Darney P, Wan L, Christ M. Levonorgestrel capsule implants in the United States: a 5-year study. Obstet Gynecol. 1998;92(3):337–44.

    CAS  CrossRef  PubMed  Google Scholar 

  3. Kuiper H, Miller S, Martinez E, Loeb L, Darney P. Urban adolescent females’ views on the implant and contraceptive decision-making: a double paradox. Fam Plann Perspect. 1997;29(4):167–72.

    CAS  CrossRef  PubMed  Google Scholar 

  4. Steiner MJ, Lopez LM, Grimes DA, Cheng L, Shelton J, Trussell J, Farley TM, Dorflinger L. Sino-implant (II) – a levonorgestrel-releasing two-rod implant: systematic review of the randomized controlled trials. Contraception. 2010;81(3):197–201.

    PubMed Central  CAS  CrossRef  PubMed  Google Scholar 

  5. Sivin I, Mishell Jr DR, Diaz S, Biswas A, Alvarez F, Darney P, Holma P, Wan L, Brache V, Kiriwat O, Abdalla K, Campodonico I, Pasquale S, Pavez M, Schechter J. Prolonged effectiveness of Norplant (R) capsule implants: a 7-year study. Contraception. 2000;61(3):187–94.

    CAS  CrossRef  PubMed  Google Scholar 

  6. Dunson TR, Amatya RN, Krueger SL. Complications and risk factors associated with the removal of Norplant implants. Obstet Gynecol. 1995;85(4):543–8.

    CAS  CrossRef  PubMed  Google Scholar 

  7. Meckstroth KR, Darney PD. Implant contraception. Semin Reprod Med. 2001;19(4):339–54.

    CAS  CrossRef  PubMed  Google Scholar 

  8. United States Medical Eligibility Criteria (US MEC) for Contraceptive Use 2010; http://www.cdc.gov/reproductivehealth/unintendedpregnancy/USMEC.htm. Accessed 14 June 2015.

  9. Heinemann LA, Assmann A, Dominh T, Garbe E. Oral progestogen-only contraceptives and cardiovascular risk: results from the transnational study on oral contraceptives and the health of young women. Eur J Contracept Reprod Health Care. 1999;4(2):67–73.

    CAS  CrossRef  PubMed  Google Scholar 

  10. Gomes MP, Deitcher SR. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review. Arch Intern Med. 2004;164(18):1965–76.

    CAS  CrossRef  PubMed  Google Scholar 

  11. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. Contraception. 1998;57(5):315–24.

    CrossRef  Google Scholar 

  12. Darney P, Patel A, Rosen K, Shapiro LS, Kaunitz AM. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril. 2009;91(5):1646–53.

    CrossRef  PubMed  Google Scholar 

  13. Acog Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. No. 73: use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. 2006;107(6):1453–72.

    CrossRef  Google Scholar 

  14. Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012;366(24):2257–66.

    CAS  CrossRef  PubMed  Google Scholar 

  15. Hennessy S, Berlin JA, Kinman JL, Margolis DJ, Marcus SM, Strom BL. Risk of venous thromboembolism from oral contraceptives containing gestodene and desogestrel versus levonorgestrel: a meta-analysis and formal sensitivity analysis. Contraception. 2001;64(2):125–33.

    CAS  CrossRef  PubMed  Google Scholar 

  16. Dorflinger LJ. Metabolic effects of implantable steroid contraceptives for women. Contraception. 2002;65(1):47–62.

    CAS  CrossRef  PubMed  Google Scholar 

  17. Suherman SK, Affandi B, Korver T. The effects of Implanon on lipid metabolism in comparison with Norplant. Contraception. 1999;60(5):281–7.

    CAS  CrossRef  PubMed  Google Scholar 

  18. Reinprayoon D, Taneepanichskul S, Bunyavejchevin S, Thaithumyanon P, Punnahitananda S, Tosukhowong P, Machielsen C, Van Beek A. Effects of the etonogestrel-releasing contraceptive implant (Implanon on parameters of breastfeeding compared to those of an intrauterine device. Contraception. 2000;62(5):239–46.

    CAS  CrossRef  PubMed  Google Scholar 

  19. Bahamondes L, Bahamondes MV, Modesto W, et al. Effect of hormonal contraceptives during breastfeeding on infant’s milk ingestion and growth. Fertil Steril. 2013;100(2):445–450.

    Google Scholar 

  20. Brito MB, Ferriani RA, Quintana SM, Yazlle ME, Silva De Sa MF, Vieira CS. Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study. Contraception. 2009;80(6):519–26.

    CAS  CrossRef  PubMed  Google Scholar 

  21. World Health Organization. Medical eligibility criteria for contraceptive use, executive summary, fifth edition 2015. World Health Organization Web site. http://apps.who.int/iris/bitstream/10665/172915/1/WHO_RHR_15.07_eng.pdf?ua=1&ua=1. Accessed 14 June 2015.

  22. Gurtcheff SE, Turok DK, Stoddard G, Murphy PA, Gibson M, Jones KP. Lactogenesis after early postpartum use of the contraceptive implant: a randomized controlled trial. Obstet Gynecol. 2011;117(5):1114–21.

    CrossRef  PubMed  Google Scholar 

  23. Han L, Teal SB, Sheeder J, Tocce K. Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective? Am J Obstet Gynecol. 2014;211(1):24.e1–e7.

    CrossRef  Google Scholar 

  24. Gariepy AM, Duffy JY, Xu X. Cost-effectiveness of immediate compared with delayed postpartum etonogestrel implant insertion. Obstetrics & Gynecology. 2015;ePublish Ahead of Print.

    Google Scholar 

  25. Abma JC, Martinez GM, Copen CE. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, national survey of family growth 2006–2008. Vital Health Statist. 2010;23(30):1–47. Data from the National Survey of Family Growth.

    Google Scholar 

  26. Mestad R, Secura G, Allsworth JE, Madden T, Zhao Q, Peipert JF. Acceptance of long-acting reversible contraceptive methods by adolescent participants in the contraceptive CHOICE project. Contraception. 2011;84(5):493–498.

    Google Scholar 

  27. Guazzelli CA, De Queiroz FT, Barbieri M, Torloni MR, de Araujo FF. Etonogestrel implant in postpartum adolescents: bleeding pattern, efficacy and discontinuation rate. Contraception. 2010;82(3):256–9.

    CAS  CrossRef  PubMed  Google Scholar 

  28. Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2012;120(4):983–8.

    CrossRef  Google Scholar 

  29. Mosher WD, Jones J. Use of contraception in the United States: 1982–2008. Vital Health Statist. 2010;23(29):1–44. Data from the National Survey of Family, Growth.

    Google Scholar 

  30. Finer LB, Jerman J, Kavanaugh ML. Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertil Steril. 2012;98(4):893–7.

    PubMed Central  CrossRef  PubMed  Google Scholar 

  31. Wenzl R, Van Beek A, Schnabel P, Huber J. Pharmacokinetics of etonogestrel released from the contraceptive implant Implanon. Contraception. 1998;58(5):283–8.

    CAS  CrossRef  PubMed  Google Scholar 

  32. Makarainen L, Van Beek A, Tuomivaara L, Asplund B, Coelingh Bennink H. Ovarian function during the use of a single contraceptive implant: Implanon compared with Norplant. Fertil Steril. 1998;69(4):714–21.

    CAS  CrossRef  PubMed  Google Scholar 

  33. Croxatto HB, Makarainen L. The pharmacodynamics and efficacy of Implanon. An overview of the data. Contraception. 1998;58 Suppl 6:91S–7.

    CAS  CrossRef  PubMed  Google Scholar 

  34. Brache V, Faundes A, Johansson E, Alvarez F. Anovulation, inadequate luteal phase and poor sperm penetration in cervical mucus during prolonged use of Norplant implants. Contraception. 1985;31(3):261–73.

    CAS  CrossRef  PubMed  Google Scholar 

  35. Varma R, Mascarenhas L. Endometrial effects of etonogestrel (Implanon) contraceptive implant. Curr Opin Obstet Gynecol. 2001;13(3):335–41.

    CAS  CrossRef  PubMed  Google Scholar 

  36. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.

    PubMed Central  CrossRef  PubMed  Google Scholar 

  37. Bahamondes L. Three years follow up: Multicentre randomised clinica trial of two implantable contraceptives for women. Jadelle and Implanon. In: European Society of Contraception and Reproductive Health; May 28-31, 2-14; Lisbon, Portugal. Symposium WHO.2.

    Google Scholar 

  38. Bouquier J, Fulda V, Bats AS, Lecuru F, Huchon C. A life-threatening ectopic pregnancy with etonogestrel implant. Contraception. 2012;85(2):215–7.

    CrossRef  PubMed  Google Scholar 

  39. Levine JP, Sinofsky FE, Christ MF, Implanon Us Study Group. Assessment of Implanon insertion and removal. Contraception. 2008;78(5):409–17.

    CrossRef  PubMed  Google Scholar 

  40. Lange J, Teal S, Tocce K. Decreased efficacy of an etonogestrel implant in a woman on antiepileptic medications: a case report. J Med Case Rep. 2014;8:43. doi:10.1186/1752-1947-8-43.

    PubMed Central  CrossRef  PubMed  Google Scholar 

  41. Leticee N, Viard JP, Yamgnane A, Karmochkine M, Benachi A. Contraceptive failure of etonogestrel implant in patients treated with antiretrovirals including efavirenz. Contraception. 2012;85(4):425–7.

    CAS  CrossRef  PubMed  Google Scholar 

  42. Adams K, Beal MW. Implanon: a review of the literature with recommendations for clinical management. J Midwifery Womens Health. 2009;54(2):142–9.

    CrossRef  PubMed  Google Scholar 

  43. Mansour D, Bahamondes L, Critchley H, Darney P, Fraser IS. The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users. Contraception. 2011;83(3):202–10.

    CAS  CrossRef  PubMed  Google Scholar 

  44. Abdel-Aleem H, D’arcangues C, Vogelsong KM, Gaffield ML, Gulmezoglu AM. Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Cochrane Database Syst Rev. 2013;10:CD003449.

    PubMed  Google Scholar 

  45. Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, De Bruyn G, Nakku-Joloba E, Ngure K, Kiarie J, Coombs RW, Baeten JM, Partners in Prevention HSV/HIV Transmission Study Team. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2012;12(1):19–26.

    PubMed Central  CrossRef  PubMed  Google Scholar 

  46. WHO Technical Statement. Hormonal contraception and HIV. http://www.who.int/reproductivehealth/publications/family_planning/rhr_12_8/en/. Accessed 14 June 2015.

  47. Darney PD, Callegari LS, Swift A, Atkinson ES, Robert AM. Condom practices of urban teens using Norplant contraceptive implants, oral contraceptives, and condoms for contraception. Am J Obstet Gynecol. 1999;180(4):929–37.

    CAS  CrossRef  PubMed  Google Scholar 

  48. US Selected Practice Recommendations for Contraceptive Use. 2013; http://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf. Accessed 14 June 2015.

  49. Folger SG, Jamieson DJ, Godfrey EM, Zapata LB, Curtis KM. Evidence-based guidance on selected practice recommendations for contraceptive use: Identification of research gaps. Contraception. 2013;87(5):517–523.

    Google Scholar 

  50. Mansour D, Mommers E, Teede H, Sollie-Eriksen B, Graesslin O, Ahrendt HJ, Gemzell-Danielsson K. Clinician satisfaction and insertion characteristics of a new applicator to insert radiopaque Implanon: an open-label, noncontrolled, multicenter trial. Contraception. 2010;82(3):243–9.

    CrossRef  PubMed  Google Scholar 

  51. Nelson AL. Neutralizing pH of lidocaine reduces pain during Norplant system insertion procedure. Contraception. 1995;51(5):299–301.

    CAS  CrossRef  PubMed  Google Scholar 

  52. Bensouda-Grimaldi L, Jonville-Bera AP, Beau-Salinas F, Llabres S, Autret-Leca E, Le Reseau Des Centres Regionaux De Pharmacovigilance. Insertion problems, removal problems, and contraception failures with Implanon. Gynecol Obstet Fertil. 2005;33(12):986–90.

    CAS  CrossRef  PubMed  Google Scholar 

  53. Mascarenhas L. Insertion and removal of Implanon: practical considerations. Eur J Contracept Reprod Health Care. 2000;5 Suppl 2:29–34.

    PubMed  Google Scholar 

  54. Ismail H, Mansour D, Singh M. Migration of Implanon. J Fam Plann Reprod Health Care. 2006;32(3):157–9.

    CrossRef  PubMed  Google Scholar 

  55. Wechselberger G, Wolfram D, Pulzl P, Soelder E, Schoeller T. Nerve injury caused by removal of an implantable hormonal contraceptive. Am J Obstet Gynecol. 2006;195(1):323–6.

    CrossRef  PubMed  Google Scholar 

  56. Brown M, Britton J. Neuropathy associated with etonogestrel implant insertion. Contraception. 2012;86(5):591–593.

    Google Scholar 

  57. Mommers E, Blum GF, Gent TG, Peters KP, Sordal TS, Marintcheva-Petrova M. Nexplanon, a radiopaque etonogestrel implant in combination with a next-generation applicator: 3-year results of a noncomparative multicenter trial. Am J Obstet Gynecol. 2012;207(5):388.e1–e6.

    CAS  CrossRef  Google Scholar 

  58. Darney P. (2015) Etonogestrel contraceptive implant. In: Eckler, K (Ed), UpToDate. Waltham, MA. (Accessed 16 June 2015).

    Google Scholar 

  59. Singh M, Mansour D, Richardson D. Location and removal of non-palpable Implanon implants with the aid of ultrasound guidance. J Fam Plann Reprod Health Care. 2006;32(3):153–6.

    CrossRef  PubMed  Google Scholar 

  60. James P, Trenery J. Ultrasound localisation and removal of non-palpable Implanon implants. Aust N Z J Obstet Gynaecol. 2006;46(3):225–8.

    CrossRef  PubMed  Google Scholar 

  61. Shulman LP, Gabriel H. Management and localization strategies for the nonpalpable Implanon rod. Contraception. 2006;73(4):325–30.

    CrossRef  PubMed  Google Scholar 

  62. Nouri K, Pinker-Domenig K, Ott J, Fraser I, Egarter C. Removal of non-palpable Implanon (R) with the aid of a hook-wire marker. Contraception. 2013;88(4):577–80.

    CrossRef  PubMed  Google Scholar 

  63. Sivin I, Lahteenmaki P, Ranta S, Darney P, Klaisle C, Wan L, Mishell Jr DR, Lacarra M, Viegas OA, Bilhareus P, Koetsawang S, Piya-Anant M, Diaz S, Pavez M, Alvarez F, Brache V, Laguardia K, Nash H, Stern J. Levonorgestrel concentrations during use of levonorgestrel rod (LNG ROD) implants. Contraception. 1997;55(2):81–5.

    CAS  CrossRef  PubMed  Google Scholar 

  64. Sivin I, Alvarez F, Mishell Jr DR, Darney P, Wan L, Brache V, Lacarra M, Klaisle C, Stern J. Contraception with two levonorgestrel rod implants. A 5-year study in the United States and Dominican Republic. Contraception. 1998;58(5):275–82.

    CAS  CrossRef  PubMed  Google Scholar 

  65. Wan LS, Stiber A, Lam LY. The levonorgestrel two-rod implant for long-acting contraception: 10 years of clinical experience. Obstet Gynecol. 2003;102(1):24–6.

    CAS  CrossRef  PubMed  Google Scholar 

  66. Speroff L, Darney PD. A clinical guide for contraception. 5th ed. Baltimore, MD: Lippincott, Williams & Wilkins; 2010.

    Google Scholar 

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Correspondence to Valerie A. French MD, MAS .

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French, V.A., Darney, P.D. (2016). Implantable Contraception. In: Shoupe, D., Mishell, Jr., D. (eds) The Handbook of Contraception. Current Clinical Practice. Humana Press, Cham. https://doi.org/10.1007/978-3-319-20185-6_9

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  • DOI: https://doi.org/10.1007/978-3-319-20185-6_9

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-20184-9

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