Patterns of Contraceptive Implant Use in a General Adolescent Medicine Clinic Population

Abstract

Purpose: Multiple national organizations recommend LARC as first-line contraception for adolescents (ACOG, CDC, SAHM). Despite this, adolescent use remains low. The CDC recently documented adolescent contraceptive implant use (Nexplanon) at 4.3% among Title IX Family Planning Clinics (1). Studies looking at LARC in adolescents have documented increased continuance rates versus patch/pill/ring/injection and uptake/continuance rates similar to adult women (2). When choosing among LARC methods, adolescents more often opt for a contraceptive implant versus an IUD, compared to adults (3). However, irregular vaginal bleeding is a common cause of discontinuation among all implant users. To date, published studies have primarily been done on adolescents in STD and Family Planning Clinics with a focus on uptake and continuance rates. This study will examine patterns of implant use in a general academic adolescent medicine clinic, particularly focused on side effects and reasons for discontinuation. Methods: Retrospective chart review of 184 adolescents who chose Nexplanon insertion in an adolescent medicine clinic in Nashville, TN. SPSS software was used to calculate continuance rates over a 12month period. Patient identified reasons for removal were documented. Additional factors analyzed included sexual history, previous contraceptive use, and post-insertion bleeding. Results: Average at age insertion was 16.9 years. More than 20% of users (n1⁄438) were not sexually active at the time of insertion, but more than 50% of those intended to use Nexplanon for pregnancy prevention. Almost 30% were naive to hormonal contraception prior to Nexplanon insertion. 50% of prior contraceptive users had tried pills and 28.8% Depo-Provera. Six users were repeaters and had Nexplanon removal and reinsertion on the same day, after three continuous years of use. 16.8% (n1⁄431) discontinued Nexplanon during the study period, with an average duration of use of 238 days. Of those who used Nexplanon for more than 12 months (n1⁄496), the continuation rate was 74%. Problematic bleeding was reported by 33% (n1⁄462), but only half required medical intervention. Post-insertion bleeding was treated with estrace in 44% of cases, NSAIDs in 25%, oral contraceptive pills in 22%, and 9% required more than one method. Seven users opted for removal prior to any medical intervention. Bleeding was the most common reason for removal (50%) but additional complaints included headache, weight gain, anxiety, and pain. Conclusions: Adolescents are good candidates for LARC, particularly Nexplanon. Users have good continuation rates, side effects are minimal, and may even choose the method despite being sexually abstinent. Sources of Support: None