Implanon Insertion Research Articles

The role of onsite Implanon insertion training for HEWs for sustainable FP programs in Ethiopia: a mixed-method study

BackgroundTraining health extension workers on Implanon insertion offsite, or away from the workplace, can be cost-intensive, can depend on the human and financial resources of partners, and can compromise routine health services by taking health workers off the job. To address these limitations, the USAID Transform Primary Health Care Activity in Ethiopia designed an onsite Implanon insertion training at the primary health care level. This study compared and documented the implementation experience of onsite vs offsite Implanon insertion training for health extension workers.MethodsIn a mixed-method study conducted in March 2020, the team collected training data from 468 participants—half trained onsite and half offsite—and conducted key informant interviews with 20 purposively sampled individuals. The team analyzed this data, summarizing the data in tables and figures and performing a t test with p value < 0.05 using SPSS v.20. Qualitative data were analyzed manually in Excel and summarized in Word based on emerging themes.ResultsHealth extension workers trained onsite were away from routine work an average of 3 days compared to 8 days for those trained offsite (P < 0.001). The difference in average per-trainee cost of onsite (2707 Birr = 87.3 USD) and offsite (6006 Birr = 193.7USD) training was significant (P < 0.001). There was no significant difference in mean scores of onsite and offsite trainees on the knowledge pre-test (P < 0.947) and post-test (P < 0.220) or in simulated practice on an arm model (p < 0.202). Onsite trainees, assigned to their own health post for clinical practice, performed Implanon insertions on an average of 10 clients: offsite trainees on an average of 5 clients. Most interview participants reported that the onsite Implanon training was better organized, conducted, followed up, and monitored by health centers to ensure community-level access to Implanon services, with quality and continuity.ConclusionsOnsite training is a promising approach and minimizes service interruption. It is a likely strategy for on-demand training of health extension workers and immediate assignment of skilled providers to ensure access to and continuity of quality community-level Implanon care.Trial registration N/A.

Knowledge, beliefs and practices of nurses with long-acting reversible contraception, Cape Town.

Implanon and copper intrauterine contraceptive device (IUCD) are long-acting reversible contraceptives (LARC) available in public primary health care (PHC) South Africa. These methods are the most effective forms of contraception. To evaluate the knowledge, beliefs and practices on provision of LARC. Primary health care facilities within the Khayelitsha Eastern Substructure, Cape Town. A descriptive survey of all permanent nurses who provided contraception. Data were collected from 72/90 (80% response rate) via a validated questionnaire and evaluated using Statistical Package for Social Sciences (SPSS). Knowledge of eligibility for LARC was tested. The mean knowledge scores for Implanon were 8.56/11 (s.d. 1.42) for the trained and 7.16/11 (s.d. 2.83) for the untrained (p = 0.007). The mean knowledge scores for IUCD were 10.42/12 (s.d. 1.80) for the trained and 8.03/12 (s.d. 3.70) for the untrained (p = 0.019). Participants believed that inaccessibility to training courses (29%), no skilled person available (24%) and staff shortages (35%) were barriers. Less than 50% of women were routinely counselled for LARC. Forty-one percent of nurses were trained and performed IUCD insertion, and 64% were trained and performed Implanon insertion, while 61% and 45% required further training. Confidence was low, with 32% trained and confident in IUCD and 56% trained and confident in Implanon insertion. Lack of training, poor confidence and deficient counselling skills were barriers to effective LARC provision. The identified system-specific barriers must be addressed to improve uptake.Contribution: The first study to evaluate knowledge, beliefs and practices on LARC in providers in the Western Cape.

Satisfaction With the Use of Subdermal Contraceptive Implant in Women Attending the Specialized Polyclinic Primary Health Care Center in Jeddah City: A Cross-Sectional Study.

Background Subdermal contraceptive implants are a convenient method of contraception for many women due to the ease of insertion and removal and because they require less follow-up with their health facility. In addition to the contraceptive benefits, women's satisfaction with such devices is essential, as this can affect their quality of life. This study aims to measure women's satisfaction with the subdermal contraceptive implant, Implanon® (Organon & Co., Jersey City, New Jersey, United States), its main side effects, and reasons for removal. Methods A cross-sectional study was conducted on women between the ages of 19 and 65 years who visited the Family Planning Clinic at the Specialized Polyclinic Primary Health Care Center in Jeddah, Saudi Arabia, between January 2018 and December 2021. An online questionnaire was distributed to the women who had Implanon inserted and 84 responded. Demographic and contraceptive data were collected, including the dates of insertion and removal of Implanon and side effects experienced while on Implanon. Results Of the 84 women, 65.84% were satisfied with Implanon, while only 19.04% were unsatisfied with the implant. The most common side effect reported was weight gain (54.76%), followed by menstrual Irregularity. (39.29%). The most common reason for removal was the end of the implant's contraceptive duration (42.86%). Conclusion Most of the women treated at this primary healthcare clinic were satisfied with Implanon. In addition, most of the women removed the implant only due to its reaching the end of its contraceptive duration despite experiencing side effects, and most women said that they would recommend it to their family and friends.

Determinants of Implanon discontinuation among women who use Implanon at Debre Berhan town public health institutions in Northeast Ethiopia: a case-control study.

Discontinuation of the most effective methods of contraception such as Implanon has now become a worldwide problem, which is significantly associated with mistimed and unwanted pregnancies and unsafe abortion, leading to an increased risk of maternal and child mortality and morbidity. However, studies on factors associated with Implanon discontinuation in Ethiopia, particularly in the area under this study, are limited. Therefore, this study aims to identify the determinants of Implanon discontinuation among women who used Implanon at Debre Berhan town public health institutions. A facility-based unmatched case-control study was conducted among 312 study participants (78 cases and 234 controls) from February 1, 2021, to April 30, 2021. The study participants were selected by using a systematic random sampling method for controls, and cases were selected consecutively until the required sample size was reached, during the data collection period. The data were collected by using a structured face-to-face interviewer-administered questionnaire and entered into Epidata version 4.6 and transferred to SPSS version 25 for analysis. Variables with a p-value of <0.25 in the bivariable analysis were entered into the multivariable logistic regression model. In the final model variables, a p-value of <0.05 was considered statistically significant at a 95% confidence interval (CI) and the strength of association was measured using an adjusted odds ratio (AOR). In this study, the determinants of Implanon discontinuation were the following: women who had no formal education (AOR: 3.57; 95% CI, 1.62-7.87), who had no children (AOR: 2.8; 95% CI, 1.50-5.17), who had no counseling about side effects (AOR: 2.43;95% CI, 1.30-4.55), who had no discussion with their partner (AOR: 2.7; 95% CI, 1.34-5.46), who had no follow-up appointment (AOR:2.81; 95% CI, 1.54-5.12), and who had side effects (AOR:1.91; 95% CI, 1.13-3.53). Women's educational status, having no children during the insertion of Implanon, received no counseling about the side effects of insertion, no follow-up appointment, experiencing side effects, and no discussion with a partner were determinants of Implanon discontinuation. Hence, healthcare providers and other health sector stakeholders should provide and strengthen pre-insertion counseling, and follow-up appointments to increase the retention rates of Implanon.

Reasons and Associated Factors of Early Discontinuation of Implanon: A Follow-up Study from Lahore, Pakistan

Background: Family planning is needed at this time when the world population is rapidly increasing. Etonogestrel sub-dermal implant is a highly effective long-acting and reversible sub-dermal contraceptive implant. Despite its success and enhancement in usage, it is stopped by a proportion of users prior to its expiration date. Objective: To ascertain the frequency of discontinuation of Implanon during one year period and uncover its reasons and associated factors among women consulting obstetrics and gynecological clinics for contraception methods and opting for Implanon among the available options. Methodology: This prospective observational study was conducted in Services Hospital, Lahore. All of the women who underwent Implanon insertion from July to December 2020 were enrolled in the study. The outcome variable is early discontinuation of the inserted implant within one year of its insertion. Results: 350 women receiving sub-dermal Implanon for contraception purposes were included in this study. Their median age and BMI were 28(IQR= 25.8-31) years and 24.3 (IQR=23.6-25) Kg/m2 respectively. The early discontinuation rate was 49.1%. Reasons for removal were menstrual problems (100%), headache (19%), weight gain (12%), pain in the arm (5%), desire to conceive (1.7%) and spouse death (0.3%). Younger age, increasing body mass index, rural residence and shorter marriage duration were found to be significantly associated with early removal. Conclusion: This study found a high early discontinuation rate. Premature removal was most commonly caused by menstrual issues. Early removal was independently predicted by an early age, length of the marriage, rising BMI, and residence in a rural location. An awareness campaign should be created specifically for rural areas to address their concerns and reduce the early discontinuation rate. Further research should be conducted to understand the menstrual problems in women undergoing implanon insertion.

Early implanon discontinuation and associated factors among women ever used implanon in Mettu district, Oromia regional state, southwest Ethiopia, 2021

BackgroundImplanon is an effective form of long-acting reversible contraceptive used to prevent conception with a clinical failure rate of less than one per 100 users. However, in sub-Saharan countries the utilization of implanon was very low. Regardless of low utilization; its early discontinuation is very common in most developing countries including Ethiopia.ObjectivesTo assess the prevalence of early implanon discontinuation and associated factors among women ever used implanon in Mettu district.MethodsA community based cross-sectional study design was conducted from October 11 to December 4, 2020 G C. A total of 430 women were included in the study by systematic random sampling technique. Data were entered into epi data version 3.1 and analyzed by SPSS version 25.0. Descriptive analysis was computed to describe descriptive results. Logistics regression was computed to see the relative effect of factors on the outcome variable. Adjusted odds ratio was calculated with 95% confidence intervals to show strength of association and p-value < 0.05 was used to declare statistical significance. The finding of the study was presented using narrations, tables and chart.ResultThe total proportion of early implanon discontinuation among 430 mothers was 19.3%. Women who did not counseled about the presence of alternatives methods [AOR = 2.28: 95% CI (1.22–4.26)], women who experienced dizziness after insertion of implanon [AOR = 1.90: 95% CI (1.06–3.43)] and being having menstrual disturbance after insertion of implanon [AOR = 2.17: 95% CI (1.16–4.08)] were significantly associated with early implanon discontinuation. Women who were counseled about the advantage of implanon [AOR: 0.49: 95% CI (0.28–0.87)] were protective from early implanon discontinuation.Conclusion and recommendationEarly implanon discontinuation among mothers was found to be high. Hence, effective counseling on advantages and side effects of implanon and proper management of the side effects should be made to increase implanon retention.

Views of Adolescent Girls on the Use of Implanon in a Public Primary Health Care Clinic in Limpopo Province, South Africa.

Background: Implanon is one of the contraceptives that protects women from falling pregnant for a period of 3 years. Levonorgestrel implants are perfect for adolescents who wish to have lengthy protection against pregnancy and for those who are not consistent in taking Oral Contraceptive Pills (OCP). Objective: The objective of the study is to investigate the views of adolescent girls on the use of Implanon as a birth control method. Methods: A qualitative explorative and descriptive study was conducted to explore and describe the views of adolescent girls regarding the use of Implanon as a birth control method at a primary health clinic in Limpopo Province. In-depth interviews were conducted with 15 adolescent girls who had previously used the Implanon and voluntarily agreed to participate in the study. Data were analyzed using the Tesch’s open coding analysis and the following themes emerged: views of adolescent’s girls on the use of Implanon, experiences of adolescent girls while using Implanon, health professionals and the insertion of Implanon and other chronic treatments. Results: The study reveals that the lack of trained health professionals, competency in performing Implanon insertion and poor counseling skills by health professionals prompted fear amongst the adolescent girls, which contributed to the low uptake of adolescent girls of the Implanon contraceptive. Conclusion: There is a need for more training of health professionals on counseling skills, insertion, and removal of Implanon. Furthermore, awareness campaigns or dialogues must be hosted annually to engage the public to talk about Implanon.

Implanon Discontinuation Rate and It&amp;apos;s Associated Factors in Debre Tabor Town, North Central Ethiopia

Family planning could avert a significant number of maternal mortality and contributes to child survival with its focus on women's rights. Generally, a long-acting reversible contraceptive is more effective and cover all the advantage and eliminates the disadvantages of other types of contraceptives. The acceptance and utilization of long-acting reversible contraceptive including implanon were very low in many developing countries including Ethiopia. The purpose of this study was to assess the level of discontinuation and to identify variables influencing Implanon utilization. A cross-sectional design was conducted between January to December 2018 in Debre Tabor town. In the community, a total of 132 women who have been using or discontinuing Implanon during the study period were selected. Face-to-face interviews using a structured questionnaire were conducted for data collection. The data were entered, cleaned and analyzed by a statistical package for social sciences version 20. The data were processed and analyzed by a statistical package for social sciences version 20 using descriptive and analytical statistics including chi-square test that identified the association between some selected independent variables and implanon discontinuation. The overall implanon discontinuation in the year 2018 was 16.7% in Debre Tabor town. The most frequently mentioned reason for implanon discontinuation was health-related issues (31.8%), side effects (27.3%), desire to have more children (22.7%) and method shift (18.2%). Factors associated with Implanon discontinuation were developing side effects, women who have living children and not providing counseling service. Implanon discontinuation among Implanon users in Debre Tabor town during the year 2018 was found to be high and the most frequently mentioned rationale was health-related issues. Health care providers should provide counseling before Implanon insertion.

Efficacy and Safety of a Single Rod – Contraceptive Implant (Implanon)

Background : Implanon is a subdermal contraceptive implant involves the delivery of a steroid progestin(68 mg of etonogesterel) from a single rod placed under the skin at the inner side of the non-dominant upper arm and the hormone diffuses out slowly at a stable rate providing contraceptive effectiveness for 3 years. Advantages of Implanon includes long term contraceptive action without requiring the user's or provider's attention , low dose of highly effective contraception without use of estrogen and fertility is readily reversible after the removal of implant.Objectives: to assess contraceptive efficacy , safety and acceptability of Implanon .Materials and methods: the study was conducted in Iraq- Al-Samawa and Al-Diwaniya maternity and pediatrics teaching hospital, family planning clinics and privet clinics from the period of October 2012 – October 2014 that includes 41 sexually active women 18-45 years seeking for contraception with normal menstrual cycles , no history of ischemic heart disease or stroke and no history of breast or genital tract malignancy.Results: contraceptive efficacy of Implanon was 98% over 2 years follow up and the most common adverse experience was abnormal bleeding pattern in 100% of women ,as amenorrhea affects 51.22% , infrequent bleeding 26.82% ,prolonged bleeding 12.20% and metromenorhagia 9.76%.. Discontinuation rate was 2.44% because of menstrual bleeding abnormality. Other adverse experiences after Implanon insertion were weight gain of ? 5kg in7.32% after 2 years follow up , acne in 31.71% , mood changes in 21.95% and headache in 12.20%.Conclusions: Implanon is a safe , highly effective and rapidly reversible new method of contraception and the safety profile is acceptable and not essentially different from progestogens in general.

Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia.

In 2009, the Ethiopian Federal Ministry of Health launched an Implanon scale-up program with the goal of improving the availability of long-acting reversible contraceptive (LARC) methods at the community level. The Integrated Family Health Program (IFHP) supported the ministry to train Health Extension Workers (HEWs), a cadre of frontline health workers, on Implanon insertion. Prior to this task-sharing initiative, HEWs were only permitted to provide short-acting contraceptive methods; Implanon insertion services were only available at higher-level health facilities, such as health centers and above. To train HEWs on Implanon insertion, IFHP followed a phase-based approach, which consisted of a learning phase (July to September 2009) that transitioned into a scale-up phase (December 2009 to December 2015). Training began with a series of service delivery-based training of trainers (TOT) sessions for clinical care providers selected from health centers followed by rollout trainings on Implanon insertion for HEWs selected from health posts. Immediately after the Implanon rollout trainings, each trained HEW was provided with consumables and Implanon implants to enable them to initiate the Implanon services at their respective health post. To reinforce knowledge and skills, we conducted mentoring visits and performance review meetings. From July 2009 to September 2015, 98 TOT sessions trained 2,328 clinicians and 320 rollout trainings reached 8,436 HEWs. A total of 1,382,318 women received contraceptive services through any IFHP-supported service delivery point, 1,273,990 of whom received an Implanon implant. The IFHP approach proved to be a successful model for increasing access to contraceptive methods in the community, and the program supported the integration of Implanon services into the existing public health service delivery system.

Determinant of Implanon Discontinuation among Women Who Ever Used Implanon in Diguna Fango District, Wolayita Zone, Southern Ethiopia: A Community Based Case Control Study.

Background A significant number of women make Implanon their first choice of contraception. However, they discontinue their Implanon before its expiry date was high, but factors that contribute to discontinuing their Implanon were poorly described in Ethiopia. Methods A community based unmatched case control study was conducted. Then simple random sampling technique was used to select 340 women. Data was collected by nurses using face to face interview. Epi-Info version 7 and SPSS 20 software were used. Bivariate and multiple logistic regressions were performed with COR and AOR with 95% CI. Findings Having preinsertion counseling (AOR: 0.36, 95% CI: 0.20–0.64), having follow-up appointment (AOR: 0.35, 95% CI: 0.2–0.62), age at insertion <20 years (AOR: 3, 95% CI: 1.16–7.8), women who had no formal education (AOR: 2.8, 95% CI: 1.31–6.11), women who had ≤4 children (AOR: 1.8, 95% CI: 1.01–3.21), and women who had previous abortion history (AOR: 2.3, 95% CI: 1.10–4.63) were determinants of Implanon discontinuation. Conclusions Policy makers and concerned bodies should take into account future intervention and also great emphasis should be given to follow-up appointment and counseling services, especially counseling on side effects, and informed choice for clients after Implanon insertion.

A clinical evaluation of bleeding patterns, adverse effects, and satisfaction with the subdermal etonogestrel implant among postpartum and non-postpartum users.

The etonogestrel implant (Implanon; Merck Sharp and Dohme, Kenilworth, NJ, USA) is an effective contraceptive with a good safety profile for up to 3 years [1]. However, its adverse effects include irregular vaginal bleeding (affecting 68.0% of users), weight gain (20.7%), acne (15.3%), breast pain (9.1%), and headache (8.5%) [2]. To provide further information about contraception options for women in the postpartum period, the aim of the present study was to investigate the bleeding patterns and adverse effects reported by women who underwent Implanon insertion within 8 weeks of delivery and compare them with those experienced by non-postpartum women. A prospective study was undertaken at Hospital Tengku Ampuan Afzan, Pahang, Malaysia, between July 1, 2010, and June 30, 2012. Women attending the postnatal clinic or family planning/gynecology clinic who met WHO medical eligibility criteria 1 and 2 (no medical restriction for use of contraception or advantages of using contraception outweigh the risks) [3] were enrolled. Nulliparous women and women who had last delivered 8 weeks to 6 months previously were excluded. The institutional ethical committee approved the study and informed consent was obtained from participants. Participants were divided into two groups. Women in the postpartum group had delivered up to 8 weeks previously and underwent Implanon insertion 4–8 weeks after delivery. Women in the non-postpartum group had last delivered at least 6 months previously and underwent Implanon insertion between day 1 and day 5 of menses. Baseline body weight was recorded for each participant. Follow-up visits were scheduled at 3 and 6 months. Bleeding patterns were categorized using the WHO 90-day reference period [4]. Non-menstrual adverse effects and satisfaction were recorded at 6 months. Data were analyzed using SPSS version 20.0 (IBM, Armonk, NY, USA). The Student t test and Fisher exact test were used to compare variables. P < 0.05 was considered statistically significant. A total of 110 women were included in the study, 60 in the postpartum group and 50 in the non-postpartum group. There were no differences in bleeding patterns between the groups at 3 months (Table 1). However, at 6 months, amenorrhea was significantly more common in the postpartum group than in the non-postpartum group (P = 0.005), and infrequent bleeding was more common in the non-postpartum group (P = 0.024) (Table 1). With regard to non-menstrual adverse effects, headache and acne were significantly more common in the non-postpartum group than in the postpartum group (P = 0.001 and P = 0.040, respectively) (Table 1). There were no significant differences for other adverse effects. Weight gain was the most frequent adverse effect, but there was no significant difference between groups (Table 1). Most users from both groups were satisfied with Implanon, with no difference in terms of satisfaction between groups ( Table 1). This finding implies that most women who experienced adverse effects were able to tolerate them. In conclusion, the present study has shown that bleeding patterns and non-menstrual adverse effects can differ according to timing of Implanon insertion after delivery. However, despite menstrual irregularities and other adverse effects, Implanon was well accepted in both groups.

A prospective cohort study of early postpartum etonogestrel implant (Implanon®) use and its effect on duration of lochia

BackgroundEtonogestrel (ENG) implants (Implanon®/Nexplanon®/Implanon NXT®) are employed as contraception in early postpartum patients. Follow-up is often not conducted by the hospital prescriber. Little is known about duration of lochia, in...

Reasons for Premature Removal of Implanon among Users in Arsi Zone, Oromia Region, Ethiopia, 2013

Abstract Background: Ethiopian government is dedicated to expansion of implanon insertion service to meet the huge unmet need in family planning since the beginning of 2010. Nevertheless, opting for premature removal of implanon by the users is very rampant at this early stage of the initiative. Objective: To identify reasons for premature removal of implanon among users Method: Descriptive cross-sectional study was conducted from February 2012 to June 30, 2013 in Arsi Zone, Southeast Ethiopia. A total sample size of 103 was decided for data collection. Data were entered through Epi info version 3.5.3 and imported to SPSS version 16 software for cleaning and analysis. Numerical summary measures and probabilities were computed as found important. Kaplan Meier survival analysis and error bar were also employed for comparison of reasons for premature removal. Result: With 97% response rate, the main reasons for premature removal of implanon among users were heavy/ prolonged menstrual bleeding, plan to conceive in the near future, about to leave for abroad and pain on insertion arm representing 36%, 24%, 15% and 13% of the reasons, respectively. The median duration the study subjects used implanon was 19.5 months. Median duration of premature removal was significantly earlier in those who reasoned heavy/prolonged menstrual bleeding compared with those presented with plan to conceive in the near future as their reason for premature removal. Conclusion and recommendation: Heavy/prolonged menstrual bleeding, plan to conceive in the near future, about to leave for abroad and pain on insertion arm were the main reasons for premature removal of implanon and the duration of implanon use was not long enough to be cost effective. Hence, thorough pre-insertion counseling on implanon side effects and discussing future fertility desire and revising effective management of side effects are indispensible to increase the duration implanon is being used.

Office device to aid in Implanon insertion

Implanon remains as an important component of the available means of hormonal contraception. This rod, implanted subdermally, has the highest rate of effectiveness of available contraceptive methods. It is recommended that the Implanon be placed in the nondominant arm, approximately 6 cm from the inner condyle of the humerus and in between the biceps and triceps muscles. These are the only specific directions for locating the insertion of the implant [ [1] Implanon package insert ��� Organon. Google Scholar ].

No effect of Implanon® on inflammatory cardiovascular parameters

Objective. Recently, we found decreased levels of C-reactive protein (CRP) during use of the low-dosed contraceptive implant Implanon®. To further elucidate, whether this finding might be a sign for a lower inflammatory reaction and is associated with changes in levels of other cytokines, we investigated the effect of this implant on interleukin-6 (IL-6) and adiponectin. Plasma lipids and sex hormone levels have been shown to interact with the investigated parameters in vivo and in vitro. Therefore these parameters were measured as well.Design. Prospective case–control study.Setting. Family-planning centre, University hospital.Subjects. Thirty-six non-smoking women with regular cycles.Interventions. Blood samples for the measurements were taken in the early follicular phase of the cycle in both groups. A second sample was taken 12 weeks after Implanon insertion or in the controls during the early follicular phase of cycle 4.Results. Implanon did not cause significant changes in IL-6, adiponectin or lipoprotein (Lp)(a). At baseline, there was a significant positive correlation between IL-6 and CRP and a negative correlation between adiponectin and CRP.Conclusion. We did not observe a negative impact of Implanon on risk markers for atherosclerotic disease such as IL-6, adiponectin, and Lp(a). These data are reassuring for clinicians who prescribe progestagen-only preparations as first choice contraceptives in females with cardiovascular risk factors.

Users&amp;rsquo; perspectives on Implanon in Malaysia, a multicultural Asian country

Background: The primary objective of this study was to evaluate Malaysian women’s perception acceptance and views on Implanon® as a contraceptive method. We also aimed to identify women who favor Implanon their vaginal bleeding patterns nonmenstrual adverse events reasons for discontinuation and effect of Implanon on breastfeeding. Study design: This study followed up 140 women after insertion of Implanon at the University of Malaya Medical Centre by examination of their medical records and telephone interviews. User profile discontinuation rate reasons for choice of Implanon discontinuation menstrual and nonmenstrual side effects and satisfaction rate were assessed. Results: The average age of users was 34.7 years and 94.2% were para 2 and above. The ethnic distribution of the women reflected that of the general Malaysian population. The majority had at least secondary education (94.2%) with 41.2% having a higher degree. All of the users reported that they chose Implanon because it does not need compliance and 72.1% felt that Implanon was cost-effective in the long term. Most users (70%) reported irregular menses and this was the main reason given for discontinuation. The vast majority reported an overall decrease in menstrual blood loss. Almost half (46%) suffered prolonged bleeding/spotting and infrequent bleeding was experienced by 71 users (50.7%). Half of the women did not experience any nonmenstrual adverse events. The commonest complaint was weight gain with the next most common complaints being hair loss acne headache nausea mood swings and reduced libido. Most of the nursing mothers denied a reduction in breast milk. There was a high mean satisfaction score with Implanon. Conclusion: Implanon is well accepted by Malaysian women despite a high incidence of irregular bleeding which was found to be a major concern among women who discontinued the implant.

Implanon use lowers plasma concentrations of high-molecular-weight adiponectin

To investigate the effect of the low-dosed etonogestrel-releasing contraceptive implant Implanon on new cardiovascular risk markers, we studied the effect of this implant on adiponectin and its metabolically important isomer high-molecular-weight adiponectin (HMW). Low-dosed progestagen-only contraception is preferentially prescribed to females with increased cardiovascular risks. Longitudinal study. Family-planning center of a university hospital. Forty healthy nonsmoking women with regular cycles (n=20 controls without hormonal contraception; n=20 cases wishing the insertion of Implanon). Blood samples for the measurements of adiponectin, HMW, C-reactive protein (CRP), sex hormone binding globulin, sexual hormones, and plasma lipids were taken in the early follicular phase of the cycle in both groups. A second sample was taken 12 weeks after Implanon insertion or in the controls during the early follicular phase of cycle four. At baseline there was a significant correlation between adiponectin and the parameters hsCRP and high-density lipoprotein. Implanon treatment caused a significant decrease in HMW and the HMW/adiponectin ratio. Additionally plasma lipids (cholesterol, high-density lipoprotein, low-density lipoprotein), sex hormone binding globulin, and testosterone levels decreased significantly. Adiponectin plasma concentrations were not affected. Short-term Implanon use in healthy premenopausal women was associated with a decrease in the cardioprotective adiponectin isomer HMW. It remains to be investigated if this decrease persists after longer use of the implant.

Clinician satisfaction and insertion characteristics of a new applicator to insert radiopaque Implanon: an open-label, noncontrolled, multicenter trial

Background The etonogestrel (ENG) implant Implanon® is a progestin-only contraceptive that provides effective contraception for up to 3 years. A new radiopaque ENG implant has been developed to extend the diagnostic modalities of Implanon and a next-generation applicator (NGA) was designed to facilitate correct subdermal insertion of Implanon. Study Design In this open-label study, 23 investigators, experienced and inexperienced with Implanon, performed 301 insertions of the new radiopaque implant using the NGA. Primary outcome measurements were obtained from clinician satisfaction questionnaires completed after the 4th, 8th and 12th insertions. Additionally, insertion characteristics and X-ray visibility were assessed. Results Almost all investigators were satisfied with the NGA from the first insertion onward, and all were satisfied or very satisfied after 12 insertions. The most frequently reported advantages included ease of use, one-handed action and fast insertion time; 2% of insertions were considered difficult in skin puncturing and/or sliding the needle subdermally. Three incorrect insertions occurred due to noncompliance with instructions. All assessed implants were visible on plain X-ray imaging. Conclusions The NGA was well accepted by investigators with or without prior experience with Implanon. The results stressed the importance of correctly following implant insertion instructions.

WITHDRAWN: Comparison of local signs and symptoms at the site of insertion of Implanon® and Jadelle® contraceptive implants in two countries

WITHDRAWN: Comparison of local signs and symptoms at the site of insertion of Implanon® and Jadelle® contraceptive implants in two countries