Experience with the use of implanon within a community
contraceptive service clinic
V. McNamara and E.J. Oloto
Contraceptive Services,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Introduction Implanon, along with other methods of long-acting reversible
contraception (LARC), was recommended by NICE (National Institute for Health and
Clinical Excellence) as a more cost-effective choice than oral contraception and
barrier methods in preventing the currently high rates of unplanned pregnancy in
the Country. Uptake of LARC in the Country however remains low in comparison
with oral and barrier methods of contraception.
Aim To evaluate the demographic
characteristics of Implanon users, the continuation rates and reasons for
discontinuation since its introduction at a Community Contraceptive Service
Clinic.
Method Retrospective review of all case records of patients that had
Implanon fitting and removal between 1.1.01 and 31.10.05.
Results A total of
410 insertions and 178 removals were carried out during the study period. The
mean age of the users was 26 (range 14 – 46); and the mean parity was 1.04
(range 0 – 8). Only 0.6% of young women (14-24 years) attending our service
chose Implanon compared with 14% that chose COC as their contraceptive methods.
However, there was an increasing trend in the number choosing the method during
the study period. The reasons most commonly quoted for choosing Implanon were
convenience and preference for a long term method while the three most common
reasons for discontinuation were irregular PV bleeding (42%), planning pregnancy
(25%) and mood swings (10%). Two pregnancies were recorded during the period,
which appeared to be undiagnosed at the time of fitting rather than
contraceptive failure. The continuation rates were 83% at 6 months, 62% at 1
year, 36% at 2 years and 16% at 3 years. Seventy-three (73%) of women who
completed 3 years chose to have a re-fit. There was no statistically significant
difference in the continuation rate at three years between the under 25 and the
25 and over age groups (p = 0.276). Of the 84 women presenting with PV bleeding
problems, 13% accepted oral treatment in the form of COC of which 67% continued
with the method.
Discussion Although 50% of our Implanon insertions were for
under 25 year age group, the method is still grossly underused by this group
compared with oral contraception and condoms which have a higher user failure
rate. The side effect profile and continuation rates for our patients were
comparable with previous studies in the developed Countries.
Conclusion Despite
the high acceptability of Implanon in initial studies subsequent assessments of
Implanon use in clinic settings, including ours, show higher discontinuation
rates despite well documented pre-insertion counselling. Although only a
minority of women opted for a trial of oral therapy to control PV bleeding prior
to removal, the symptoms settled in the majority (67%) of those that did This
highlights the need for a more proactive approach to the control of bleeding
problems if the benefit of this otherwise useful LARC is to be maximised.
Nevertheless, greater understanding of the mechanism for the vaginal bleeding
associated with progestogen methods is needed.