Experience with the use of implanon within a community contraceptive service clinic 

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


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.

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