Three-year observational study of immediate post-abortion insertion versus menstrual insertion of etonogestrel contraceptive implant

Objective This study aimed to estimate the difference in vaginal bleeding pattern, discontinuation rate, and satisfaction between immediate after abortion and menstrual insertions of etonogestrel contraceptive implants. Study design Between May 2013 and November 2015, 66 women were recruited in the abortion group who selected etonogestrel implants as their contraceptive immediately after induced abortion. 84 women who underwent the placement of the etonogestrel implant during their menstrual period were enrolled as the menstrual group. The two groups participated in 3-year follow-up outpatient visits at 1, 6, 12, 24, and 36 months after implantation. The vaginal bleeding pattern, discontinuation rate, satisfaction rate were recorded and compared. Results No woman had pregnancy over the study period of 3 years. The incidence of amenorrhea/infrequent bleeding did not differ between the two groups after 12, 24, and 36 months of implantation (53.0% vs. 58.4%, 47.8% vs. 51.6%, and 48.6% vs. 55.6%, respectively). In the abortion group, the incidences of frequent/prolonged bleeding were 15.1%, 32.6%, and 27.0% after 12, 24, and 36 months of implantation, respectively, while the other group showed 27.3%, 25.8%, and 20.4%, respectively. After 12 and 24 months, the continuation use rates were 69.7% and 56.1% in the abortion group and 73.8% and 64.2% in the menstrual group. The 12-month satisfaction rate between abortion group and menstrual group was 69.6% versus 72.6%. Statistical analyses show that there was no difference in vaginal bleeding pattern, discontinuation rate or satisfaction between the two groups. Conclusions Immediately post-abortion may be also a favorable time to undergo etonogestrel implantation.

Ectopic pregnancy with etonogestrel implant

The etonogestrel implant is the most effective contraceptive available. We report a case of ectopic pregnancy in a woman who had an etonogestrel implant inserted 15 months ago and the effective concentration of the implant was within normal limits.

Early Removal of the Etonogestrel Contraceptive Implant and Associated Factors Among Users at the Urban Family Planning Clinic in Siriraj Hospital, Bangkok, Thailand

Objective: To study the rate and reasons for the early removal of etonogestrel contraceptive implants and associated factors at the family planning clinic in Siriraj Hospital. Materials and Methods: This retrospective cohort study was conducted between May 2015 and December 2019 and contained 1,030 women who received the etonogestrel contraceptive implant. The medical records of demographic characteristics and clinical factors i.e., implant insertion date, implant removal date, reason for implant removal, contraceptive use before implant insertion and after implant removal, documented bleeding pattern and acceptability, were identified. Results: The mean age of participants was 28.6 ± 6.9 years. About 21% of women (218/1030) prematurely discontinued their etonogestrel implant. A desire to become pregnant was the most common reason for early removal of the etonogestrel implant (32%). Meanwhile, the most common side-effect contributing to early removal was unscheduled bleeding. The associated variables of early etonogestrel implant removal were low BMI (p-value = 0.021) and unacceptability of bleeding pattern at one year (p-value < 0.001) and two years (p-value < 0.001) after insertion. Conclusion: Early etonogestrel implant discontinuation rate was remarkable and the main reasons for it include a desire to become pregnant and bleeding side effects. Moreover, a lower BMI and unacceptability of bleeding problems also increased the likelihood of early removal of this contraceptive method.