etonogestrel implant

Question 1

what is the etonogestrel implant

Answer 1

small subdermal ethylene vinyl acetate rod (eg. implanon NXT)
progestogen only long acting reversible contraceptice

Question 2

how does it work

Answer 2

thickens cervical mucous and suppresses ovulation
can be used as first line option in famales of all ages

Question 3

contraindications of etonogestrel implant

Answer 3

current breast cancer

Question 6

can implanon be used in people with history of VTE

Answer 6

yes - generally safe in people with history of IHD, cerebrovascular disease or VTE

Question 7

use of etonogestrel implant requires judgemeent in those with

Answer 7

unexplained vaginal bleeding before investigation of the cause
past breast cancer
severe cirrhosis
hepatocellularr adenoma or malignant liver tumour
IHD, stroke or TIAs developing during use

Question 8

advantages of implanon

Answer 8

extremely effective 99.95%
minimal user involvement
effective for three years
high continuation rates
cost effective
no adverse effect on bone mineral density, can be used for adolescents and perimenopausal people
suitable for quickstart
useful alternative when oestrogen is contraindicated
induces amenorrhea in 22% of users
may improve dysmenorrhea

Question 9

can implanon be used while breast feeding

Answer 9

safe to use immidiately post partum and during breastfeeding

Question 10

how soon is ovulation restored after removal of implanon

Answer 10

restored within weeks of removal

Question 11

cost of implanon

Answer 11

available on PBS but cost of insertion varies with provider

Question 12

disadvantages of implanon

Answer 12

altered bleeding patterns
requires procedure for insertion
deep insertion can result in implant migration
scarring at implant site
drug interactions
benign ovarian cysts
other adverse effects: headaches, mood changes, weight gain, breast tenderness, loss of libido

Question 13

when can etonogestrel implants be inserted

Answer 13

at any time during the menstrual cycle
suitable for quickstart
if pregnancy cannot be excluded, follow up pregnancy test is advised 4 weeks after insertion, or 3 weeks if no further episodes of unprotected sex occured in the first week of use

Question 14

implanon is immediately effective if

Answer 14

inserted day 1-5 of a regular cycle
inserted less than 21 days post-partum
inserted within 5 days of an abortion
replacing an etonogestrel implant
switching from depot injections
switching from copper IUD during days 1-5 of regular menstrual cycle

takes 7 days to become effective at all other times

Question 15

recommended site of insertion

Answer 15

over the triceps

Question 16

implants from other countries

Answer 16

these implants may contain two rods
implants containing two rods include jadelle (lasts 5 years) sino-implant and levoplant (3-4 years)

Question 17

managing deep insertion

Answer 17

risk of implant migration if inserted into muscle or blood vessel
palpable deeply iinserted implanon should only be removed by an experienced practitioner
iif it cant be palpated, it should be removed, organise x-ray to ensure it is present and refer to specialist to remove under US guidance

Question 18

altered bleeding patterns

Answer 18

occur in all users
blood loss overall is less than menstruation, amenorrhea occus in 20% of users
may imporve after the first 3 months of use as serum etonogestrel concentration drops

Question 19

options for medical management of altered bleeding patterns

Answer 19

taking COCP for first three months - minimal evidence
5 day course of NSAIDs, or tranexamic acid if bleeding is heavy