Implant Flashcards
In what women may the implant not be suitable?
- Taking liver enzyme inducing drugs
- Have had hormone-dependent tumour in the last 5 years
- Have severe decompensating liver disease or liver tumours
- Sensitive to any of the components of the implant
- Currently using an implant and develop ischaemic heart or cerebrovascular disease
- Unexplained vaginal bleeding
How many years does the implant (Nexplanon) last for?
3 years
What is the MOA of the implant?
- Inhibits ovulation
- Alters cervical mucus and inhibits sperm penetration
- Prevents implantation by inducing endometrial atrophy
- May modify sperm function and motility
What is the effectiveness of the implant?
Less than 1 women in every 1000 users become pregnant over a 3 year period
What are some advantages of the implant?
- Long-lasting, effective, immediately reversible
- No effect on future fertility
- No evidence of adverse effects on the pregnancy or fetus
- Non-intercourse related method
- Free from oestrogen side-effects
- May reduce ovulation pain
- Reduced dysmenorrhoea
- Lighter periods
- Can be used in women with migraines with aura
- No increased risk of VTE, MI or stroke
- Minimal effects on glucose metabolism and liver function
What are some disadvantages of the implant?
- Unpredictable and irregular bleeding patterns common
- Enlarged ovarian follicles may be found in 5-25% of implant users
- Side effects - headache, weight gain, acne, loss of libido, mood change. No causal association found.
- Fat atrophy at site of implant
- Needs to be inserted by trained professional
- Mild discomfort/bruising following insertion or removal
When are additional contraceptives not required for 7 days when starting the implant?
- Up to and including day 5 of the natural menstrual cycle
- Before and including day 21 following childbirth
- Within 5 days following abortion, miscarriage, ectopic pregnancy or gestational trophoblastic disease
- Switching from a COC - D1-2 of HFI or week 2-3 of CHC
- Switching from progestogen-only anovulatory methods (desogestrel pill or injectable)
- Switching from IUD D1-5 of cycle
- Switching from IUD after D5 of cycle if IUD remains in situ for 7 days until the IMP becomes effective
What should you advise if the implant cannot easily be felt by the woman?
Abstain from sex or use an additional method of contraception.
Do not attempt removal.
Arrange an X-ray of the arm.
What is the advise about late removal of implants?
If more than 3 years has elapsed the chance of pregnancy is small. A pregnancy test should be performed and if negative, the implant can be changed with advice to use condoms for the next week. Repeat UPT in 3/52. It is unlikely that emergency contraception will be needed if unprotected sex has occurred and the implant was fitted less than 4 years ago.
Is there any delay in return to fertility after removal of the implant?
No
How would you manage troublesome bleeding on the implant?
- Take a careful medical and relationship history
- Exclude STIs and any gynaecology pathology
- Check cervical screening is up-to-date
- Perform a pelvic examination if there are other symptoms
What can you offer as treatment if unexplained troublesome bleeding has persisted for more than 3 months on the implant?
- Continuous or cyclical CHC (pill, patch or ring) for 3 months (off-license use). This approach can be continued for longer if bleeding is controlled and the patient wishes to use the implant for contraception and the COC to control bleeding.
- Tranexamic acid 250mg QDS for 5 days
- Mefenamic acid 500mg TDS for 5 days
- One desogestrel POP daily or therapeutic doses of progestogen for up to 3 months
What bleeding patterns may be expected with the implant?
In the first two years of implant use:
- Approximately 22% have amenorrhoea
- 33% have infrequent bleeding
- 7% have frequent bleeding
- 18% have prolonged bleeding
List some UKMEC 3 contraindications for the implant?
- IHD or stroke (for continuation, UKMEC 2 for initiation)
- Unexplained vaginal/suspicious vaginal bleeding
- Past breast Ca
- Severe liver cirrhosis
- Liver cancer
What is UKMEC 4 contraindication for the implant?
Current breast cancer
