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Postpartum Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Elena R. Magro-Malosso, Sarah K. Dotters-Katz, Daniele Di Mascio
The contraceptive implant is another highly effective form of long-acting reversible contraception that can be placed immediately postpartum. The implant can be placed in the delivery room immediately after delivery. However, unlike the IUD, it can also be placed anytime during the delivery admission. Though theoretical concerns about lactogenesis in the setting of early exposure to exogenous progesterone have been raised, a recent RCT showed women who had the implant placed immediately postpartum showed no difference in lactogenesis or inability to breastfeed [222]. Similar to concerns about low attendance, the postpartum visit, and financial barriers mentioned with regard to the IUD, immediate postpartum placement of the implant alleviates those concerns. While an IUD cannot be placed in the setting of intraamniotic infection, this is not a contraindication to immediate postpartum implant placement.
Termination and Contraceptive Options for the Cardiac Patient
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
The etonogestrel contraceptive implant is a radio-opaque single-rod progestin implant that is placed subdermally in the inner arm. It contains 68 mg of etonogestrel and provides highly effective contraception for at least 3 years with a pregnancy rate of only 0.05% in the first year [8]. Its primary mechanism of action is suppression of ovulation. Secondary progestin mechanisms are similar to the hormonal IUD [14].
Contraception Across the Reproductive Life-Course
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Long Acting Reversible Contraception methods are over 99% effective (Trussell, 2011) but immediately reversible if a woman wants to become pregnant or wants to discontinue because of side-effects. IUDs and implants need to be inserted and removed by a trained doctor or nurse, usually under local anaesthetic, which can limit their accessibility. Contraceptive implants take the form of one or two matchstick-sized flexible rods placed under the skin of the upper inner arm, which slowly release a progestogen hormone over three or five years to prevent ovulation (Faculty of Sexual & Reproductive Healthcare, 2014b). Hormonal IUDs are plastic T-shaped devices placed in the uterus that release a low dose of a progestogen hormone called levonorgestrel for up to five years; copper IUDs last for five or ten years depending on the type (Faculty of Sexual & Reproductive Healthcare, 2015a). IUDs prevent fertilisation by stopping sperm movement and survival of the egg, and may also prevent implantation of a fertilised egg in the uterus. Hormonal IUDs reduce or even eliminate menstrual bleeding, which makes them an important option for women with heavy bleeding and anaemia, whereas copper IUDs tend to make bleeding longer and heavier. Copper IUDs are inexpensive, and implants are becoming increasingly more affordable and available in low-income countries, but the more expensive hormonal IUDs remain out of reach for many women. Pharmaceutical companies and governments should make efforts to provide these highly effective devices at low or no cost to the women who most need them.
Giving voice to the end-user: input on multipurpose prevention technologies from the perspectives of young women in Kenya and South Africa
Published in Sexual and Reproductive Health Matters, 2021
Alexandra M. Minnis, Emily Krogstad, Mary Kate Shapley-Quinn, Kawango Agot, Khatija Ahmed, L. Danielle Wagner, Ariane van der Straten
Among the anticipated barriers to adoption and use of future MPTs, women primarily identified side effects. They reflected on their experiences switching contraceptive methods due to undesirable side effects and drew inferences with regard to future MPTs in envisioning possible adverse effects. Many articulated misperceptions about side effects in general, and some confused dosage-form-related side effects with drug-related side effects. This emerged, for example, in expectations that menses-related side effects experienced with a contraceptive implant would occur with any implant regardless of its active pharmaceutical agents. Given that future MPTs will contain multiple pharmaceutical agents with different side effect profiles and may present physical and/or social risks tied to the dosage form itself, there is potential for side effects, both actual and perceived, to constitute a considerable barrier to uptake and use.
Contraception and reproductive planning during the COVID-19 pandemic
Published in Expert Review of Clinical Pharmacology, 2020
Edson Santos Ferreira-Filho, Nilson Roberto de Melo, Isabel Cristina Esposito Sorpreso, Luis Bahamondes, Ricardo Dos Santos Simões, José Maria Soares-Júnior, Edmund Chada Baracat
Finally, for subdermal implants, a prospective cohort study with 291 ENG implant users (444.0 women-years of follow-up; mean age of the study population was 29.9 years; almost 90% of implant users were 18 to 34 years old) documented no pregnancies during the 2 years of extended use beyond labeled approval. Authors found no differences in median serum ENG levels across body mass index (BMI) groups at method expiration or at the end of the fifth year of use. This study included 23% overweight and 53% obese women; ENG levels were above the contraceptive threshold of 90 pg/mL in all BMI classes at 3, 4, and 5 years [37]. Another study examined contraceptive efficacy of the ENG-subdermal implant beyond its labeled approval of 3 years and up to 5 years. Of the 390 participants (mean age of 27.8 ± 6.1 years-old) who accepted to continue use of the product, none became pregnant in the fourth and fifth years under observation. In this research, over 200 women used the product for at least 5 years [38]. A systematic review also provided data for extended duration of two different (ENG, LNG) implants; and there is enough evidence to recommend extended duration of the contraceptive implants [39]. Hence, women can be counseled to keep ENG implants for some more months, during this critical period. When counseling women, providers must consider the woman’s individuality. Despite potential concerns about BMI, these recommendations are also valid for obese women.
Prevalence and predictors of Implanon uptake in Ugu (Ugu North Sub District) 2016/17
Published in South African Family Practice, 2019
Contraceptive implants have been recognised as one of the most effective family planning methods available and are well known worldwide.8 Due to its efficacy and convenience,8 the implant is a long-term hormonal contraceptive method and is a healthier choice for women in sub-Saharan Africa. The following benefits of implants over other contraceptive methods have been listed:9 (a) requires only motivation for long-term usage; (b) their effectiveness is not user-dependent nor do they require adherence; (c) they have the lowest discontinuation rates of all contraceptive methods; (d) they do not require regular visits for resupply; (e) no extra subsidy is required for consistent use once they have been placed; (f) they are extremely cost effective; (g) the procedure is reversible, and fertility is returned after removal of Implanon.