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Contraceptive implants
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
Nexplanon is inserted with a sterile technique under local anaesthetic into the inner aspect of the upper arm of the non-dominant arm. Insertion of Nexplanon is performed with a specially designed applicator. Nexplanon should be inserted at the inner side of the upper arm about 8–10 cm above the medial epicondyle of the humerus. The insertion site should be marked and cleaned with disinfectant, and local anaesthetic given. The skin should be stretched, and the tip of the implant applicator inserted into the site at a slight angle of 30°. The capsule is held inside the applicator at the tip. Release the skin and lower the applicator to a horizontal position, lift the skin with the tip of the needle but keep the needle in the subdermal connective tissue. While lifting the skin gently insert the needle to its full length without using force. The purple slider is unlocked by pushing it slightly down and the slider is moved back until it stops; this releases the implant subdermally and locks the needle in the applicator. The applicator is removed, and the implant should be palpated. A dry dressing and pressure bandage are applied which can be removed in 24 hours. The insertion procedure takes 15 minutes. Batch number and expiry date of the implant should be recorded in the clients notes.
Contraceptive implants
Published in John Guillebaud, Contraception Today, 2019
Nexplanon®, formerly known as Implanon, works primarily by ovulation inhibition, supplementing it is thought the usual sperm-blocking mucus effect caused by progestogens. Sustained low blood levels of the progestogen block LH surges while allowing some ovarian follicular activity. It is a single 40-mm rod, just 2 mm in diameter, containing 68 μg of etonogestrel – the chief active metabolite of desogestrel – and so has much in common with a well-taken DSG POP. This is dispersed in an EVA matrix and covered by a 0.06-mm rate-limiting EVA membrane. The rod now also contains barium sulfate, so it can be imaged by x-ray studies but it remains bio-equivalent to Implanon, with the same release rate and 3-year licensed duration of action.
Contraception
Published in James M. Rippe, Lifestyle Medicine, 2019
Nexplanon is a highly effective method of contraception, with less than one pregnancy per 100 women in one year. It is considered among the most effective methods of contraception, because it doesn’t rely on patient compliance. Recent studies have shown prolonged effectiveness of up to five years, which improves the cost-effectiveness and potential patient continuation and satisfaction.40 Etonogestrel levels have been studied and found to be independent of BMI through three years of use. Therefore, Nexplanon is effective for women, including those who are obese.41
Co-delivery of an HIV prophylactic and contraceptive using PGSU as a long-acting multipurpose prevention technology
Published in Expert Opinion on Drug Delivery, 2023
Jarrod Cohen, Dennis Shull, Stephanie Reed
Long-acting devices can include inserts, implants, pumps, and stents [34,35]. Several of these have been commercialized for indications including contraceptives (Nexplanon®) [36–38], chronic illness (Susvimo™) [39–41], pain management (Xaracoll®) [42,43], and opioid abuse disorder (Probuphine®) [44–47]. While current commercialized implants are non-degradable, a market shift in drug delivery has focused on using biodegradable materials. These materials, often polymeric, degrade in vivo through hydrolysis and eliminate the need for removal procedures, minimizing the risk of infection and burdensome visits to the clinic [48]. Biodegradable polymers have been applied in medical applications ranging from bioresorbable cardiovascular stents to surgical sutures. While long-acting contraceptives have been clinically and commercially established [36,49], long-acting HIV prophylactics have only recently became commercially available [50,51]. As such, there is a prime opportunity to combine these therapies in a single long-acting drug delivery device.
Localized, on-demand, sustained drug delivery from biopolymer-based materials
Published in Expert Opinion on Drug Delivery, 2022
Junqi Wu, Sawnaz Shaidani, Sophia K. Theodossiou, Emily J. Hartzell, David L. Kaplan
Nearly 80% of women from high-income countries have reported using oral hormonal contraceptive pills [32]. These hormones include androgens, estrogens, and/or progesterone. Combination pills that include both estrogen and progestin are associated with breakthrough bleeding, a twofold risk of myocardial infraction and stroke and a 37 times higher risk of venous thrombosis [32,33]. Additionally, contraceptive pills must be taken daily, leading to decreased patient compliance and drug effectiveness if the user forgets to take or misplaces the pills. Subdermal implants that achieve sustained, long-term systemic release of contraceptives were created to address these issues [34]. Nexplanon is an etonogestrel-releasing ethylene vinylacetate copolymer rod-shaped implant inserted subdermally in the arm, and can be left in place for 3 years via surgical incision [35]. If the patient sustains injuries near the implant site, however, the implant could be damaged and may require surgical removal [36]. Additional side effects associated with systemic subdermal contraceptives include menstrual disturbances, acne, headache, abdominal pain, hair loss, weight gain, and follicular cysts [34]. Currently, the most popular local contraceptive delivery systems are intrauterine devices (IUDs), which are used by more than 168 million women worldwide. However, IUDs also have complications such as causing infections, pelvic inflammatory disease, uterine perforation, and menstrual disturbances [37,38].
Risk of female sexual dysfunction following concussion in women of reproductive age
Published in Brain Injury, 2019
Martina Anto-Ocrah, Jeff Bazarian, Vivian Lewis, Courtney Marie Jones, Todd A Jusko, Edwin Van Wijngaarden
Univariate analyses and descriptive statistics were performed to examine the frequencies and distributions of the study population by exposure type (mTBI vs extremity injury). Because responses on the BIQS, RPQ and HADS measures were not normally distributed, we compared reponses between injury groups using Wilcoxon rank-sum tests. Chi-square tests (Х2) were used to compare groups in bivariate analyses. If in bivariate analyses any covariate met the p-value cut off of < 0.2, they were included in multivariable analyses and adjusted for. The effect estimate for the risk of sexual dysfunction was determined using log-binomial regression models estimating relative risk, since the outcome prevalence was greater than 10% (62–64). Additionally, linear regression models were used to compare the mean differences in RPQ and HADS scores between mTBI subjects with and without decreased sexual functioning. We used p < .05 to determine statistical significance for all crude and adjusted multivariable models. All analyses were restricted to eumenorrheic women (8–14 menstrual cycles/year) who were not taking any hormonal birth control (Oral contraceptive pill, Mirena/Skyla IUD, Implanon/Nexplanon, DepoProvera injection, Ortho Evra skin patch, NuvaRing, Levonorgestral Implants (10,53)) at the time of injury.