#315 The LARC (long-acting reversible contraception) Song: Is the etonogestrel implant a hit?
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- No statistical analysis unless mentioned.
- One systematic review, 51 studies, only one RCT looking at etonogestrel implant versus other contraception.1 68mg etonogestrel implant (Nexplanon®) versus 13.5mg levonorgestrel intrauterine device (IUD) (Jaydess®) over 12 months (766 women).2
- Pregnancies: 0 versus 3 (IUD).
- Discontinuation: 27% versus 20% (IUD) (statistically different), mostly due to adverse events [examples increased bleeding 11% versus 3% (IUD), acne 5% versus 3% (IUD)].
- Patient satisfaction: 66% versus 80% (IUD) (statistically different).
- Amenorrhea: 29% versus 9% (IUD).
- Prolonged bleeding: 16% versus 5% (IUD).
- “Normal bleeding pattern”: 4% versus 31% (IUD).
- IUD manufacturer funded.
- Available IUDs in Canada are higher dose.
- Integrated analysis, 11 non-controlled trials assessed bioequivalent etonogestrel implant (Implanon®) over 2-4 years (942 women, 18-40 years old).3
- Pregnancy in six women, conception presumed to be following implant extraction (0.34 pregnancies per 100 women per year).
- Adverse events leading to discontinuation: Bleeding irregularities (11%), emotional lability (2%), weight gain (2%), headache (2%), acne (1%), and depression (1%).
- Insertion and removal complications 1% and 2%, respectively.
- Limitations: Industry funded, not a systematic review.
- Non-comparative trial of etonogestrel implant (Nexplanon®) for 3 years (301 women, mean age 28) found similar efficacy and adverse events.4
- Average weight gain 1.4kg at 36 months.
- Similar efficacy5 and insertion/removal complications6 in observational studies.
- Nexplanon® is a subcutaneous, radio-opaque, matchstick-sized flexible rod that lasts 3 years.7,8
- Costs ~$310 versus ~$370 for hormonal IUDs which last 5 years.7
- Training required for insertion and removal.8
- Cases of pulmonary migration, infections, barium allergic reactions, and insertion-related neuropathies have been reported.9 No effect observed on bone mineral density.10,11