etonogestrel implant Flashcards

1
Q

what is the etonogestrel implant

A

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

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2
Q

how does it work

A

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

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3
Q

contraindications of etonogestrel implant

A

current breast cancer

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4
Q
A
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5
Q
A
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6
Q

can implanon be used in people with history of VTE

A

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

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7
Q

use of etonogestrel implant requires judgemeent in those with

A

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

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8
Q

advantages of implanon

A

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

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9
Q

can implanon be used while breast feeding

A

safe to use immidiately post partum and during breastfeeding

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10
Q

how soon is ovulation restored after removal of implanon

A

restored within weeks of removal

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11
Q

cost of implanon

A

available on PBS but cost of insertion varies with provider

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12
Q

disadvantages of implanon

A

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

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13
Q

when can etonogestrel implants be inserted

A

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

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14
Q

implanon is immediately effective if

A

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

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15
Q

recommended site of insertion

A

over the triceps

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16
Q

implants from other countries

A

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

17
Q

managing deep insertion

A

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

18
Q

altered bleeding patterns

A

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

19
Q

options for medical management of altered bleeding patterns

A

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