Implanon

Question 1

Implanon:

What is the drug and duration of action?

Answer 1

Progestogen only

3 years

Question 2

Implanon:

MOA?

Answer 2

ovulation prevention and thickening cervical mucous

Question 3

Implanon:

Effectiveness?

Answer 3

99.9%

Question 4

Implanon:

How does it affect menstruation and acne?

Answer 4

20% amenorrhoeic
45% more frequent or prolonged bleeding
35% no change/lighter
acne may worsen, improve or resolve

Question 5

Implanon:

Disadvantages?

Answer 5

• surgical insertion (cost, risk of infection, scarring, bleeding, migration and vasovagal)
• no STI protection
• changes in menstruation
• acne may worsen
• headaches/mood changes/weight gain/loss of libido/breast tenderness

Question 6

Implanon:

Eligibility criteria contraindications?

Answer 6

• IHD
• CVA/TIA
• Current or previous breast Cancer
• HCC/decompensated liver cirrhosis
• unexplained vaginal bleeding

Question 7

Implanon:

When to implant post pregnancy?

Answer 7

Anytime, but consider possible pregnancies if ≥3 weeks post partum

Question 8

Implanon:

When can it be ineffective?

Answer 8

When taking the following liver enzyme inducers:

• rifampicin
• antiepileptics
• some antiretrovirals
• St Johns Wort

Question 9

Implanon:

When is it effective?

Answer 9

-If implanted during day 1 - 5 of cycle then immediately
-or in 7 days in all other scenarios
(the 7 days can be covered with other forms of hormonal contraception or barrier methods)

Question 10

Implanon:

Timing of insertion with emergency contraception?

Answer 10

• Delay for 5 days after ulipristal as it reduces its effectiveness
• insert at same time as levonorgestrel

Question 11

Implanon:

Follow up?

Answer 11

pregnancy test at 4 weeks to cover 3 weeks prior to insertion and 7 days until implanon became effective

Question 12

Implanon:

Suitable trial time to see if frequent/longer bleeding post insertion resolves?

Answer 12

50% of women with unacceptable bleeding pattern will improve within 4 months

Question 13

Implanon:

How to manage unacceptable bleeding post insertion?

Answer 13

• 3-4 months is a suitable trial
• bleeding control with COCP or transexamic acid are possible measures to support quality of life to wait for trial time to see if improvement develops

Question 14

Implanon:

What happens to deeper implants?

Answer 14

they should be removed by specialist in their removal.