Progestin only implants- FSRH 2014 Flashcards
“Progestin only implants”
Menstrual pattern
Infrequent bleeding: 33 %
Prolonged or frequent bleeding: 25 %
Regular bleeds: 22 %
No bleeding: 20 %
Altered bleeding patterns-likely to remain
irregular.
“Progestin only implants”
Unproven concerns
- Little or no increased risk of VTE, stroke or MI.
- No evidence of a clinically significant - effect on BMD.
- No evidence of a causal association- changes in weight, mood and libido- some women report.
- No evidence of a causal association- headache- some women report
“Progestin only implants”
Ambivalent effect
Acne
- Some woman improvement,
- Some worsening or new onset
“Progestin only implants”
Only benefit
May help to alleviate dysmenorrhoea.
“Progestin only implants”
Insertion, removal and replacement
- Professionals: trained, maintain competence & updated regularly, UKMEC
- Local anaesthesia
- No need - precautions or abstinence prior to removal, providing removal no later than 3 years after insertion.
- After removal, effective contraception is required.
“Progestin only implants”
Timing of repeat insertions
If replaced immediately, & after no longer than 3 years since insertion, there is no need for additional contraceptive precautions after replacement.
“Progestin only implants”
Follow-up
- No routine follow-up required,
- But can return any time ( problems or change method.)
- Return if:
- cannot feel implant or
- changed shape; skin changes or pain around the site ; – they become pregnant; or
- they develop any condition that may contraindicate continuation of the method.
“Progestin only implants”
enzyme inducing drugs
- Reduce efficacy (switch method)
or to use additional contraception until 28 days
after stopping the treatment.
HIV and other sexually transmitted infections.
Weight
- Obesity (BMI>30 kg/m2) no restriction on use UKMEC 1
- No increased risk of pregnancy has been demonstrated in women weighing up to 149 kg.
- Because of inverse relationship b/w weight and serum etonogestrel levels, a reduction in the duration of contraceptive efficacy cannot be completely excluded.
- Inform, manufacturer states that earlier replacement can be considered in ‘heavier’ women but that there is no direct evidence to support earlier replacement.
HIV and other sexually transmitted infections.
HIV and other sexually transmitted infections.
consistent and correct use of condoms is the most efficient means of protecting
“Progestin only implants”
mpalpable implant
Advised: to use additional precautions or avoid intercourse until the presence of an implant is confirmed.
- The location of an impalpable or deep implant should be identified before exploratory surgery.
- Referral to an expert implant removal centre is recommended.
“Progestin only implants”
troublesome bleeding
- After exclusion of other causes and who are eligible to use combined hormonal contraception, may be offered combined oral contraception (COC) cyclically or continuously for 3 months (outside the product licence).
- Longer-term use of the implant and COC has not been studied and is a matter of clinical judgement.
“Progestin only implants”
pregnancy
- not known to be harmful in pregnancy
- but women with a continuing pregnancy should be advised to have the implant removed.
- Women may retain the implant if they wish to continue the method after a non-continuing pregnancy.
” Progestogen-only implant”
- License
- How much progesteron, which type
- Release rate
- Single, non-biodegradable, subdermal rod
- Licensed for up to 3 years of use.
- Each implant contains 68 mg ENG.
- Release rate decreases with time 60–70 µg/day in Weeks 5–6 to 25–30 µg/day at the end of third year.
Main difference between Nexplanon and Implanon
- Barium sulphate added to Nexplanon to enable detection by X-ray.
- Applicator modified to reduce the risk of deep insertion and to facilitate one-handed insertion.
- Implanon is no longer available
