Implantable contraceptives for women

Abstract

Progestogen-only implantable contraceptives are used by increasing numbers of women worldwide. This review outlines the evidence accumulated on these methods to date. Reviews of toxicological evaluations, clinical trials, endocrinological, epidemiological and social science studies, as well as operations research and economic evaluation were undertaken in preparation for an Expert Consultation convened by the World Health Organization in 2001. At the meeting, these reviews were further evaluated and the research results summarized in this consensus paper. A large body of evidence demonstrates the high contraceptive effectiveness and safety of the 5-year levonorgestrelreleasing implants Norplant and Jadelle. Information on the 3-year etonogestrel-releasing implant Implanon is more limited, but suggests that this implant has a high contraceptive effectiveness and a satisfactory safety pro®le. Information available on levonorgestrel-releasing implants manufactured and approved in China suggests that their clinical performance is satisfactory, but was insuf®cient to allow their full safety assessment. For all implants, there is insuf®cient information on their use by women with medical conditions. Provision of contraceptive implants requires good quality family planning services and speci®c provider training.

To Study the Acceptability and Efficacy of Combined Contraceptive Vaginal Ring Amidst Indian Women

“…(1)(2)(3)(4)(5) But these oral contraceptives have some unavoidable disadvantages like first-pass metabolism, large fluctuations in serum hormone levels and poor compliance in some users (6)(7)(8) for which non-oral hormonal methods have been tried with their own drawbacks. (9,10) One of the advances in the contraceptive field has been the development of combined contraceptive vaginal rings (CCVRs). (11)(12)(13) The acceptability of a new method of contraception is an important consideration as it may affect overall uptake and compliance.…”

Considerations for the use of progestin‐only contraceptives

“…The ENG implant is a single rod made of an ethylene vinyl acetate copolymer with a core containing approximately 68 mg of ENG (Shulman, Nelson, & Darney, 2004). It is inserted subdermally under local anesthesia, usually in the inner aspect of the nondominant arm (Meirik, Fraser, & d’Arcangues, 2003). The rod initially releases approximately 67 µg of ENG per day, which gradually decreases over a 3‐year period (Affandi, 2002).…”

“…Full toxicology data for ENG are not available, however, because ENG is an active metabolite derived from the prodrug desogestrel, data can be extrapolated from studies of desogestrel (Meirik et al, 2003). Toxicology, genotoxicity, carcinogenicity, and fetal development studies with desogestrel have demonstrated its overall safety (Jordan, 2002).…”

Implanon: A New Contraceptive Implant

“… Note. Adapted with permission from “A new progestin implant (2006)” and http://www.implanon-usa.com. …”

“…However, even for women experiencing frequent or heavier bleeding, the total number of bleeding days per annum was noted to be similar to that of normal menstruating women. None of the irregular bleeding led to the development of anemia (Affandi, 1998; Meirik, Fraser, & d’Arcangues, 2003).…”