Prevalence of early discontinuation and associated factors among a retrospective cohort of etonogestrel contraceptive implant users

Peterson, Andrea; Brown, Amy; Savage, Ashlyn H.; Dempsey, Angela

doi:10.1080/13625187.2019.1666361

Cited by 16 publications

(14 citation statements)

References 21 publications

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“…In contrast, the rate in our study was slightly higher compared to a study conducted in Egypt [ 7 ]. However, the figure was similar with reports from the USA, Nigeria, Kenya, and Ethiopia [ 4 , 13 , 25 – 27 ]. The low rate of discontinuations in our study could be related to the fact that in comparative studies, discontinuations such as removal due to wanting to get pregnant were considered as an event of interest.…”

Section: Discussionsupporting

confidence: 89%

“…Reports have shown that access to FP methods differ significantly by region [3]. However, regarding the discontinuation of the first year of Implanon, a similar magnitude was observed between developed and developing countries, ranging from 13.5% to 28% [4][5][6][7].…”

Section: Introductionmentioning

confidence: 85%

“…Different contributing factors can affect the discontinuation of the first year of Implanon. Age, marital status, prior contraceptive use, partner educational level, counselling on side effects, and parity are among the predictors reported in developed and developing countries [ 4 , 7 , 11 , 14 , 15 ]. A report showed that contraceptives are estimated to prevent nearly half of maternal deaths [ 16 ], and if stopped early without switching or for reasons other than wanting to get pregnant, it contributes to unwanted pregnancies, miscarriages, and can lead to pregnancies that may be terminated through unsafe abortion [ 2 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and predictors of first-year unplanned discontinuation of Implanon at Ayder comprehensive specialized hospital, northern Ethiopia: A retrospective follow-up study

et al. 2022

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Background Discontinuing contraception without switching to a different type of family planning (FP) method contributes to unwanted pregnancy and unsafe abortion. Unplanned discontinuation of Implanon (which is discontinuation of Implanon without switching, but not for reasons of wanting to get pregnant) during the first year and its possible determinants have not been well investigated in Ethiopia. Therefore, this study aimed to determine the incidence and predictors of unplanned discontinuation of Implanon during the first year. Methods A retrospective follow-up study was conducted among 413 consecutive series of eligible women at Ayder Comprehensive Specialized Hospital in Northern Ethiopia. Data were drawn from both FP initiation and removal registration books and from contacting users by phone over a one-year period (April 2016 and March 2017). The inclusion of the categorical predictor in the final Cox model was considered if the test had a P-value of <0.25 in the log-rank test. We identified predictors of time to unplanned discontinuation using a multivariable Cox regression analysis. Adjusted hazard ratios with 95% confidence intervals (CI) were used to assess the association of covariates with the risk of discontinuation. There were no statistically significant interaction terms and proportionality assumption was fulfilled. Results The unplanned discontinuation rate of Implanon during the first year was 18.2%, with an incidence density of 16.3 discontinuations/1000 women-months. Compared with those under 20 years of age, women aged 20 to 24 years (AHR = 0.42; 95% CI: 0.19–0.91) had a protective effect against discontinuation. On the other hand, clients whose partner’s educational level was lower than secondary (AHR = 2.20; 95% CI: 1.08–4.49) and who had never used any modern contraception method before (AHR = 3.26; 95% CI: 1.61–6.61) had a higher risk of discontinuation. Conclusions Our findings have significant implications for understanding why Implanon is discontinued in an unplanned manner, and will help policy makers plan the interventions needed to improve Implanon continuity by overcoming identified barriers. Providers in similar settings should pay more attention to clients whose partners have lower educational status and who are new acceptors.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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Incidence and predictors of first-year unplanned discontinuation of Implanon at Ayder comprehensive specialized hospital, northern Ethiopia: A retrospective follow-up study

et al. 2022

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“…More recently, Nageso et al [64] showed an Implanon discontinuation rate of 23.4%, with a mean duration of use of 9.6 ± 2.5 months; side effects represented the main reasons for discontinuation in 34.4% of cases [64]. In a retrospective study, Peterson et al [65] documented a discontinuation of contraceptive method in 16% of implant users prior to 12 months, especially in women with irregular bleeding (odd ratio (OR) 4.36, CI: 2.71, 7.00) [65]. In a cross-sectional community-based survey [66] conducted on a total of 430 women, the overall discontinuation rate of Implanon was 34%; Implanon discontinuation was significantly observed in cases of women who never use a contraceptive method other than Implanon (OR 2.96, 95% CI 1.53-5.74), women who did not have a discussion with a partner (OR 3.32, 95% CI 1.57-7.04), poor counselling and follow-up (OR 9.23, 95% CI 4.7-18.13), fear of side effects (OR 0.12, 95% CI 0.058-0.24), and poor satisfaction of service (OR 5.2, 95% CI 2.77-9.76) [66].…”

Section: Implanonmentioning

confidence: 98%

Safety and Benefits of Contraceptives Implants: A Systematic Review

et al. 2021

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Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.

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“…45 Contraception-induced vaginal bleeding changes are frequently cited as reasons for non-use, discontinuation and dissatisfaction 49 Changes in bleeding are a leading cause for early ENG implant discontinuation in adults and adolescents. [49][50][51][52][53] Therefore, these changes should be addressed during counseling.…”

Section: What Changes In Vaginal Bleeding Do Eng Implant Users Experimentioning

confidence: 99%

Best Practices for Counseling Adolescents about the Etonogestrel Implant

Berlan

Richards

Vieira

et al. 2020

Journal of Pediatric and Adolescent Gynecology

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Among young persons, ease of use, high efficacy, and high acceptability makes the etonogestrel (ENG) contraceptive implant an important choice for this age group. Adolescent-friendly, patient-centered counseling considers the patient's cognitive development, the influence of friends and family, as well as their own preferences and values. Age appropriate language, graphics and models are useful to explain contraceptive options and relevant side effects. Effectiveness, reversibility, safety, non-contraceptive benefits, and side effects are important attributes and should be discussed when teens are choosing a contraceptive method. This review describes suggested best practices for counseling adolescents about the ENG implant so they can make informed, prudent decisions about using this contraceptive method.

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Prevalence of early discontinuation and associated factors among a retrospective cohort of etonogestrel contraceptive implant users

Cited by 16 publications

References 21 publications

Incidence and predictors of first-year unplanned discontinuation of Implanon at Ayder comprehensive specialized hospital, northern Ethiopia: A retrospective follow-up study

Incidence and predictors of first-year unplanned discontinuation of Implanon at Ayder comprehensive specialized hospital, northern Ethiopia: A retrospective follow-up study

Safety and Benefits of Contraceptives Implants: A Systematic Review

Best Practices for Counseling Adolescents about the Etonogestrel Implant

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