Etonogestrel implant is a cost-effective and tolerable solution

Clinical update: Contraception – Implanon is very well tolerated by 72 per cent of women, according to Dr Sarah Riney, a GP at Dublin’s Suffolk Street Surgery.

“The etonogestrel implant is a very effective long-term contraceptive for patients,” said Dr Riney. “It’s inserted into the arm under local anaesthetic. The hormone is released on a daily basis over three years. You can feel it, but you cannot see it. There is only a small area of insertion visible on the arm and scarring is minimal.”
On average, one in five do not tolerate it well and this may necessitate removal of the device. It is important that patients are aware of this before insertion, said Dr Riney, who, along with Dr Brendan O’Shea and Dr Ann Forde, carried out a study of Implanon in an Irish general practice setting.
In 2007, the group found the device was removed early in 28 per cent of women, whereas 72 per cent kept it in for three years. Implanon lasts for three years and is thus cost-effective. It can be taken out at any time. “If put in correctly, it is fairly easy to remove. I have taken out a few but it’s not a high percentage at all,” said Dr Ann Forde, of the Bridge Medical Centre in County Kildare.
Irregular bleeding is the most commonly cited side effect. As with the progesterone-only pills, the cycle is often irregular with Implanon, resulting in irregular bleeding. In a small number of women, the implant has to be removed because the bleeding problem does not settle. Depression or low mood was reported by a small percentage: this was the reason for device removal in about 8 per cent of cases.
Pre-insertion counselling is very important, in Dr Riney’s view. “I would always make women aware of the potential side-effects,” she said. It is important for a doctor to have a significant level of experience, in order to build up the required skills for insertion. Also, fibrous tissue can develop over the three-year period and the removal process can be intricate and take time. Overall, the etonogestrel implant is more cost-effective than someone taking an oral contraceptive pill over a long-term period.