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FSRH Guideline (February 2021) Progestogen-only Implant

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1 Purpose and scope

This document updates previous Faculty of Sexual & Reproductive Healthcare (FSRH) guidance and aims to summarise the available evidence and expert opinion relating to the etonogestrel subdermal contraceptive implant. The guideline is intended for use by healthcare practitioners (HCPs) providing or giving information about etonogestrel implants.

2 Identification and assessment of the evidence

This guideline was developed in accordance with standard methodology for developing FSRH clinical guidelines. The recommendations made within this document are based on the best available evidence and the consensus opinion of experts and the guideline development group (GDG). The methodology used in developing this guideline and a list of GDG members and other contributors can be found in Appendix 1.

Appendix 1

[SP1.pdf]

The recommendations included should be used to guide clinical practice but are not intended to serve alone as a standard of medical care or to replace clinical judgement in the management of individual cases.

3 Introduction

The guideline will consider only the etonogestrel subdermal implant (ENG-IMP) as this is the only progestogen-only implant currently available in the UK. At the time of writing, Nexplanon is the only available ENG-IMP; recommendations in this guideline relate to evidence from studies of the ENG-IMP Nexplanon and its predecessor, Implanon. Implanon had a different insertion device and did not contain the barium sulphate that renders Nexplanon radio-opaque.

4 Summary, including changes to existing guidance

The ENG-IMP is a single-rod subdermal contraceptive implant that releases the progestogen etonogestrel (ENG). It acts by suppressing ovulation, with additional effects on endometrium and cervical mucus. The contraceptive effect is lost rapidly after removal.

Contraceptive effectiveness

The ENG-IMP provides very effective contraception for 3 years and is not user-dependent during this time. True implant failures have been reported, but it is estimated that only 0.05% of users have unplanned pregnancies in the first year of ENG-IMP use. Very limited evidence suggests that risk of pregnancy is likely to be very …

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Footnotes

  • Correction notice Since this set of guideline were published online the following changes have been made:

    July 2023Table 2 and Table 3 updated; Section 10.3 Breast cancer updated to reflect newly published evidence.