A successful approach to long-acting contraceptive implants in primary care

Background: Subdermal implants of etonogestrol are an effective method of contraception but have a high discontinuation rate often due to irregular uterine bleeding. Implants are often placed in specialist environments away from the woman's usual primary health care provider in the UK.

Study design: The aim of the study was to assess the rate of (and reasons for) discontinuation of the implant using a two-stage procedure for device placement in primary care.

Results: One hundred thirty-one implants were placed between July 2005 and September 2009. Follow-up was complete at 9th November 2010, with the exception of seven women who left the practice area. The median age at placement was 24.0 years (interquartile range, 18.0-32.8 years). At 1 year, 90% of implants were still in place. Twelve implants (10%) were removed: seven were for irregular bleeding, three were for weight gain and one each was for acne and wishing to conceive. Over the next year, a further nine were removed (three for irregular bleeding, one to conceive and one each for acne, low mood, abdominal pain and amenorrhea). Two more were removed at 25 and 27 months (both for irregular bleeding), with no further implants removed thereafter other than to exchange for a new implant at 36 months. There were no pregnancies in 3595 women-months.

Conclusions: Etonogestrel implants can be safely and successfully inserted in primary care by well-trained users. It is possible for well-trained users to achieve a very high device retention rate in primary care compared with published data from other practice settings.