Implanon

Infobox Birth control
name = Implanon


width =
caption =
bc_type = Hormonal
Progestin-only implant
date_first_use = 1998 (Indonesia)
rate_type = Failure
perfect_failure% = 0.05
typical_failure% = 0.05
duration_effect = 3 years
reversibility = Yes
user_reminders = Requires removal after the 3 years
clinic_interval =
STD_protection_YesNo = No
periods_advantage = Minimizes pain. 20% of women will stop having their period.
benefits = Longterm contraception.
periods_disadvantage = Various.
weight_gain_loss = No proven effect
risks =
medical_notes =

Implanon, made by Organon International, is a single-rod contraceptive subdermal implant that is inserted just under the skin of a woman's upper arm. The 4 cm by 2 mm Implanon rod contains 68 milligrams of the gonane progestin etonogestrel which is released over a three year period.

Peak serum etonogestrel concentrations have been found to reach 781–894 pg/mL in the first few weeks, gradually decreasing to 192–261 pg/mL after 1 year, 154–194 pg/mL after 2 years, and 156–177 pg/mL after 3 years, maintaining ovulation suppression and contraceptive efficacy.cite web | url=http://www.fda.gov/cder/foi/label/2006/021529lbl.pdf | title=Implanon label | publisher=FDA | format=PDF | date=2006-07-17 | accessdate=2006-08-23] Implanon may be removed at any time, but must be removed after three years.

Implanon was first approved for use in Indonesia in 1998, was subsequently approved for use in over 30 other countries, and has been used by over 2.5 million women worldwide. Implanon was approved for use in the United States by the FDA on July 17, 2006.

Mechanism of action

The mechanism of action of progestin only contraceptives depends on the progestin activity and dose. cite book |last=Glasier |first=Anna |editor=DeGroot, Leslie J.; Jameson, J. Larry (eds.) |title=Endocrinology |edition=5th ed. |year=2006 |publisher=Elsevier Saunders |location=Philadelphia |id=ISBN 0-7216-0376-9 |pages=pp. 3000-1 |chapter=Contraception] Intermediate dose progestin-only contraceptives, like Implanon (and the progestin-only pill Cerazette) allow some follicular development but inhibit ovulation in almost all cycles as the primary mechanism of action. Ovulation was not observed in studies of Implanon in the first two years of use and only rarely in the third year with no pregnancies. A secondary mechanism of action is the progestogenic increase in cervical mucus viscosity which inhibits sperm penetration. cite web |author=Organon |month=April |year=2006 |title=Implanon SPC (Summary of Product Characteristics) |url=http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=5382 |accessdate=2007-04-15] Hormonal contraceptives also have effects on the endometrium that theoretically could affect implantation, however no scientific evidence indicates that prevention of implantation actually results from their use. [cite journal |author=Rivera R, Yacobson I, Grimes D |year=1999 |title=The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices |journal=Am J Obstet Gynecol |volume=181 |issue=5 Pt 1 |pages=1263–9 |pmid=10561657 |doi=10.1016/S0002-9378(99)70120-1]

Insertion

Local anaesthetic is applied to the upper arm, and then a needle-like applicator is used to insert the implanon rod under the skin. The procedure can take less than a minute. An experienced clinician is required for proper insertion, to minimize the risk of nerve damage, [cite journal | author=Wechselberger G, Wolfram D, Pulzl P, Soelder E, Schoeller T | title=Nerve injury caused by removal of an implantable hormonal contraceptive | journal=Am J Obstet Gynecol | year=2006 | month=July | volume=195 | issue=1 | pages=323–6 | pmid=16813761 | doi=10.1016/j.ajog.2005.09.016] or misplacement which could result in unintended pregnancy. Implant site complications are experienced by 3.6% of patients, and include swelling, redness, hematoma and pain.

Side effects and risks

There are notable side effects caused by Implanon that occur in some women. Irregular periods, headaches, acne, weight gain and abdominal pain were among the most commonly reported side effects in clinical trials.Fact|date=December 2007 Eleven percent of women had Implanon removed because of irregular menstrual bleeding, which can include excessive menstrual bleeding. Some women may have no menstrual period at all while using Implanon.cite news | author =Susan Heavey & Lisa Richwine | url =http://today.reuters.com/News/newsArticle.aspx?type=healthNews&storyID=2006-07-18T205203Z_01_L18815482_RTRUKOC_0_US-CONTRACEPTIVE.xml&pageNumber=0&imageid=&c
Reuters | date= Jul 18, 2006] It is not known whether Implanon changes a woman's risk for breast cancer.cite web | url=http://www.implanon-usa.com/authfiles/images/543_174732.pdf | title=Implanon patient information | publisher=Organon USA Inc. | format=PDF | year=2006 | month=July | accessdate=2006-08-23] Failure rate for Implanon was reported at 0.1%. Most cases of failure were due to incorrect insertion or insertion during pregnancy. In comparison, surgical sterilization has a failure rate of 0.2%.cite web | url=http://www.fpahealth.org.au/news/20030211_implanon2.html | title=Implanon effectiveness]

Fertility after Implanon

Within a few days of having Implanon removed the hormones released by Implanon will have left the body. The chances of becoming pregnant should be the same as they were before using Implanon.

Complications

Complications which can occur include:

* impalpability of implant
* broken or damaged implant
* slight migration
* fibrosis.

If Implanon is "impalpable"—cannot be felt—an ultrasound must be performed. Surgery under local or general anesthesia may be required to remove an impalpable Implanon implant, especially if it is broken, damaged, has migrated, or is deeply embedded in scar tissue or fibrosis.

ee also

*Progestogen only contraception

References

External links

* [http://www.implanon.com Official website]