Insertion and removal of Implanon®: practical considerations

ABSTRACT

Implanon®, a novel contraceptive implant containing the progestogen, etonogestrel (68 mg), provides highly effective, well-tolerated contraception for up to 3 years. Its single-rod design, semi-rigid polymer base and convenient pre-loaded presentation mean that Implanon® has potential insertion and removal advantages over the six-capsule Norplant® implant. Insertion of Implanon® is simple: the applicator needle is positioned subdermally and the cannula is withdrawn, leaving the implant rod in place. Implanon® is removed using the ‘pop out’ technique, involving a 2-mm incision. A meta-analysis of data from seven open-label, randomized studies in 1378 women compared the ease of insertion and removal of the Implanon® and Norplant® implants and the frequency of associated complications. It was approximately four times quicker to insert and remove Implanon® than Norplant® (mean insertion times 1.1 vs. 4.3 min, respectively; mean removal times 2.6 vs. 10.2 min, respectively). Insertion complications were very rare with both Implanon® (0.3%) and Norplant® (0.0%). However, Implanon® was associated with a significantly lower frequency of removal complications (0.2 vs. 4.8% with Norplant®; p < 0.001). Implant site abnormalities were uncommon. The simplicity of the insertion and removal procedures with Implanon® may have significant implications for contraceptive implant training programs and user counselling.

KEY WORDS:

• Contraceptive implant
• Implanon®
• Etonogestrel
• Insertion
• Removal
• Norplant®
• Progestogen-only