SAN ANTONIO — A minority of teens and young women in a study who chose an implantable contraceptive device discontinued because of spotting and irregular bleeding, despite prior counseling about this common side effect.
“We noticed there was increased interest from our adolescent patients for Implanon and realized some were complaining of bleeding,” Dr. Wendy L. Jackson said. Implanon (Organon), a 4-cm rod implanted in the subdermis, contains 68 mg of etonogestrel.
Dr. Jackson and her colleagues conducted a chart review at the University of Kentucky in Lexington. “We know that 52 patients had Implanon placed at our clinic” since February 2008, she said in an interview at her poster at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
“The likelihood of their having some bleeding is relatively high,” she said. “We counsel them to make sure it's an appropriate choice for them.” Still, 6 (12%) of the patients (age range, 13-21 years) returned to have Implanon removed at the University of Kentucky Adolescent Medicine Clinic, where Dr. Jackson is in the department of obstetrics and gynecology.
Because 31% of the patients did not return later for treatment or consultation, the study might have underestimated the discontinuation rate. It's unclear why 16 patients did not return, but it might represent normal adolescent behavior, satisfaction with Implanon, or removal of the device at another clinic, she speculated.
When patients return complaining of bleeding and/or spotting, a trial of oral contraceptives or Premarin (conjugated estrogens, Wyeth) can stop the bleeding so they can keep the device in place. “Implanon is a safe method for the adolescent population. It is more long term, so compliance is not an issue,” Dr. Jackson said. She had no relevant disclosures.
“Implanon is great birth control,” Dr. Nichole Tyson said during a separate presentation at the meeting. “It's good for 3 years, probably longer.”
“The downside is bleeding, and they all bleed,” said Dr. Tyson, director of the Teen Clinic at Kaiser Permanente, Roseville, Calif. She cautioned that the return to fertility is rapid—often within 24 hours—once the implant is removed. Dr. Tyson could not be reached to ascertain whether she had any conflicts of interest.
In terms of future research, Dr. Jackson said, “It would be nice to look back at the charts and see if any of the 31% returned for bleeding.”
The Food and Drug Administration revised instructions for implantation and removal of Implanon in February 2009.
Counseling is important because 'the likelihood of their having some bleeding is relatively high.' DR. JACKSON