Abstract
Objective
The etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive
method. Uptake remains limited in adolescents, a population at high risk for unintended
pregnancy. The objectives of this study were to determine the 12-month discontinuation
rate of the ENG implant among adolescents in an outpatient setting and to characterize
risk factors for discontinuation.
Study design
A retrospective chart review identified adolescent females aged 12 to 22 years who received the ENG implant in one pediatric institution between January 1,
2011, and April 15, 2014. Patients were categorized into ENG discontinuers (removed
prior to 12 months) and ENG continuers (continued for ≥12 months). Associations between demographic, clinical and postplacement characteristics
with ENG discontinuation category were assessed with t tests, χ2/Fisher's Exact Tests and backwards stepwise logistic regression.
Results
Of the 750 patients who had an ENG implant inserted, 77 (10.3%) had the device removed
prior to 12 months of use. The mean length of implant use for those who discontinued was 7.5 months. Problematic bleeding was the most commonly cited reason for discontinuation.
Older age at time of insertion, history of pregnancy and ≥1 medical visit for implant concerns (not including removal) were independently predictive
(p<.01) of method discontinuation.
Conclusion
The vast majority of adolescents continued the ENG implant at 12 months, making it an excellent contraceptive choice for adolescents within the outpatient
pediatric setting. Greater efforts should be made to increase its use by pediatric
providers.
Implications
The ENG implant is an excellent contraceptive option for adolescents in the outpatient
pediatric setting.
Keywords
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Article info
Publication history
Published online: March 03, 2016
Accepted:
February 28,
2016
Received in revised form:
February 24,
2016
Received:
September 28,
2015
Footnotes
☆Funding: This work was supported by Research Data & Computing Services at Nationwide Children's Hospital and the Center for Clinical and Translational Science at The Ohio State University (CTSA grant UL1TR001070) and by the OSU College of Medicine Bennett Research Scholarship awarded to Ms. Mizraji.
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© 2016 Elsevier Inc. All rights reserved.
