Anlalysis Of The Safety And Efficacy Of Etonogestrel Implants

BackgroundSubdermal contraceptive implant is a new type of birth control technology, the progesterone and silicone rubber or plastic stick or capsule, after inserting a drug slow, constant released into the blood and have the effect of long-term contraception, belongs to the drug controlled release system. Subdermal contraceptive progestin implants provide highly effective, safe and easily reversible birth control. The implant is acceptable to patients and requires no use compliance.Subdermal contraceptive implant applied to clinical has nearly40years,its development advances in implant technology is embodied in reducing the number of implants to1instead of6to facilitate easier insertion and removal.Etonogestrel (or3-keto-desogestrel) is the active metabolite of the progestin prodrug desogestrel (19-nortestosterone derivative). Etonogestrel is one of the newly developed third-generation progestins (others include norgestimate, gestodene, nomegestrol). This class of agents is designed to provide better selectivity (increased progestogenic and reduced and rogenic receptor activity) than second-generation progestins (norethisterone, levonorgestrel), thereby reducing a dverse metabolic effects, and improving cycle control and contraceptive efficacy. The subdermal contraceptive implant etonogestrel (Implanon;NV Organon International, Oss, The Netherlands) is a long-acting reversible contraceptive method consisting of a single subdermal implant that releases etonogestrel (ENG). Etonogestrel implants was approved by the Food and Drug Administration (FDA). It provides contraceptive protection for3years. It is currently in use in more than40countries, recently been approved by the China’s Food and Drug Administration (FDA) in2012and is now available for use in the China.Although several broadly cited studies have confirmed its high efficacy, convenience and cost-effectiveness, restricted availability to trained providers, similar to other progestin-only contraceptives, etonogestrel implants can cause side effects such as irregular vaginal bleeding. In China,it is lacking of efficacy and safety of the clinical use of data with etonogestrel implants.Especially,There was no report on vaginal bleeding patterns, continuation rates and satisfaction of etonogestrel implants with different placement.ObjectiveTo evaluate an integrated analysis of bleeding patterns, side effects, safety, acceptability and satisfaction associated with use of the subdermal contraceptive etonogestrel implants.Becises comparative study of vaginal bleeding patterns, continuation rates and satisfaction between women undergoing immediate postabortion placement and women who underwent menstrual placement.Materials and MethodsFrom May to November,2013,150healthy women cases requested the insertion of Etonogestrel implants in Women’s Hospital School of Mendice Zhejiang Univisity. At1.3.6.12months they completed a questionnaire about clinical symptoms,bleeding patterns, and side effects,satisfaction, an reasons for discontinuation.Results1. The contraceptive efficacy of etonogestrel implants was high, with zero pregnancies during1588women months in150cases, resulting in a Pearl index of0.2. Safety:The vaginal bleeding pattern is the most common side effects: amenorrhoea (36.0%) and infrequent (20.0%), frequent (8.6%), and/or prolonged bleeding(20.0%).Other reported side-effects included weight gain (24.7%), acne(16.0%), breast tenderness (10.7%) and ovarian cyst (14.0%). Etonogestrel implants has no clinically important effect on blood pressure, blood routine, liver and kidney function, blood lipid,and blood sugar.3. Acceptability:The continuation rate at the end of6months was89.3%and atl years was72.0%.76.2%of patients discontinued owing to bleeding problems, mainly because of amenorrhoea,prolonged flow and frequent irregular bleeding. Side effects leading to discontinuation were weight increased (30.9%), family planning reasons (4.8%), other reasons (7.1%).4. The vaginal bleeding patterns, continuation rates and satisfaction between women undergoing immediate postabortion placement and women who underwent menstrual placement has no statistical significance.ConclusionsEtonogestrel subdermal contraceptive implants have high efficacy, no significant side effects. and good safety. The vaginal bleeding patterns, continuation rates and satisfaction between women undergoing immediate postabortion placement and women who underwent menstrual placement has no statistical significance. The most common side effects was for bleeding irregularity. Counseling before and after implant removal, especially search for effective treatment measures, is a key to improve its continuation rates.