Original research articleInsertion and 3-year follow-up experience of 372 etonogestrel subdermal contraceptive implants by family physicians in Granada, Spain☆,☆☆
Introduction
Unplanned pregnancy is a problem in Granada, where in 2003 the rate of induced abortions was 14.4 per 1000 women aged between 10 and 49 years, and 37.6 per 1000 among 20- to 24-year-olds [1].
The contraceptive methods that have proven to be most effective in the prevention of unplanned pregnancy are those that are not dependent on compliance and are long-acting, reversible and have high continuation rates. Intrauterine devices (IUD) and subdermal contraceptive implants (SCI) fit this profile. An etonogestrel subdermal contraceptive implant (ESCI) called Implanon®, the first SCI in our country, became available in 2002, and so could be added to our choice of contraceptives. Currently, the SCI is among the most effective methods (Pearl index 0.05 [2]) and has an excellent safety profile [3], [4]. The ESCI Implanon® is a flexible, nonbiodegradable single rod of ethylene vinyl acetate, measuring 2×40 mm and containing 68 mg of etonogestrel. It provides 3 years of effective contraception.
Like all gestagen-only methods, use of the ESCI may result in irregular and unpredictable menstrual bleeding, and acceptability depends greatly on sociocultural factors and counseling. Initial studies have been carried out in other countries and many of them took place in specialized contraception centers [5]. Currently, little is known about ESCI acceptability in our country [6]. Use levels of any contraceptive among the population depend greatly on accessibility and on the quality of counseling [7]. Given its accessibility, primary care facilities could prove to be the ideal environment for delivery of the ESCI, once the obstacles related to the insertion and removal techniques have been overcome.
Our objectives were to assess user profile, continuation rates, reasons for discontinuation, adverse events related to insertion and removal, and contraceptive efficacy when used within family medical practice, including 3 years of follow-up after insertion.
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Design, scope and period of the study
Analysis was conducted on a series of cases involving women who had an ESCI inserted in the University Health Centre of La Chana (Granada, Spain) run by the Andalusian Health Service (AHS). The majority of insertions were carried out by two of the 12 family physicians (FP) at the center and by family medicine residents under supervision of the former. Insertions carried out between March 14, 2003, and December 13, 2005, were included. They were followed up until December 13, 2008, in order to
Results
ESCI insertions were performed on 372 women. The implant was used by 5.09% of our population of women of childbearing age. The 12 FP contributed a total number of 281 women from their patient lists, an average of 8.5 implants/FP per year. Another 91 women were registered with a FP in a different medical center.
The characteristics of the population are shown in Table 1. One hundred sixty-one (43.3%) were under 26 years and 15 (4.0%) under 18 years of age. Nearly a fifth (72, 19.2%) of the women
Discussion
The principal advantage of this study is that it proves the practicality of ESCI use by FP. It covers a series of three full years of follow-up of 372 insertions, carried out by FP, a number only exceeded by the 417 of Otero et al. [11]. The fact that this study was carried out in real-life conditions increases its external validity. Also, the loss to follow-up rate (4.3%) was lower than in the majority of other series [12], [13], [14], which report between 14.5% and 18.9% rates. The key to
Acknowledgments
The authors are grateful to the Health District of Granada and to the Andalusian Health Service for the confidence placed in the family physicians for contraception, and to all the professionals at the University Health Centre of La Chana, in particular to Nieves Casarrubios.
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This study has been funded by Health District of Granada, Andalusian Health Service.
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Conflicts of interest: The undersigned authors certify that they have no conflicts of interest related to the submitted article.