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. 2022 Aug;68(8):594. doi: 10.46747/cfp.6808594

Etonogestrel implant effectiveness

Nicolas Dugré 1, Nidhi Choksi 2, Jessica Kirkwood 3
PMCID: PMC9374080  PMID: 35961721

Clinical question

How does the etonogestrel implant (Nexplanon) compare with other long-acting reversible contraception?

Bottom line

The etonogestrel implant is effective, with 0 to 0.34 pregnancies per 100 women per year. In 1 RCT, the implant had a higher discontinuation rate (27% vs 20%), more amenorrhea (29% vs 9%), and lower patient satisfaction (66% vs 80%) compared with a low-dose levonorgestrel intrauterine device (IUD).

Evidence

No statistical analysis unless mentioned.

  • In 1 systematic review (51 studies),1 only 1 RCT (766 women) compared a 68-mg etonogestrel implant with a 13.5-mg levonorgestrel IUD (Jaydess) over 12 months.2
    • -
      The RCT found the following: the number of pregnancies was 0 versus 3 (IUD); discontinuation was 27% versus 20% (IUD) (statistically different), mostly owing to adverse events (eg, increased bleeding 11% versus 3% [IUD]; acne 5% versus 3% [IUD]); patient satisfaction was 66% versus 80% (IUD) (statistically different); amenorrhea was 29% versus 9% (IUD); prolonged bleeding was 16% versus 5% (IUD); and normal bleeding pattern was 4% versus 31% (IUD).
    • -
      Limitations: The study was funded by the IUD manufacturer; IUDs available in Canada are higher in dose.
  • An integrated analysis of 11 noncontrolled trials assessed a bioequivalent etonogestrel implant for 2 to 4 years (942 women, 18 to 40 years of age).3 Six women became pregnant, with conception presumed to be following implant extraction. The analysis found 0.34 pregnancies per 100 women per year in those with the implant.
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      Adverse events leading to discontinuation: bleeding irregularities (11%), emotional lability (2%), weight gain (2%), headache (2%), acne (1%), and depression (1%). Insertion and removal complications were 1% and 2%, respectively.
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      Limitations: The study was industry funded and not a systematic review.

  • A noncomparative trial of the etonogestrel implant over 3 years (301 women, mean age 28) found similar efficacy and adverse events.4 The average weight gain was 1.4 kg at 36 months.

  • Similar efficacy5 and insertion and removal complications6 were found in observational studies.

Context

  • The etonogestrel implant is a subcutaneous, radiopaque, matchstick-sized flexible rod that lasts 3 years.7,8 It costs roughly $310 versus $370 for hormonal IUDs, which last 5 years.7

  • Training is required for insertion and removal.8

  • Cases of pulmonary migration, infections, barium allergic reactions, and insertion-related neuropathies have been reported.9 No effect has been observed on bone mineral density.10,11

Implementation

The most common reported adverse effect during etonogestrel implant insertion is “pins and needles/numbness” in the insertion limb, and it is more common among repeat users than new users (10 of 1000 repeat insertions vs 1.2 of 1000 new users).6 The implant can be inserted at any time, but backup contraception should be used for 7 days after insertion if not inserted between day 1 and 5 of the menstrual cycle.8 Efficacy and safety data are limited in women with obesity or irregular bleeding patterns as most studies excluded them.3

Tools for Practice articles in CFP are adapted from peer-reviewed articles at http://www.toolsforpractice.ca and summarize practice-changing medical evidence for primary care. Coordinated by Dr G. Michael Allan and Dr Adrienne J. Lindblad, articles are developed by the Patients, Experience, Evidence, Research (PEER) team and supported by the College of Family Physicians of Canada and its Alberta, Ontario, and Saskatchewan Chapters. Feedback is welcome at toolsforpractice@cfpc.ca.

Footnotes

Competing interests

None declared

References

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  • 6.Reed S, Do Minh T, Lange JA, Koro C, Fox M, Heinemann K.. Real world data on Nexplanon® procedure-related events: final results from the Nexplanon Observational Risk Assessment study (NORA). Contraception 2019;100(1):31-6. Epub 2019 Apr 10. [DOI] [PubMed] [Google Scholar]
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  • 8.Nexplanon [product monograph]. Kirkland, QC: OrganonCanada Inc; 2021. Available from: https://www.organon.com/canada-en/wp-content/uploads/sites/5/2021/05/NEXPLANON-PM_E.pdf. Accessed 2022 Jul 12. [Google Scholar]
  • 9.Rocca ML, Palumbo AR, Visconti F, Di Carlo C.. Safety and benefits of contraceptives implants: a systematic review. Pharmaceuticals (Basel) 2021;14(6):548. [DOI] [PMC free article] [PubMed] [Google Scholar]
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  • 11.Modesto W, Dal Ava N, Monteiro I, Bahamondes L.. Body composition and bone mineral density in users of the etonogestrel-releasing contraceptive implant. Arch Gynecol Obstet 2015;292(6):1387-91. Epub 2015 Jun 19. [DOI] [PubMed] [Google Scholar]

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