Hormonal contraceptive implant

Description

The hormonal implant is a female means of Contraception. It is a fine stick of approximately 4cm length on 2mm of diameter which one establishes in the internal part of the arm of the patient (in the left arm if the patient is droitière and vice versa), it is a surgical act which must be practiced by a Médecin. He is active at the end of 24:00 and this for one three years duration. At the end of this period, it will be necessary to turn over in its doctor to make it replace. It can however be withdrawn before this expiry, the natural hormonal cycle will take again its normal course in a few weeks. During these three years, the implant will diffuse a Hormone (the étonogestrel, derived from the gestodene, a progestatif of synthesis) which will guarantee the contraceptive effect by blocking ovulation and thus to prevent the pregnancy. Without risk of lapse of memory, contrary to the Pill which requires a rigor in the catch. A three months medical monitoring is recommended after the installation bus of the side effects or an intolerance can be constatés.

Ablation of the device

The withdrawal is done by incision, a local anesthesia is necessary (for example: Lidocaïne (injectable, pomade or “patch”). The most current difficulties with the withdrawal:

Difficulty of localization of the implant (it is sometimes necessary to seek it by echography)
Difficulté related to an important catch of weight of the patient
fibrous Coque around the implant and adherence

The withdrawal of the implant requiring a surgical act, it can involve rare complications (in particular the attack of the ulnar Nerf).

Indications

Method of particularly interesting contraception in the event of:

Against indication with the pill and the severe Coil
Nicotinism
Failure of contraception (regular lapses of memory of pill, for example)
personal Conditions preventing the use of the contraceptive Pill.

Counter-indications

Accident thromboembolic venous.
progestogène-dependant Tumors.
severe hepatic Affection.
Hemorrhage S genital not diagnosed.
Over-sensitiveness with the active ingredient or the one of the Excipients.

Side effects

Side effects are noted at about half of the users. It can involve a irregularity of the cycles, a lengthening of the duration of the rules… It can also cause a catch of weight, acne, migraines, vomiting, an embarrassment or pains with the centres (not proven yet however)…

Studies one shown that these side effects (in particular the Métrorragie S (bleedings apart from the period of the rules)) are the main cause of the stop of the treatment.

Cost

Enough expensive (124,77€ in France or 195,258$ Canadian), it is however refunded to 65% by the Social security and has one relatively long lifespan for an effectiveness which seems to be maximum.

Effectiveness

The rate of effectiveness of this implant to the étonogestrel is very high, about 99,9% (Indice of Pearl = 0,06) according to the the World Health Organization. The principal failures seem to be mainly had with a bad handling with the installation (the implant was not found at the time of the diagnosis of pregnancy) and with the catch of enzymatic inductive drugs.

External sources and bonds

information on the site of the CHU of Rouen
SERGEANT F., CLAMAGERAN C., BASTARD has. - Mr., VERSPYCK E., MARPEAU L. - J. gynécol. obstét. Biol. reprod. : " Acceptability of the contraceptive implant to the étonogestrel (Implanon®) "
NR. Osman, A. Dinh, T. Dubert and J.N. Goubier - Surgery of the Hand (Volume 24, Issues 3-4, June-August 2005, Pages 181-183): " A new iatrogenic cause of attack of the ulnar nerve to the arm: the hormonal implant contraceptif."

Note

In France, only one contraceptive implant is marketed. There is however a diffusing second of the levonorgestrel, another progestatif.

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