Progestogen-only implants

Question 1

Age cut off

Answer 1

55

Question 2

Medical CI’s and their UKMEC

Answer 2

• current/hx of IHD - 3 (C), 2 (I)
• hx of stroke - 3 (c), 2 (i)
• unexplained vaginal bleeding - 3
• current breast ca - 4
• past breast ca - 3
• severe decomp cirhossis, HCC or adenoma - 3

note that anti-coag and bleeding disorders do not necessarily CI implant as local haemostasis can usually be achieved

Question 3

How effective is it

Answer 3

99.5%

Question 4

What can interact with it to make it less effective

Answer 4

enzyme inducing drugs
daily UPA for fibroids

Question 5

does bmi affect it

Answer 5

no

Question 6

what need to say about bleeding

Answer 6

• unpredictable and can change at any time
• number of bleeding days is usually same or less than that with natural cycle
• some will be amenorrhoeic
• unfavourable patterns in first few months improve in 50% people
• hard to be specific

Question 7

reported side effects

Answer 7

unscheduled bleeding
headache
depression
mastalgia

may not be caused by ENG-IMP

acne can get better or worse. no evidence eng-imp causes weight gain.

Question 8

considerations for starting the implant in normal circumstances, when to start and advice depending on situation

Answer 8

• if on period - start, no condoms needed, nil else
• if after period, and had upsi since LMP and less than 21d ago consider EC, do PT, repeat PT at 21d and put implant in if todays is neg. CONDOMS FOR 7 DAYS
• after period but no upsi since LMP, start and use condoms 7d
• after period, no upsi past 21d but no period yet, PT now, start imlant if negative with condoms 7d. no f/u PT needed

same applies if had miscarriage or ectopic but days 1-5 after this are equivalent to d1-5 of cycle

Question 9

considerations for starting the implant post pregnancy

Answer 9

• if <21d since childbirth, start, no condoms needed, nil else
• if >21d since childbirth, and had sex in past 21d, do PT, start if negative, condoms 7d, repeat PT at 3w
• • if >21d since childbirth, and had sex in > 21d ago, do PT, start if negative, condoms 7d

Question 10

considerations when switching implants, on time, vs late

Answer 10

on time, straight switch, no extra protection needed
3-4y in situ - do a PT, repeat at 21d if not yet been 21d, put new one in if negative, condoms 7d
>4y in situ - as above but consider EC

Question 11

What minimal info needs to be given prior to insertion [7]

Answer 11

1. effectiveness - 0.05% preg in first year. highly effective for 3y.
2. 3y duration of use
3. interaction with medicines / herbal remedies
4. potential bleeding patterns
5. potential other SEs
6. insertion procedure and assoc risks incl local reaction, deep insertion, intravascular insertion, migration and neurovascular damage [5]
7. removal procedure

Question 12

After removal info needs to be given? [3]

Answer 12

1. immediate requirement for alt contraception
2. suitable options
3. wound care