Contraceptive Implants and Injectables
摘要
Contraceptive implants, including pre-loaded one-rod etonogestrel (ENG) and the two-rod levonorgestrel (LNG) implants, and contraceptive injectables, including 3-, 2-month and once-a-month formulations, are highly effective and safe, with pregnancy rates of 4 per 1,000 women-years [W-Ys]) for both implants and 6 per 100 W-Ys, for 3-month injectables. Both implants, as members of the long-acting reversible contraceptive (LARC) ‘family,’ contribute to reductions in the global maternal mortality ratio and unplanned pregnancy rate, which remain high mainly in low- and middle-income countries and settings. The contraceptive effectiveness of both implants is similar in efficacy to permanent surgical contraception. These contraceptives are extremely safe with few contraindications because they are progestin-only methods. They can be used by women with hypertension, diabetes, and current or past venous thromboembolism as well as by nulligravidas and adolescents, and during the postpartum and post-abortion periods. Notably, their use may induce profound endometrial atrophy, which can induce bothersome bleeding; this is the main cause of discontinuation. Cultural acceptance of the resulting menstrual patterns varies among women, highlighting the importance of regional considerations when promoting the most appropriate contraceptive methods.