Use of the Etonogestrel-Releasing Contraceptive Implant

Jaclyn Grentzer; Colleen McNicholas; Jeffrey F Peipert


Expert Rev of Obstet Gynecol. 2013;8(4):337-344. 

In This Article

Five-year View

Over the next 5 years, we anticipate that research will begin to address some of the side effects of the implant and how they can best be managed. The most bothersome adverse effect is the unpredictable bleeding with the implant. We anticipate that adjunctive pharmacotherapies (e.g., NSAIDs, doxycycline, estrogen/progestin or estrogen alone, among others) will be investigated for their potential use in mitigating the bleeding irregularities. Hopefully, some management algorithm will be found to be effective and result in increased continuation rates.

We also foresee that further studies will address if the ENG implant is effective for longer than 3 years. Results from a small study out of Thailand suggest the implant is safe and effective through 4 years of use.[28] In addition, the WHO is currently completing a multicountry trial evaluating prolonged use of the method with expected results in 2014. If the method is proven to be effective beyond 3 years of use, then patients may choose to leave the implant in for longer periods of time. Additional effectiveness studies should be performed in special populations, such as overweight and obese women, to determine the true duration of effectiveness.

Finally, as information regarding LARC methods becomes more widely disseminated, ENG implant provision by non obstetrician–gynecologists, such as pediatricians, family medicine physicians, physician assistants, nurse practitioners and other primary care providers will become accepted and expected. In other countries such as the UK and Australia, the trend towards ENG implant provision by non obstetrician–gynecologists is already occurring. We believe the use of the ENG implant will continue to grow in popularity as providers, mainstream media and the public become more aware of its extremely low failure rates, ease of use and noncontraceptive benefits.