Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting

ObjectiveThe etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive method. Uptake remains limited in adolescents, a population at high risk for unintended pregnancy. The objectives of this study were to determine the 12-month discontinuation rate of the ENG implant among adolescents in an outpatient setting and to characterize risk factors for discontinuation.Study designA retrospective chart review identified adolescent females aged 12 to 22 years who received the ENG implant in one pediatric institution between January 1, 2011, and April 15, 2014. Patients were categorized into ENG discontinuers (removed prior to 12 months) and ENG continuers (continued for ≥ 12 months). Associations between demographic, clinical and postplacement characteristics with ENG discontinuation category were assessed with t tests, χ2/Fisher's Exact Tests and backwards stepwise logistic regression.ResultsOf the 750 patients who had an ENG implant inserted, 77 (10.3%) had the device removed prior to 12 months of use. The mean length of implant use for those who discontinued was 7.5 months. Problematic bleeding was the most commonly cited reason for discontinuation. Older age at time of insertion, history of pregnancy and ≥ 1 medical visit for implant concerns (not including removal) were independently predictive (p < .01) of method discontinuation.ConclusionThe vast majority of adolescents continued the ENG implant at 12 months, making it an excellent contraceptive choice for adolescents within the outpatient pediatric setting. Greater efforts should be made to increase its use by pediatric providers.ImplicationsThe ENG implant is an excellent contraceptive option for adolescents in the outpatient pediatric setting.