title: Etonogestrel Implants in Adolescents: Experience, Satisfaction, and Continuation.
abstract: OBJECTIVE
  Few studies have evaluated the use of etonogestrel subdermal implants (ESI) by U.S. adolescents. We assessed several factors, including continuation rates, the association of implant removal with postimplant management of nuisance bleeding, and the relation between bleeding and body mass index.
  
  
  METHODS
  We reviewed 116 charts from all adolescent females with ESI placement in our adolescent medicine clinic from January 2010 to August 2013. Data were obtained from follow-up encounters up to 36 months after insertion.
  
  
  RESULTS
  Of the 116 adolescents, 94% were nulliparous. Follow-up data were available for 81% (n = 94). Early ESI removal was defined as removal <32 months. ESI continuation rates at 12, 24, and 32 months were 78%, 50%, and 40%, respectively; this represents an early removal rate of 35% (33 of 94). Nuisance bleeding occurred in 48% (45 of 94). Of those complaining of bleeding, 63% (25 of 40) received medication management. Resolution of bleeding occurred in 25% of those in the early removal group versus 15% in the full retention group. Early implant removal due to nuisance bleeding occurred in 18% (17 of 94). There was no significant association between body mass index, nuisance bleeding, and early ESI removal.
  
  
  CONCLUSIONS
  Implant continuation rates were quite high at 12 and 24 months, with 40% of patients reaching 32 months retention, providing a significant period of pregnancy prevention. Treatments for nuisance bleeding were often not prescribed and when they were, medication regimens varied among providers. An evidence-based protocol for medication management, combined with more routine use of appropriate medications and preventive or long-term therapies, may help improve continuation of ESI.
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York. Electronic address: lobijuru@uhs.rochester.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Obijuru
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bumpus
authors.affiliation: Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester Medical Center, Rochester, New York.
authors.forename: Peggy
authors.initials: P
authors.lastname: Auinger
authors.affiliation: Department of General Academic Pediatrics, University of Rochester Medical Center, Rochester, New York.
authors.forename: Constance D
authors.initials: CD
authors.lastname: Baldwin
mesh_terms: D000293:Adolescent; D003271:Contraceptive Agents, Female / Q000009:adverse effects; D017135:Desogestrel / Q000009:adverse effects; D020878:Device Removal; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000209:etiology*; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; C044815:etonogestrel; D017135:Desogestrel
keywords: Adolescents; Etonogestrel implant; Intrauterine device; Irregular bleeding; Long-acting reversible contraception; Nuisance bleeding; Unintended pregnancy