Understanding the Determinants of Implanon Contraceptive Discontinuation: A Systematic Review

Abstract

Background: Implanon (Etonogestrel) is a reversible contraceptive of prolonged action (LARC), presenting as a single rod of second generation, containing only progestogen and a clinical failure rate less than 1%. Although there have been significant improvements in the effectiveness, safety, accessibility and affordable price of Implanon, discontinuation of the method has become a concern, with more than half of users discontinuing its use before the recommended 3-year term. Methods: This study aimed to conduct a systematic review of the literature using the PubMed, Scielo, Science Direct and BVS databases, using the following search strategy: "Implanon" AND "discontinuation" AND "factors". Results: The search resulted in the identification of 482 publications, being 362 excluded because they deal with duplicate publications and 115 discarded because they are narrative/systematic/editorial reviews or incomplete studies, articles to be included for the construction of the qualitative synthesis of the present work. The studies highlight that, despite the high effectiveness of the Implanon contraceptive, its discontinuation rate before the recommended three years is significant, being mainly motivated by side effects such as menstrual irregularities and local discomfort. Women with less education, no children and lack of prior counseling are more likely to discontinue use. Conclusion: According to the publications analyzed, it is demonstrated that the discontinuation of the contraceptive method is essentially associated with the occurrence of adverse effects according to its use. To address this challenge, it is crucial to promote the dissemination of appropriate information, improve the quality of services, and provide training to healthcare professionals to provide comprehensive advice to ensure the continued and effective use of Implanon.