Priority 24 from the Contraception PSP

UNCERTAINTY: How frequently do women stop using the implant because of side effects?  (JLA PSP Priority 24)
Overall ranking 24
JLA question ID 0049/24
Explanatory note The use of LARCs is increasing, the most commonly used LARC in England is the implant (12.9% attendess at community SRH clinics, 159 thousand prescriptions). Irregular bleeding is a common side effect The systematic review included RCTs but these assessed levonorgestrel implants and not the etonogestrel implant which is currently used in the UK.  The authors suggest that “many women using progestin-only methods experience unacceptable bleeding disturbances, discontinue use, and are left without contraceptive protection or switch to a less effective method. The development of common outcome reporting measures should be developed to ease the synthesis and comparison of studies”, RCTs should include interventions currently used in clinical practice such as the etonogestrel implant, combined hormonal contraception and alternative treatment options. (Overlap with priority 2,5 and 17)
Evidence

Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons. David Hubacher, Laureen Lopez, Markus J. Steiner, Laneta Dorflinger. Contraception, Vol. 80, Issue 2, p113–118. Published online: April 24, 2009. 

RCT of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives Modesto W, Bahamondes MV, Bahamondes L. Hum Reprod. 2014 Jul;29(7):1393-9. 

NICE LARC Guideline  Research recommendations

RCT etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls Luis Bahamondes,*, Vivian Brache, Olav Meirik, Moazzam Ali,Ndema Habib, and Sihem Landoulsi for the WHO Study Group on Contraceptive Implants for Women Human Reproduction, Vol.30, No.11 pp. 2527–2538, 2015. 

RCT comparing a 13.5 mg levonorgestrel intrauterine contraceptive system with the etonogestrel subdermal contraceptive implant in women aged 18–35. Years. M. Tuppurainen et al; Fertil Steril ASRM Abstracts Vol 102, No3 S Sept 2014
Health Research Classification System category Reproductive Health and Childbirth
Extra information provided by this PSP
Original uncertainty examples

“How to decide when best to have implantable contraception removed and to consider alternatives? (Patient),  ~  “I have heard that due to the expense of the contraceptive implant, they advise women who are struggling with this form of contraception against removal. Is this true?” (both)
Submitted by Healthcare Professionals x 1~Patients x 3~Both x 1
PSP information
PSP unique ID 0049
PSP name Contraception
Total number of uncertainties identified by this PSP. 57  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 April 2017