Implanon: just slip it in?

Over the past weeks Implanon, the three-year contraceptive implant, has been in the media spotlight. It was reported that 12-year old Aboriginal girls were “temporarily sterilised” with Implanon in a number of Queensland and Northern Territory remote communities (see, for instance, Tim Dick in The Sydney Morning Herald, April 16, 2008).

This issue raises serious questions about health professionals aiding and abetting sex under the legal age of 16. It also reminds us that the law is often not enforced and males who have sex with underage girls get away without prosecution. However, other than reporting that some of these young girls were found with sexually transmitted infections (STIs), Implanon itself was not queried for its medical problems.

As Implanon is gaining widespread currency as the new “cool” contraceptive for young women everywhere in Australia, it warrants a closer look at what it is and what it does.

Implanon is a second generation progesterone-like contraceptive implant. Its ingredient Etonogestrel is very similar to the Depot progesterone in Depo Provera and Levonorgestrel in the discredited Norplant (which caused blindness in women and was taken off the US market in 2002 but is now making its comeback as Norplant-II in Europe).

Implanon consists of a 40mm single polymer rod that is injected under the skin in a girl’s/woman’s upper arm where it can be felt. It can migrate and may be hard to find if she wants to have the rod removed before its three-year effectiveness has run out. Health providers need to be instructed in both implantation and removal.

Implanon was approved in Australia in 2001 and has since become one of the most favoured contraceptive options by reproductive choice groups. In 45 years on: What now in Contraceptives?, a widely-distributed free booklet available in GP surgeries published in 2007 by the National Council of Women in Australia, Implanon is listed as the number one non-daily method.

Its advantages are described as:

• convenience - not having to remember to take anything;
• long duration of use;
• reliability; and
• fertility returns quickly upon removal of implant.

All points that may especially appeal to young girls and women who have grown up with the “one stop-quick-fix-no-bother” approach to life.

Indeed, featured in the booklet as “Being a busy girl …”, is Biana Dye, presenter of Nova radio, a station for the young. She is excited about Implanon: “What a cool concept not having to worry about contraception for three years.”

The only disadvantage the booklet includes is that the “menstrual cycle is altered and some women have irregular periods”.

Throughout the booklet, Implanon is then repeatedly mentioned as the latest exciting contraceptive choice. Unfortunately, underplaying risk and adverse effects does no service to girls and women. In June 2003, the TGA (Therapeutic Goods Administration) mentioned in their Adverse Drug Reactions Bulletin that they had received 130 adverse reaction reports, 37 of which related to prolonged bleeding between two and 26 weeks. (33 of the 37 women had their implant removed.) Other well known adverse effects, listed by the US FDA (Food and Drug Administration who only approved Implanon in July 2006) include “increased or decreased bleeding frequency including amenorrhea (no periods), headaches, acne and emotional lability [mood swings]”.