Implanon: just slip it in?

The problems don’t stop there. As with the three-month injection Depo Provera (also still widely administered to girls and women of all ethnicities) there is the serious problem of potential bone mineral density (BMD) loss. Because Implanon has only been on the market since 1998 (in Europe), it will be years before Implanon users will know whether the oestrogen decreasing mechanism of this synthetic progestin will significantly reduce BMD.

A 2007 study of the forearm bone density of 111 women, reported in Reproductive Health Vol 4, No 11, comparing levonorgestrel (Norplant) and etonogestrel (Implanon) is cause for concern. After 18 and 36 months of use, BMD of the “distal radius” of the forearm in both groups was “significantly lower” (Monteiro-Dantas et al.,) although the “ultra-distal radius” appeared not to be affected.

It needs to be remembered that it took from the mid 1980s to 2004 for the manufacturer of Depo Provera to finally acknowledge BMD loss from the three-month injectable drug and for the FDA to require them to put a black box-warning on the product.

A similar time span of almost 20 years would make it another 10 years (to 2018) before it will be known more conclusively whether Implanon leads to significant bone density loss. Like Depo Provera it may only be partially recovered once the contraceptive is stopped. In the meantime, thousand of users - including girls and young women who are most vulnerable to bone loss - may jeopardise their long-term health and risk higher levels of fractures from osteoporosis as they get older. And they’re not even told that this “cool” contraceptive may put them at risk.

In common with other progesterone-like contraceptives (including the mini pill) Implanon is not recommended for women who smoke and those with heart or liver disease and vaginal bleeding. Loss of libido during the use of Implanon is another frequent problem not mentioned by its enthusiastic promoters. So are problems with its removal. As one recent user remembers:

I had it implanted when I was 18 (I had really adverse reactions to the pill), and it has done something permanently to me - ever since I have had no sex drive at all. Must be something to do with hormone levels. I didn't get my period for the whole three years I had it in. Anyway, I had it implanted in (state), and when I wanted it out I couldn't find ANYONE who did it. I rang doctors, hospitals, family planning clinics, and they all knew how to put them in, but not take them out. So I thought I may as well wait until the three years was up and I was in (another state).

As girls and boys are subtly and not so subtly steered towards engaging in sex at a pre-teen age by various media messages, and, unfortunately as rape and sexual abuse are rife (and not just in Aboriginal communities), how to prevent a teen pregnancy becomes an important question.

In general, the popular understanding is that there is a whole cafeteria of safe contraceptive “choices” available and your doctor or family planning clinic will help you select the one “that’s best for you”. All hormonal contraceptives have side effects but at least if the pill makes you sick, you can discontinue it and look for something else. A plastic rod stuck in your arm is a different matter. Girls and women deserve to be told that Implanon may make them very sick and possibly reduce their bone density for good.