Effectiveness and continuation rates of the etonogestrel‐subdermal contraceptive implant versus short‐acting contraceptive methods offered at no cost in Campinas, Brazil

• Published in: International journal of gynecology and obstetrics 2024-07, Vol.166 (1), p.305-311
• Main Authors: Laporte, Montas, Marcelino, Ana C., Cunha Pereira, Paula, Espejo‐Arce, Ximena, Juliato, Cassia T., Bahamondes, Luis
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Brazil; continuation rate; contraception; Contraceptive Agents, Female - administration & dosage; Contraceptive Agents, Female - economics; Contraceptive Devices, Female; Contraceptive Effectiveness; Desogestrel - administration & dosage; Drug Implants; etonogestrel implant; Female; Humans; Patient Satisfaction; Prospective Studies; short‐acting contraceptives; Young Adult
• ISSN: 0020-7292; 1879-3479; 1879-3479
• DOI: 10.1002/ijgo.15415

Objectives To compare the efficacy, reasons for discontinuation and continuation rates of the etonogestrel (ENG)‐subdermal contraceptive implant when offered at no cost, and the basis of free choice versus short‐acting reversible contraceptive (SARC) methods including combined oral contraceptives (COCs), once‐a‐month injectables, vaginal ring, and patch. Methods We conducted a prospective study at the University of Campinas, Brazil, involving women aged 18 to 40 years. They were counseled on various contraceptive methods before entering the study and followed up every 3 months for up to 24 months. Satisfaction was assessed using a Likert scale. Survival rates were estimated using the Kaplan–Meier test, and curve comparisons were performed using the log‐rank test. Results We enrolled 609 women including 358/609 women (58.8%) who chose the ENG‐implant and 251/609 (41.2%) who chose SARC methods. Contraceptive failure and all other reasons for discontinuation were significantly higher in SARC users compared to the ENG‐implant users (P 82%). Conclusions The ENG‐implant showed higher contraceptive effectiveness and higher continuation rates than SARC methods up to 2 years after study initiation. Furthermore, users from both groups were highly satisfied with their contraceptive. The main reason for discontinuing use of the ENG‐implant was bothersome uterine bleeding, while for SARC methods it was for personal reasons. Synopsis We found that users of the ENG‐implant showed higher contraceptive effectiveness and higher continuation rates when compared to users of the SARC methods up to 2 years after study initiation.