Publication:

Complications of nexplanon contraceptive implants and reasons for discontinuation, in Yenagoa, Nigeria

Background Though nexplanon is a safe and effective contraceptive implant, the complications are often troublesome to warrant removal. This study intends to determine the complications of nexplanon contraceptive implant, and the reasons for removal.

Methods It was a retrospective cross-sectional study of 258 women, who used nexplanon contraceptive implants for a while and discontinued. Data collected was: bio-data, the duration of contraceptive use, rank of the inserter (nurse or resident doctor), rank of the remover, the complications experienced, and the reasons for implant removal.

Results The mean duration of nexplanon use was 30.95±14.34 months, majority (96.1%) were inserted, and (82.2%) removed by trained nurses. Insertion by resident doctor significantly resulted in more complications than by trained nurses, odds ratio=5.10 [1.06, 24.51], p=0.02. The complication rate was 50%, and vaginal bleeding (25.2%) was the most common. Others are: headache (8.9%), pain at the injection site (3.9%), Weight gain (3.1%), amenorrhoea (1.6%), mood swing (1.6%), and breast pain (1.2%). Regarding contraceptive failure, the pearl index was low (0.06). Women who inserted once significantly had more complications than those who inserted twice, odds ratio=0.46 [0.22, 0.77], p=0.03. Women who used it for a period of ≤36 months significantly had more complications than those who used it for a longer period, odds ratio=0.53 [0.30, 0.92], p=0.02. The commonest reasons for removal were: expired implant (41.9%), desire to get pregnant (31.8%), and heavy vaginal bleeding (21.3%). The removal rate (secondary to complications) was 26.4%.

Conclusions Nexplanon is an effective contraceptive implant with a very low failure rate. Irregular vaginal bleeding is the commonest complication, and the most common reason for discontinuation.