Likelihood of Side Effect Recurrence with Implanon Reinsertion
When reinserting Implanon, patients are likely to experience the same side effects they had with their previous implant, particularly bleeding irregularities which are the most common reason for early removal. 1
Bleeding Pattern Recurrence
Bleeding irregularities are the most common side effects with Implanon (etonogestrel implant) use and are likely to recur with reinsertion:
- 22% of etonogestrel implant users experience amenorrhea
- 34% experience infrequent spotting
- 7% report frequent bleeding
- 18% report prolonged bleeding 1
These bleeding patterns are generally not harmful but may be bothersome to patients. They may or may not decrease with continued implant use, and patients should be counseled about this before reinsertion 1.
Other Side Effects and Their Recurrence
Besides bleeding irregularities, other side effects that may recur include:
- Emotional lability
- Weight gain (reported by 5.8% of users requesting removal in one study) 2
- Headache (reported by 4.2% of users requesting removal) 2
- Acne (reported in 26.8% of users in one study) 3
- Dizziness (reported by 3.3% of users requesting removal) 2
- Loss of libido (reported by 1.7% of users requesting removal) 2
- Pain/numbness in the arm (reported by 1.7% of users requesting removal) 2
Continuation Rates and Satisfaction
Despite side effects, Implanon has relatively high continuation rates:
- In one South African study, 75.8% of women kept the implant for the full 3-year duration 2
- Of those who completed the full 3 years, 57.1% requested reinsertion 2
- Early discontinuation rates due to side effects range from 19.5% to 24% in various studies 3, 4
Management of Recurrent Side Effects
If a patient experienced side effects with a previous Implanon and is considering reinsertion, the following approach is recommended:
For bleeding irregularities:
- NSAIDs for short-term treatment (5-7 days)
- Hormonal treatment with low-dose COCs or estrogen for short-term treatment (10-20 days) if medically eligible 1
For amenorrhea:
- Provide reassurance that this is not harmful
- Rule out pregnancy if the bleeding pattern changes abruptly 1
For other side effects:
- Weight gain: Monitor and provide counseling
- Headaches: Assess severity and consider analgesics
- Acne: Consider topical treatments
Clinical Implications
- Enhanced counseling about expected side effects before reinsertion has been shown to reduce discontinuation rates 1
- If side effects were intolerable with the first implant and led to early removal, consider alternative contraceptive methods
- The implant remains highly effective with a failure rate of only 0.05% 1, 5
Pitfalls to Avoid
- Failing to counsel patients about the likelihood of recurrent side effects before reinsertion
- Not offering treatment options for manageable side effects like irregular bleeding
- Overlooking the possibility that new side effects may develop with a subsequent implant
- Not considering drug interactions that might reduce efficacy (e.g., hepatic enzyme-inducing medications) 6
If side effects are unacceptable to the patient despite treatment attempts, counsel on alternative contraceptive methods and offer another method if desired 1.