What is a recommended implant for postpartum contraception?

Etonogestrel Implant for Postpartum Contraception

The etonogestrel implant (Nexplanon/Implanon) is the recommended implant for postpartum contraception due to its high efficacy, safety profile, and ability to be inserted immediately postpartum with no negative effects on breastfeeding. 1

Efficacy and Benefits

The etonogestrel implant is a single-rod device containing 68 mg of etonogestrel that:

• Has the highest efficacy among all reversible contraceptives with a typical and perfect use failure rate of <0.05% 2
• Provides continuous contraception for 3 years 2
• Can be inserted immediately postpartum before hospital discharge 2
• Does not require regular adherence, making it ideal for postpartum women 2

Timing of Insertion

The implant can be inserted at different times postpartum:

• Immediate postpartum insertion (within 24 hours of delivery):

  • Safe and effective with U.S. MEC 1 rating (no restrictions) for non-breastfeeding women 2
  • U.S. MEC 2 rating (benefits generally outweigh risks) if <1 month postpartum for breastfeeding women 2
  • Leads to higher continuation rates at 6 months (97% vs 68% with delayed insertion) 3
  • Results in high 3-year continuation rates (66.3%), particularly among adolescents and women with fewer prenatal visits 4

• Delayed insertion (≥1 month postpartum):

  • U.S. MEC 1 rating for breastfeeding women 2
  • May result in lower continuation rates compared to immediate insertion 3

Effects on Breastfeeding

Research shows the etonogestrel implant does not negatively impact breastfeeding:

• Studies have found no significant differences in time to lactogenesis stage II between early (1-3 days) and standard (4-8 weeks) postpartum insertion 5
• No significant differences in breastfeeding continuation at 8 weeks between immediate and delayed placement 6
• No negative effects on breastfeeding performance or infant health and growth 2, 1, 7

Practical Considerations

When placing the etonogestrel implant postpartum:

• The implant is inserted into the inside of the upper arm by a trained clinician 2
• For non-breastfeeding women, it can be inserted at any time immediately postpartum 2
• For breastfeeding women, while some older research suggested waiting until 6 weeks postpartum 7, more recent guidelines and studies support immediate postpartum insertion 2, 1, 6, 5
• No backup method is needed if inserted within the first 5 days postpartum 2
• If inserted ≥21 days postpartum and menstrual cycles have not returned, additional contraceptive protection is needed for 7 days 2

Common Side Effects and Management

The most common reasons for early removal include:

• Unpredictable bleeding or spotting (41.2% of removals) 2, 4
• Weight gain (19.1% of removals) 4

Patient Counseling

When counseling patients about the etonogestrel implant:

• Explain that it does not protect against STIs; consistent and correct condom use is still recommended for STI prevention 2
• Discuss potential irregular bleeding patterns, which is the most common reason for discontinuation 2
• Emphasize the high satisfaction rates, with 81% of women who received immediate postpartum insertion reporting they would choose the same timing again 3
• Highlight the convenience of not needing to return for contraception during the busy postpartum period

The etonogestrel implant represents an excellent option for postpartum contraception, combining extremely high efficacy with convenience and safety for both breastfeeding and non-breastfeeding mothers.