From the Guidelines
In patients requiring contraception, particularly those with antiphospholipid antibody-positive status, an Intrauterine Device (IUD) is recommended over Nexplanon (Etonogestrel) due to its effectiveness and lower risk of thromboembolism 1. When considering the comparative effectiveness of IUDs versus Nexplanon, several factors come into play, including the risk of venous thromboembolism (VTE), contraceptive effectiveness, and side effects.
Key Considerations
- The risk of VTE is a critical consideration, especially in patients with antiphospholipid antibody-positive status, as it can significantly impact morbidity and mortality.
- IUDs, particularly those containing levonorgestrel or copper, are recommended for patients with positive aPL because they do not increase the risk of thromboembism 1.
- Nexplanon, a progestin-only implant containing etonogestrel, has limited data regarding its VTE risk, making it a less favorable option in this context.
Comparative Effectiveness
- Both IUDs and Nexplanon are highly effective forms of contraception, but their effectiveness and side effect profiles differ.
- IUDs have a failure rate of about 0.1-0.8%, depending on the type, while Nexplanon has a failure rate of less than 0.1% 1.
- The choice between IUDs and Nexplanon should be based on individual patient preferences, including the desire for hormonal or non-hormonal options, duration of use, and potential side effects.
Recommendations
- For patients with antiphospholipid antibody-positive status, an IUD is the preferred contraceptive method due to its lower risk of thromboembolism and high effectiveness 1.
- In patients without antiphospholipid antibody-positive status, the choice between IUDs and Nexplanon should be based on individual patient preferences and medical history.
- It is essential to weigh the benefits and risks of each contraceptive method, considering the patient's overall health and quality of life.
From the Research
Comparative Effectiveness of IUD and Nexplanon (Etonogestrel)
- The available studies do not provide a direct comparison between Intrauterine Device (IUD) and Nexplanon (Etonogestrel) in terms of comparative effectiveness 2, 3, 4, 5, 6.
- However, studies have compared the effectiveness of different types of IUDs, such as levonorgestrel-releasing and copper IUDs, and found that both types are highly effective, with overall Pearl indices of 0.06 and 0.52, respectively 3.
- A study comparing the etonogestrel- and levonorgestrel-releasing contraceptive implants found that both implants had the same 3-year cumulative pregnancy rate of 0.4 per 100 women-years, and that method continuation rates were similar between the two implants 6.
- Another study found that women who chose the levonorgestrel intrauterine device (IUD) or the etonogestrel implant as their postabortion contraceptives were less likely to be currently experiencing intimate partner violence, and were more likely to have finished high school and to have used the pill before 5.
- A clinical recommendation suggests that extended use of long-acting reversible contraception, including IUDs and etonogestrel subdermal implants, may be a safe, effective, and desirable option for many patients 4.
Key Findings
- IUDs and etonogestrel implants are highly effective contraceptive methods 3, 6.
- The choice of contraceptive method depends on various factors, including patient preferences, medical history, and social circumstances 5.
- Extended use of long-acting reversible contraception may be a viable option for many patients 4.
- More research is needed to directly compare the effectiveness of IUDs and Nexplanon (Etonogestrel) 2, 3, 4, 5, 6.