Nexplanon is Safe and Potentially Beneficial for This Patient
Yes, Nexplanon (etonogestrel implant) is safe for a patient with menorrhagia and anemia, and may actually improve her condition by reducing menstrual bleeding. 1
Safety Profile Based on Medical Eligibility
According to the U.S. Medical Eligibility Criteria for Contraceptive Use, the etonogestrel implant receives a Category 1 rating (no restrictions on use) for patients with anemia, meaning there are no safety concerns for use in this population. 1
Menorrhagia itself is not a contraindication to Nexplanon use—in fact, progestin-only methods like implants are appropriate contraceptive options for women with heavy menstrual bleeding. 1
The implant contains no estrogen, making it safe for women who cannot use combined hormonal contraceptives due to various medical conditions including cardiovascular disease, stroke history, thromboembolic disorders, and migraine with aura. 2
Potential Therapeutic Benefits
Nexplanon may actually help treat this patient's menorrhagia and improve her anemia:
While irregular bleeding patterns are the most common side effect of Nexplanon, many users experience reduced menstrual blood loss or amenorrhea over time, which could improve her anemia. 3, 4
The American Academy of Pediatrics supports the use of implants for management of dysmenorrhea and menstrual disorders in adolescents and adults. 5
Nexplanon is considered medically necessary for management of primary dysmenorrhea and related menstrual symptoms. 5
Absolute Contraindications to Rule Out
Before insertion, ensure the patient does NOT have:
- Current or history of breast cancer (the only absolute contraindication to Nexplanon). 2
- Current pregnancy (Category 4 contraindication). 1
Clinical Considerations and Counseling
Bleeding pattern changes are common but manageable:
The most common adverse reaction is change in menstrual bleeding patterns, which occurs in most users. 3, 4
If irregular bleeding persists and is bothersome, NSAIDs for 5-7 days can be used for management. 1
Abnormal bleeding is the main reason for premature discontinuation, so thorough pre-insertion counseling is essential. 4
Efficacy and duration:
Nexplanon is the most effective long-acting reversible contraceptive with a failure rate of less than 1%. 5, 3
The device is FDA-approved for 3 years of use, though emerging evidence suggests efficacy may extend to 5 years. 3, 4
Fertility returns rapidly after removal. 3
Insertion Requirements
All healthcare providers must be trained on Nexplanon before performing insertions or removals. 3
The procedure can be performed as an office-based intervention. 3
Proper subdermal insertion technique in the inner non-dominant upper arm is critical to prevent rare complications like device migration. 6
In summary, Nexplanon is not only safe for this patient with menorrhagia and anemia, but may provide therapeutic benefit by reducing menstrual blood loss over time, thereby potentially improving her anemia. 1, 5, 3