Can I use the Implanon (etonogestrel) implant together with Slinda (drospirenone) mini‑pill?

Using Implanon and Slinda Together

There is no medical contraindication to using the etonogestrel implant (Implanon) together with the drospirenone mini-pill (Slinda), though this dual progestin-only approach is not standard practice and lacks specific guideline support.

Evidence for Dual Progestin-Only Contraception

Proof-of-Concept Data

• A 2018 prospective study demonstrated that women can successfully use the etonogestrel implant as a "back-up" method while continuing combined oral contraceptives, with 90% completing 6 months of dual hormonal contraceptive use 1
• In this study, most women (10 of 18 completers) continued using both methods through 6 months, and only 2 participants discontinued the implant for mood changes before 6 months 1
• No subjects discontinued the implant specifically for bleeding complaints when using dual hormonal methods 1

Pharmacologic Considerations

• The etonogestrel implant provides steady-state serum levels of approximately 200 pg/ml after 4-6 months, which are sufficient to inhibit ovulation for 3 years 2
• Drospirenone has a long half-life of 30-34 hours and maintains ovulation inhibition even with a single missed pill 3
• Both agents work primarily through ovulation suppression, meaning dual use provides redundant contraceptive mechanisms without harmful drug interactions 3, 2

Clinical Rationale for Dual Use

When This Approach May Be Considered

• For bleeding pattern management: If a woman requires the highly effective contraception of the implant but experiences unacceptable irregular bleeding, adding a progestin-only pill may help regulate cycles 4
• For non-contraceptive benefits: Drospirenone has antimineralocorticoid and antiandrogenic properties that may address acne, bloating, or premenstrual symptoms not managed by the implant alone 3, 5
• For patient reassurance: Some women desire the "back-up" security of dual methods while maintaining progestin-only contraception 1

Safety Profile

• Progestin-only methods do not increase venous thromboembolism risk, with relative risks of 0.90 for progestin-only pills and no increased VTE risk documented for etonogestrel implants in most populations 4
• The CDC Medical Eligibility Criteria does not list concurrent progestin-only method use as a contraindication 4
• No evidence suggests additive harm from using two progestin-only methods simultaneously 4

Important Caveats and Considerations

Lack of Standard Practice

• No guidelines specifically recommend or endorse dual progestin-only contraception as a routine strategy 4
• The implant alone provides Pearl index values of 0-0.07, making it one of the most effective contraceptive methods available without requiring additional hormonal backup 2

Alternative Approaches to Consider First

• For irregular bleeding with the implant, short-term treatment with NSAIDs (celecoxib 200 mg daily for 5 days or mefenamic acid 500 mg three times daily for 5 days) has demonstrated significant bleeding cessation within 7 days 4
• If bleeding remains unacceptable despite treatment, counseling on alternative contraceptive methods (such as the levonorgestrel IUD) may be more appropriate than adding a second progestin method 4

Monitoring Recommendations

• Assess the woman's satisfaction with dual method use at routine visits 6
• Evaluate for side effects that may be amplified with dual progestin exposure, including mood changes, acne, or weight changes 6, 1
• Confirm that the patient understands the implant alone provides sufficient contraceptive protection 2

Cost and Adherence Considerations

• Adding a daily pill to an already highly effective implant increases medication burden without clear evidence of improved outcomes
• The primary advantage of the implant is its "set and forget" nature, which is partially negated by requiring daily pill adherence 2

Bottom Line

While not contraindicated, using Implanon and Slinda together represents an off-label approach with limited evidence. If the goal is improved bleeding control, consider NSAIDs or short-term hormonal treatment first 4. If the goal is non-contraceptive benefits of drospirenone (antimineralocorticoid or antiandrogenic effects), this dual approach may be reasonable with informed patient consent and close monitoring 3, 1.