Currently, there is one implantable transdermal contraceptive device available in the United States: Nexplanon. This system releases a progestin (synthetic progesterone, etonogestrel) into the body at a constant rate. Nexplanon provides up to 3 years of contraception. Research indicates that Nexplanon is a highly effective contraceptive, with a less than 1% incidence of pregnancy among women who use Nexplanon for 1 year, and a less than 2% incidence in women who use this method for 2 years. It replaces Implanon, which was discontinued in October 2010. Nexplanon is easier to insert and replace than its predecessor, Implanon, and contains varium to make it easier to find by means or an x-ray or computed tomography (CT) scan.
Nexplanon consists of one 4-cm-long rod that is placed approximately 3 to 4 inches above the elbow crease at the inner side of the upper arm between the biceps and triceps. Most women elect to have the rod placed on their nondominant arm. Patients can verify the presence of Nexplanon by palpating both ends of the rod after it has been inserted.
The potential risks associated with Nexplanon are quite small but may include difficulties with insertion or removal of the system (rare), a slightly higher chance of an ectopic pregnancy if pregnancy does occur, and the development of ovarian cysts. As with all hormonal contraceptives that contain progestins, the U.S. Food and Drug Administration (FDA) requires warnings regarding the incidence of high blood pressure, gallbladder problems, and rare cancerous or noncancerous liver tumors. Conventional wisdom holds that these problems occur less frequently with progestin-only products. A small amount of weight gain may also occur (on average, users have reported increases of 2.8 lb after 1 year and 3.7 lb after 2 years).
It is important to exclude pregnancy before Nexplanon is inserted!
Nexplanon may be inserted when:
A woman has experienced 1 to 5 days of menstrual bleeding, even if she is still bleeding.
A woman is switching from a combined hormonal contraception and has taken an active contraceptive tablet within the past 7 days.
A woman is on a progestin-only method of contraception and has taken a pill in the last 24 hours or has used the implant or progestin-containing intrauterine system (IUS) in the last 24 hours.
A woman has used an injectable contraceptive and is now due for her next injection.
A woman has had a 1st trimester pregnancy loss (abortion or miscarriage) within the past 5 days.
A woman has had a 2nd trimester pregnancy loss and is 21 to 28 days postpartum.
A woman is breastfeeding and is 4 or more weeks postpartum.
» BASIC TRIAGE ASSESSMENT FORM FOR NEXPLANON
When was your last menstrual period? _______________ Was it normal? _______________
Have you been using Nexplanon or are you interested in information on using it? ___________________________________________________________________________________
How much do you know about its side effects and risks? ____________________________
Are you taking other medications? _________________________________________________
Do you routinely use a backup method? _____________________________________________
Stopping Nexplanon requires medical intervention. Are you comfortable with this? _______________________________________________________________________________________
Are you planning a pregnancy in the next 3 years? _________________________________
Have you or do you have any of the following conditions: history of breast cancer, cardiovascular disease, blood clot, kidney problems, liver tumors, liver problems, high low density lipoproteins. Are you more than 130% overweight? _________________________
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