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Removal rates of subdermal levonorgestrel implants
1Department of Obstetrics and Gynecology, Johns Hopkins Medical Services Corporation, Baltimore, Maryland 21202.
The Journal of Reproductive Medicine
|November 1, 1994
Summary
Subdermal levonorgestrel implants (SLIs) removal rates are achievable at 2.04% with extensive counseling and support. High continuation rates are possible, increasing acceptance beyond six months.
Area of Science:
- Reproductive Health
- Contraception
- Public Health
Background:
- Subdermal levonorgestrel implants (SLIs) are a long-acting reversible contraceptive method.
- High continuation rates are crucial for effective unintended pregnancy prevention in at-risk populations.
- Understanding removal rates and reasons is key to improving patient satisfaction and adherence.
Purpose of the Study:
- To quantify the removal rate of subdermal levonorgestrel implants (SLIs) in an unselected, inner-city population.
- To identify strategies for increasing SLI continuation rates.
- To analyze reasons for SLI removal and timing.
Main Methods:
- Prospective study of 1,076 SLI insertions over 16 months in a lower socioeconomic, high-risk population.
- Provided extensive pre- and post-insertion counseling and follow-up care.
- Managed complications conservatively before considering removal upon patient request.
Main Results:
- Achieved a low SLI removal rate of 2.04% due to SLI-related problems.
- Most removals (77%) occurred within the first six months, primarily due to bleeding/irregular menses, headaches, and hair loss.
- No age or parity trends were observed for removals.
Conclusions:
- Extremely low removal rates and high continuation rates for SLIs are achievable in inner-city populations.
- Extensive counseling, patient support, and conservative management are vital for successful SLI use.
- SLI acceptance and continuation increase when implants are maintained past the initial six months.